Kansas opts out

Became effective April 2, 2003

March 31, 2003

The Honorable Thomas A. Scully, Administrator

Centers for Medicare and Medicaid Services

314G Hubert Humphrey Building

200 Independence Ave., S.W.

Washington, D.C. 20201

Dear Mr. Scully,

In accordance with the final rule published in the November 13, 2001

Federal Register, Volume 66, Number 219, I am writing to notify you that

the State of Kansas is electing a state exemption from the requirement for

physician supervision of Certified Registered Nurse Anesthetists (CRNAs) in

the following regulations:

... Hospitals - 42 CFR 482.52 Condition of Participation: Anesthesia Services

... Critical Access Hospitals - 42 CFR 485.639 Condition of Participation;

Surgical Services

... Ambulatory Surgical Centers - 42 CFR 416.42 Condition of Participation:

Surgical Servies

After consulting with the state Board of Nursing and Board of Healing Arts

and other interested and affected parties regarding this matter, I have

concluded that this exemption is consistent with Kansas state law and is in

the best interests of Kansas citizens, rural communities and hospitals.

Our state relies heavily on CRNAs; the majority of Kansas hospitals have

only CRNA staff to provide surgical, obstetrical, and trauma stabilizing

services.

Please consider this full notification of Kansas' election for state

exemption.

Sincerely,

KATHLEEN SEBELIUS

Governor of the State of Kansas