12th State Opts Out

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MONTANA

(from OGP)

Subject: Montana Governor Martz Removes Physician Supervision for Nurse Anesthetists

Montana Governor Martz Removes Physician Supervision for Nurse Anesthetists

Havre, Montana (January 24) - Governor Judy Martz informed on January 22nd the

Centers for Medicare and Medicare Services (CMS) that Montana has opted out of

the Federal physician requirements of Certified Registered Nurse Anesthetists

(CRNAs) that apply to reimbursement for anesthesia services.

Montana makes the 12th state to opt out, following Washington, Alaska, Kansas,

Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, North Dakota, Oregon,

and Iowa. Many other states are currently investigating whether opting out is

in the best interest of their citizens, particularly their rural citizens.

Roughly one-quarter of the states have opted out of this financially oriented

Federal requirement to date.

Montana has approximately 40 anesthetizing locations that use CRNAs and/or

physician anesthetists. Currently, 31 of these areas are exclusively served by

CRNAs.

"Opting out of the supervision requirement is excellent and long-awaited news

for the hospitals and communities of Montana," said Michael Barts, CRNA, APRN,

AAAPM, President of the Montana Association of Nurse Anesthetists (MTANA).

After two years of exhaustive investigation, Governor Martz made the decision

that this opt out was clearly in the best interests of her state. The

investigation included consultation with the Board of Medical Examiners and the

Board of Nursing of Montana, consulting with other governors, observing the

decision of the Montana House Committee On Human Services during the last

legislative session, and, recently, the verdict of a recent court decision

concerning the Montana Board of Nursing's authority.

Across the states that have already opted out, no changes have been observed

in CRNAs' excellent safety and service record over the past two years. Montana

CRNAs' independent and/or collaborative practice relationship with Montana

physicians will continue unchanged. CRNAs have provided anesthesia service to

Montana patients since the earliest days of surgery in this state.

According to an Institute of Medicine report published in October 1999,

anesthesia care is nearly fifty times safer than it was twenty years ago. CRNAs

administer 65 percent of the anesthetics given each year in the U.S., and are

the predominant anesthesia providers in rural and other medically underserved

areas. Without these Advanced Practice Nurse Practitioners (APRNs), many

facilities serving these areas would be unable to maintain surgical,

obstetrical, trauma stabilization, and pain management services.

[air]

I hear about this opt-out, It must be good for the CRNA profession, what I do not understand are the future ramifications in the job market. Now, does it mean CRNA's are allowed to bill for services? if they are allowed to bill for services, will they be reimbursed at the same rate as MDA's? Is this opt-out thing experimental or is it here to stay or are these new rules being made under executive decisions whereby if the present Gov. leave office the new Gov. might decide to rescind the decision?

[WntrMute2]

The "opt-out" is a state's way of allowing medicare reimbursment for serviced provided by CRNAs without medical supervision. My facts may be a little shaky here but the gist should be correct. At some point during the Clinton administration a policy was formulated to allow CRNAs that were not medically directed to be reimbursed for services rendered. This Clinton policy was set to go into effect shortly after the new president would take office. Unfortunatly, "W" decided this was not a good idea, nurses working without a doc supervising. He halted the implementation of the policy and ordered hearings. Well, the new policy now says that CRNAs must be medically supervised if the facility wishes to be reimbursed for anesthesia services. Remember, this is NOT about practice, there is NO law requireing supervision in order to practice, this is financial. Since the goverment in its infinite wisdom finally realized that not all states have enough anesthesiologists to supervise all the anesthetics provided, they wrote into their regulation a loophole called, wait for it... Opt-Out. All this says is that a governor can write a letter stating that she considered the needs of the state and consulted the respective boards (note, he or she does not need approval of said boards) to medicare advising medicare that they would allow CRNAs to bill and recieve reimbursement for their services. That's why the lesser states (just joking) such as Alaska are opting out, they need to allow anesthesia providers to practice in their hospitals and be compensated. Hopefully, a more populated state with major metro areas will opt out and maybe the rest will follow. Then we will be back to where we were before "W" intruded. Support those govenors that support us, Colorodo's govenor is being sued by the anesthesiologists as he wants to opt-out. Who will you vote for this November?

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Originally posted by WntrMute2

....during the Clinton administration a policy was formulated to allow CRNAs that were not medically directed to be reimbursed for services rendered. ......

......Colorodo's govenor is being sued by the anesthesiologists as he wants to opt-out. ....

To clarify two points:

1 - CRNAs have been directly reimbursed by Medicare since 1986, the first APRN group to gain such economic parity. Anesthesia is anesthesia: same pay rate, MD or CRNA. The removal of supervision requirement has to do with COP, Conditions of Participation, under which hospitals bill Medicare. Very technical BS.

2 - The CSA lawsuit was dismissed. We're still waiting for Gov Owens to act.

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