State Legislators Push Forward Full Practice Authority for Advanced Practice Nurses

Park Ridge, Ill. (AANA)—At an unprecedented pace, state legislators are voting in favor of lifting restrictions that would enable advanced practice nurses and other nonphysician providers to practice at the full extent of their education and expertise. The American Association of Nurse Anesthetists (AANA) deems recent legislative activity as strong steps toward modernizing the role nurses play in U.S. healthcare.

“This kind of legislation is indicative of a rapid change in the way healthcare needs are met compared to five to 10 years ago,” said AANA CEO Randall Moore, DNP, MBA, CRNA.

“With an aging and growing population, our nation’s healthcare system needs providers to deliver high quality care to patients while keeping costs down,” said Moore. “The utilization of CRNAs in healthcare facilities, for example, is one solution that has gained traction among lawmakers.”

Moore said nurse anesthesia state associations and other advanced practice nursing organizations are working hard to push legislation that removes restrictive physician supervision and extends prescriptive authority—efforts that ensure “accessible and affordable healthcare for all.”

Below is a roundup of state legislation that has advanced through committees and houses:

• Virginia House Bill 1059 passed the full House Feb. 3. The bill seeks to give CRNAs prescriptive authority and increase access to patient care.
• West Virginia House Bill 4356 passed a House committee Jan. 29. The bill proposes to remove physician supervision and other restrictions on CRNA practice, alleviate surgeon concerns regarding liability, and allow healthcare facilities to staff appropriately.
• Ohio House Bill 224 passed the House Jan. 29. The bill seeks to clarify CRNA scope of practice regarding ordering medications, treatments and diagnostic tests in the perioperative period and remove burdensome restrictions on CRNAs providing anesthesia care.
• Indiana Senate Bill 98 passed the Senate Jan. 23. The bill proposes to deregulate the supervision of advanced practice nurses like CRNAs and expand the types of doctors who may provide supervision to include podiatrists.
• South Dakota Senate Bill 50 passed the Senate Jan. 23. The bill proposes to authorize CRNAs to collaborate with podiatrists and dentists (in addition to physicians) and extend prescriptive authority and pain management.

Other legislative proposals include South Carolina Senate Bill 563, which proposes to remove physician supervision; Massachusetts House Bill 4134, which seeks to remove restrictions on CRNA prescriptive authority and restrictive medical board regulation; and, Florida House Bill 607 proposes to remove physician supervision.

In other activities, the AANA commended the Centers for Medicare & Medicaid Services’ (CMS) for recognizing CRNAs’ ability to perform pre-anesthetic assessments in Ambulatory Surgical Centers as part of the final rule made this past fall on the Physician Fee Schedule.

The final rule also includes a provision that finalizes broad modifications to CMS’ documentation policy for evaluation and management services so that CRNAs, along with other APRNs, physicians, and physician assistants, can review and verify, rather than re-document notes in a patient’s medical record. The preamble related to this provision of the rule recognizes Medicare Part B payment to CRNAs for evaluation and management services as defined by a state’s scope of practice.

The policy changes implement key provisions of the U.S. president’s executive order on reducing regulatory burden in Medicare.

Along with the American Association of Nurse Practitioners, the AANA supports Health and Human Services (HHS) Secretary Alex Azar’s efforts to make several reforms in 2020 to Medicare and propose a regulation that would eliminate burdensome regulatory billing requirements, remove costly and needless physician supervision requirements, and all other licensure requirements of the Medicare program that limit physicians and non-physicians from practicing at full scope.

“Special interest groups would have healthcare administrators, lawmakers and patients believe that advanced practice nurses like CRNAs would ‘jeopardize’ healthcare. Nothing could be further from the truth,” said AANA President Kate Jansky, MHS, CRNA, APRN, USA, LTC (ret).

“Patients and health systems across the nation depend on CRNAs, who have an exemplary record of providing 49 million safe anesthetics to patients every year,” said Jansky. “Known for their topflight skills, comprehensive education and training, CRNAs are proud to be part of America’s most trusted profession.”

About the American Association of Nurse Anesthetists
Founded in 1931 and located in Park Ridge, Ill., and Washington, D.C., the American Association of Nurse Anesthetists (AANA) is the professional organization representing nearly 54,000 Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists across the United States. For more information, visit www.aana.com and www.future-of-anesthesia-care-today.com.

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