Medicare Academic Anesthesiology and CRNA Payment Improvement Act of 2006 - Amends title XVIII (Medicare) part B (Supplementary Medical Insurance Benefits for the Aged and Disabled) of the Social Security Act to set forth a special payment rule for teaching anesthesiologists (TAs) and teaching certified registered nurse anesthetists (CRNAs).
Requires payment of 100% of the fee schedule amount otherwise applicable for anesthesia services personally performed by the TA alone when the TA is training physician residents or student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases, if: (1) the TA is present during all critical or key portions of the anesthesia service or case involved; and (2) either the TA or an anesthesiologist or a CRNA with whom the TA has made special arrangements is immediately available to furnish anesthesia services during the entire case.
States that this special payment rule shall not apply in the case of physician services furnished by an anesthesiologist who medically directs a CRNA involved in the training of student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases.
Applies to a CRNA medically directed or medically supervised by a physician in the performance of anesthesia services the current fee schedule amount of one-half of the amount for a physician's medical direction of the performance of such services, regardless of whether or not the CRNA is involved in the training of student nurse anesthetists in a single case or two concurrent cases.
Requires payment, however, of 100% of the fee schedule amount otherwise applicable for anesthesia services personally performed by a teaching CRNA alone when the teaching CRNA is not medically directed but is involved in the training of student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases, if: (1) the teaching CRNA is present during all critical or key portions of the anesthesia service or case involved; and (2) the teaching CRNA (or other CRNA or anesthesiologist with whom the CRNA has made special arrangements) is immediately available to furnish anesthesia services during the entire case.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6184 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 6184
To amend title XVIII of the Social Security Act to provide for improved
payments under the Medicare Program for academic anesthesiology
programs for resident physicians and for academic programs for student
registered nurse anesthetists.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 26, 2006
Mr. English of Pennsylvania (for himself, Ms. Hart, Mr. Pomeroy, and
Mr. Stupak) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for improved
payments under the Medicare Program for academic anesthesiology
programs for resident physicians and for academic programs for student
registered nurse anesthetists.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Academic Anesthesiology and
CRNA Payment Improvement Act of 2006''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Since 1991, the Medicare program has reduced
reimbursements for anesthesia services provided to Medicare
beneficiaries by 50 percent in certain instances when education
of student nurse anesthetists or anesthesiology medical
residents is involved, imposing financial disincentives against
anesthesia education. These Medicare payment policies are known
as anesthesia teaching rules.
(2) In 2002, the Centers for Medicare & Medicaid Services
(CMS) authorized an alternative payment system for certain
cases involving nurse anesthesia education and subsequently for
anesthesiology resident education, in which the agency allowed
reimbursement for base units plus discontinuous time. However,
the alternative has not propagated in the marketplace and CMS
has declined to reform the anesthesia teaching rules further
without an Act of Congress.
(3) To ensure the access of patients to safe, high quality
anesthesia care, society has a strong interest in providing for
high quality anesthesia educational institutions. The
population of the United States is aging, resulting in an
increase in demand for health care requiring anesthesia and
pain management services provided by anesthesiologists and
certified registered nurse anesthetists (CRNAs).
(4) Though the Institute of Medicine in 2000 found the
provision of anesthesia in such year to be 50 times safer than
the provision of anesthesia during the 20 years previous to
such year, continued evaluation, innovation, and quality
improvements in anesthesia are required to further enhance
patient safety.
(5) As of August 2006, there are 130 anesthesiology
residency programs and 102 programs accredited by the Council
on Accreditation of Nurse Anesthesia Educational Programs in
the United States. Under the current payment rules under the
Medicare program, both anesthesiology residency and nurse
anesthesia educational programs report challenges recruiting
and retaining faculty.
(6) Since part B under the Medicare program provides for
reimbursement for the services of anesthesiologists and the
services of CRNAs, reforms to the anesthesia teaching rules
under the Medicare program should treat teaching
anesthesiologists and teaching CRNAs similarly with respect to
anesthesiology medical residents and student registered nurse
anesthetists, respectively, and should not favor one provider
over another.
SEC. 3. PURPOSE.
The purpose of this Act is to ensure financial stability of nurse
anesthesia and anesthesiology educational programs to provide
sufficient opportunities for student nurse anesthetists and medical
residents to pursue the specialty of anesthesia so that patients
continue to have access to quality health care.
SEC. 4. SPECIAL PAYMENT RULE FOR TEACHING ANESTHESIOLOGISTS AND
TEACHING CERTIFIED REGISTERED NURSE ANESTHETISTS.
(a) For Physicians' Services.--Section 1848(a) of the Social
Security Act (42 U.S.C. 1395w-4(a)) is amended--
(1) in paragraph (4)(A), by inserting ``except as provided
in paragraph (5)(A)'' after ``anesthesia cases,''; and
(2) by adding at the end of paragraph (4) the following new
paragraph:
``(5) Special rule for teaching anesthesiologists.--
``(A) In general.--With respect to physicians'
services furnished by a teaching anesthesiologist
involved in the training of physician residents or
student nurse anesthetists in a single anesthesia case
or two concurrent anesthesia cases, notwithstanding
paragraph (4), the fee schedule amount to be applied
for each such case shall be the amount described in
subparagraph (B) if both of the following conditions
are met:
``(i) The teaching anesthesiologist is
present during all critical or key portions of
the anesthesia service or case involved.
``(ii) At least one of the following
individuals is immediately available to furnish
anesthesia services during the entire case:
``(I) The teaching
anesthesiologist.
``(II) An anesthesiologist with
whom the teaching anesthesiologist has
entered into an arrangement for such
purpose.
``(III) In the case of the training
of student nurse anesthetists, a
certified registered nurse anesthetist
with whom the teaching anesthesiologist
has entered into an arrangement with
respect to such training.
``(B) Amount described.--For purposes of
subparagraph (A), the amount described in this
subparagraph, with respect to anesthesia services
furnished by a teaching anesthesiologist described in
such subparagraph, is 100 percent of the fee schedule
amount otherwise applicable under this section if the
anesthesia services were personally performed by the
teaching anesthesiologist alone.
``(C) Clarification for anesthesiologists who
medically direct teaching certified registered nurse
anesthetists.--Subparagraph (A) shall not apply in the
case of physician services furnished by an
anesthesiologist who medically directs a certified
registered nurse anesthetist who is involved in the
training of student nurse anesthetists in a single
anesthesia case or two concurrent anesthesia cases.''.
(b) For Services of Certified Registered Nurse Anesthetists.--
Section 1833(l) of such Act (42 U.S.C. 1395l(l)) is amended--
(1) in paragraph (4)(B)(iii)--
(A) by striking ``In the case of'' and inserting
``(I) Subject to clause (II), in the case of'';
(B) by striking ``1848(a)(5)(B)'' and inserting
``1848(a)(4)(B)''; and
(C) by adding at the end the following new
subclause:
``(II) Subclause (I) shall apply to a certified registered nurse
anesthetist who is medically directed or medically supervised by a
physician notwithstanding whether or not such certified registered
nurse anesthetist is involved in the training of student nurse
anesthetists in a single case or two concurrent cases.''; and
(2) by adding at the end the following new paragraph:
``(7)(A) With respect to services furnished by a teaching certified
registered nurse anesthetist who is not medically directed and who is
involved in the training of student nurse anesthetists in a single
anesthesia case or two concurrent anesthesia cases, the fee schedule
amount to be applied for each such case shall be the amount described
in subparagraph (B) if both of the following conditions are met:
``(i) The teaching certified registered nurse anesthetist
is present during all critical or key portions of the
anesthesia service or case involved.
``(ii) The teaching certified registered nurse anesthetist
(or other certified registered nurse anesthetist or
anesthesiologist with whom the teaching certified registered
nurse anesthetist has entered into an arrangement) is
immediately available to furnish anesthesia services during the
entire case.
``(B) For purposes of subparagraph (A), the amount described in
this subparagraph, with respect to services furnished by a teaching
certified registered nurse anesthetist described in such subparagraph,
is 100 percent of the fee schedule amount otherwise applicable under
this subsection if the services were personally performed by the
teaching certified registered nurse anesthetist alone.''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2007.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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