Governor Gretchen Whitmer recently signed into law House Bill 4359, which expands the scope of practice for Certified Registered Nurse Anesthetists (CRNAs) in Michigan. Effective October 11, 2021, CRNAs will fit within the definition of “prescriber” under the Michigan Public Health Code (MCL § 333.17708) and will be allowed to provide anesthesia/analgesia services without physician supervision if certain additional requirements are met. Many health care facilities and practices utilize CRNAs to administer anesthesia to patients.
For CRNAs to practice anesthesia care without physician supervision, Michigan law requires the providers and facilities to meet the following criteria, as applicable:
- The CRNA must either (1) have a minimum of three years or more of experience practicing as a nurse anesthetist along with a minimum of 4,000 hours practicing in a health care facility or (2) hold a doctor of nursing practice degree or doctor of nurse anesthesia practice degree.
- The CRNA must be collaboratively practicing in a patient-centered care team.
- The health facility where the CRNA practices must adopt a policy (1) allowing for CRNAs to provide unsupervised anesthesia and analgesia services and (2) ensuring that a physician (or other qualified health care professional) is immediately available to the CRNA either in-person or through telemedicine to address any urgent or emergent clinical concerns.
While these CRNA professionals are highly competent in their area of expertise, physicians and hospitals must also be mindful of the Medicare Conditions of Participation that impose additional restrictions. Hospitals, critical access hospitals and ambulatory surgical centers that bill Medicare must comply with the Medicare Conditions of Participation. These regulations provide that CRNAs may only administer anesthesia under the supervision of a physician who is immediately available, meaning the physician and the CRNA must either be in the same operating suite or same unit (42 CFR §§ 482.52; 485.639; 416.42). The regulations allow for individual states to “opt out” of the federal supervision requirements if the state expressly allows CRNAs to practice without supervision.
Update: May 13, 2022
Governor Gretchen Whitmer recently sent a letter to the Centers for Medicare & Medicaid (CMS) attesting that she consulted with the Michigan Boards of Nursing and Medicine about issues related to access to and the quality of anesthesia services in Michigan, and that she has concluded that it is in the best interests of Michigan’s citizens to opt-out of the current physician supervision requirement, and that the opt-out is consistent with Michigan law.
Michigan has joined several other states that have opted out of federal regulations requiring physician supervision of CRNAs. Contingent on the above-referenced limitations and requirements under Michigan law, eligible CRNAs can now provide anesthesia/analgesia services without physician supervision in a manner that complies with Michigan law, and the facilities in which CRNAs provide those services will remain compliant with the Medicare Conditions of Participation.
Warner attorneys are here to help you navigate whatever changes come your way.
For more information about House Bill 4359 or any other matter related to health law, please contact Alan Rogalski, Jeffrey Segal or a member of the Health Law Practice Group.
