< Back to H.R. 4291 (103rd Congress, 1993–1994)

Text of To direct the Secretary of Health and Human Services to revise existing regulations concerning the conditions of payment under part ...

...payment under part B of the medicare program relating to anesthesia services furnished by certified registered nurse anesth

This bill was introduced on April 21, 1994, in a previous session of Congress, but was not enacted. The text of the bill below is as of Apr 21, 1994 (Introduced).

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HR 4291 IH

103d CONGRESS

2d Session

H. R. 4291

To direct the Secretary of Health and Human Services to revise existing regulations concerning the conditions of payment under part B of the medicare program relating to anesthesia services furnished by certified registered nurse anesthetists, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

April 21, 1994

Mr. KREIDLER introduced the following bill; which was referred jointly to the Committees on Ways and Means and Energy and Commerce


A BILL

To direct the Secretary of Health and Human Services to revise existing regulations concerning the conditions of payment under part B of the medicare program relating to anesthesia services furnished by certified registered nurse anesthetists, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. REVISION OF CONDITIONS OF PAYMENT RELATING TO ANESTHESIA SERVICES FURNISHED BY CERTIFIED REGISTERED NURSE ANESTHETISTS.

    (a) PROMULGATION OF REVISED REGULATIONS- The Secretary of Health and Human Services shall revise any regulations describing the conditions under which payment may be made for anesthesia services under the medicare program so that--

      (1) payment may be made for anesthesia services furnished in a hospital or an ambulatory surgical center by a certified registered nurse anesthetist who is permitted to administer anesthesia under the law of the State in which the service is furnished; and

      (2) the conditions under which payment may be made for a physician service consisting of the medical direction or medical supervision of a certified registered nurse anesthetist meet the requirements of subsection (b)(1).

    (b) REQUIREMENTS FOR MEDICAL DIRECTION DESCRIBED-

      (1) IN GENERAL- The requirements of this subsection are that the conditions under which payment may be made for the medical direction or medical supervision of a certified registered nurse anesthetist--

        (A) shall not restrict such nurse anesthetists working with anesthesiologists from performing all the components of the anesthesia service that such nurse anesthetists are legally authorized to perform in the State in which the service is furnished; and

        (B) shall prevent fraud and abuse in payment for anesthesia services by requiring that the physician providing medical direction or medical supervision must be physically present in the facility where the certified registered nurse anesthetist’s services are performed and be available in a timely manner for consultation or assistance if indicated.

      (2) CONSULTATION REQUIRED- The Secretary shall revise the regulations referred to in subsection (a)(2) after consultation with representatives from professional associations of certified registered nurse anesthetists and anesthesiologists.

    (c) EFFECTIVE DATE- The revisions to the regulations referred to in subsection (a) shall apply to anesthesia services furnished on or after January 1, 1995.

    (d) TERMINATION OF REGULATIONS ON MEDICAL DIRECTION OR SUPERVISION- The regulations referred to in subsection (a)(2) shall be repealed effective January 1, 1998.

SEC. 2. ENSURING PAYMENT FOR PHYSICIAN AND NURSE FOR JOINTLY FURNISHED ANESTHESIA SERVICES.

    (a) PAYMENT FOR JOINTLY FURNISHED SINGLE CASE-

      (1) PAYMENT TO PHYSICIAN- Section 1848(a)(4) of the Social Security Act (42 U.S.C. 1395w-4(a)(4)), as added by section 13516(a) of the Omnibus Budget Reconciliation Act of 1993 (hereafter referred to as ‘OBRA-1993’), is amended by adding at the end the following new subparagraph:

        ‘(C) PAYMENT FOR SINGLE CASE- Notwithstanding section 1862(a)(1)(A), with respect to physicians’ services consisting of the furnishing of anesthesia services for a single case that are furnished jointly with a certified registered nurse anesthetist, if the carrier determines that the use of both the physician and the nurse anesthetist to furnish the anesthesia service was not medically necessary, the fee schedule amount to be applied shall be equal to 50 percent of the fee schedule amount otherwise applicable under this section if the anesthesia service were personally performed by the physician alone.’.

      (2) PAYMENT TO CRNA- Section 1833(l)(4)(B) of such Act (42 U.S.C. 1395l(l)(4)(B)), as added by section 13516(b) of OBRA-1993, is amended by adding at the end the following new clause:

    ‘(iv) Notwithstanding section 1862(a)(1)(A), in the case of services of a certified registered nurse anesthetist consisting of the furnishing of anesthesia services for a single case that are furnished jointly with a physician, if the carrier determines that the use of both the physician and the nurse anesthetist to furnish the anesthesia service was not medically necessary, the fee schedule amount shall be equal to 50 percent of the fee schedule amount otherwise applicable under this section if the anesthesia service were personally performed by the physician alone.’.

    (b) UNIFORM TREATMENT OF ALL MULTIPLE CONCURRENT CASES- Section 1848(a)(4) of such Act (42 U.S.C. 1395w-4(a)(4)) and section 1842(b)(13) of such Act (42 U.S.C. 1395u(b)(13)), as amended by section 13516(a) of OBRA-1993, are each amended--

      (1) by striking ‘two, three, or four’ each place it appears and inserting ‘two or more’; and

      (2) by inserting ‘or medical supervision’ after ‘medical direction’ each place it appears.

    (c) EFFECTIVE DATE- The amendments made by subsections (a) and (b) shall apply to services furnished on or after January 1, 1995.