Anesthesiology leaders are navigating unprecedented financial pressure and structural changes. Faced with declining reimbursements, rising costs and shifting care models, leaders are walking a tightrope to maintain patient safety and operational efficiency while operating on tighter margins than ever before.
Here are five state-specific updates slated to further shift the landscape next year:
- Insurer time-limit bans on anesthesia reimbursement: Illinois enacted legislation in August prohibiting insurers from setting time limits on anesthesia coverage, requiring reimbursement for the entire duration of procedures. Similar proposals are moving forward in Washington state and New Jersey. These measures follow a national debate over insurer policies that sought to limit coverage based on procedure length.
- Expanded scope of practice for CRNAs: In May, West Virginia updated its law to allow certified registered nurse anesthetists to administer anesthesia in cooperation with, rather than under the supervision of, physicians. Florida lawmakers have introduced bills that would grant CRNAs full practice authority, reflecting a national trend toward expanded autonomy.
- Medicaid reimbursement variability by state: Anesthesia groups continue to face wide differences in Medicaid reimbursement rates across states. Disparities in payment structures and conversion factors can financially strain practices operating in states with lower rates or higher Medicaid patient volumes.
- Legislative action on insurer reimbursement practices: Lawmakers in several states, including Missouri and New York, have introduced bills to strengthen oversight of insurer reimbursement practices. The efforts follow backlash over policies that attempted to restrict anesthesia coverage, which prompted some states to seek more transparency and regulatory enforcement.
5. Federal payment changes with state-level impact: The 2026 Medicare Physician Fee Schedule proposes an anesthesia conversion factor of $20.57, a 1.3% increase from 2025. While a federal change, updates to Medicare payment rates often influence how commercial insurers and state Medicaid programs adjust anesthesia reimbursement benchmarks.
