A full one-third of all states have now taken advantage of a rule implemented by the Bush Administration in 2001 giving governors the ability to opt out of the supervision requirement and ensure citizens access to safe, cost-effective anesthesia care, especially in medically underserved areas, according to the American Society of Anesthesiologists.1. Iowa — December 2001
Less than one month after CMS published its anesthesia care rule granting state governors the ability to opt out of the supervision requirement, Iowa Gov. Thomas Vilsack sent a letter to CMS on Dec. 12 informing the government agency of his decision to opt out. In 2001, 91 of 118 Iowa hospitals relied solely on CRNAs to provide anesthesia care.
2. Nebraska — February 2002
Nebraska opted out of the physician supervision requirement for anesthesia three months after CMS granted states the option. Nebraska Gov. Mike Johanns sent a letter to CMS saying "it is in the best interest of the State's citizens to exercise this exemption." Approximately 69 of the state's 85 acute care hospitals relied solely on CRNAs to provide anesthesia care.
3. Idaho — March 2002
In March 2002, Idaho Gov. Dirk Kempthorne informed CMS that Idaho would opt out of the physician requirement to benefit "Idaho's citizens, rural communities and hospitals." The majority of Idaho's hospitals relied solely on CRNAs to provide anesthesia care to patients in 2002.
4. Minnesota — April 2002
Gov. Jesse Ventura informed CMS in April 2002 that Minnesota would opt out of the federal physician supervision requirement, saying his office consulted with medical and nursing boards, the attorney general and various other parties.
5. New Hampshire — June 2002
New Hampshire Gov. Jeanne Shaheen opted out of the federal requirement in June 2002, saying that failure to do so "may severely limit the ability of rural hospitals to treat emergencies and provide other services that require anesthesia care."
6. New Mexico — November 2002
New Mexico Gov. Gary Johnson opted out of the rule in Nov. 2002, making New Mexico the sixth state to exercise the option.
7. Kansas — April 2003
Kansas Gov. Kathleen Sebelius informed CMS that her state would follow Iowa, Nebraska, Idaho, Minnesota, New Hampshire and New Mexico in opting out of the supervision rule.
8. North Dakota — October 2003
North Dakota Gov. John Hoeven informed CMS of his decision to opt out of the physician supervision rule within a week of a similar decision by Washington state governor Gary Locke.
9. Washington — October 2003
Washington Gov. Gary Locke opted out of the supervision rule in Oct. 2003, within a week of the same decision by North Dakota.
10. Alaska — October 2003
Alaska became the third state in three weeks to opt out of the federal physician supervision requirement for CRNAs in Oct. 2003. Alaska's decision meant that one-fifth of the nation's states had chosen to opt out of the rule.
11. Oregon — December 2003
Oregon Gov. Theodore Kulongoski informed CMS that Oregon would opt out of the supervision rule in Dec. 2003, citing the reason that "in many of Oregon's small rural hospitals, CRNAs are the only, or primary, anesthesia providers."
12. Montana — Jan. 2004
Gov. Judy Martz elected to opt out of the supervision rule in 2004, a decision that was later reversed by Gov. Brian Schweitzer in May 2005. Gov. Schweitzer restored the opt-out in June 2005.
13. South Dakota — March 2005
Gov. M. Michael Rounds informed CMS that South Dakota would opt out in March 2005, citing limited anesthesia care in rural communities as a reason for the decision.
14. Wisconsin — June 2005
Gov. Jim Doyle made Wisconsin the 14th state to opt out of physician supervision of anesthesia in 2005.
15. California — June 2009
California Gov. Arnold Schwarzenegger sent a letter to CMS in June 2009 exercising his option to exempt the state from physician supervision of CRNAs. Following the governor's decision, the California Society of Anesthesiologists and California Medical Association filed a motion aimed at requiring the governor to withdraw his letter. The motion was denied in Oct. 2010, and the CSA and CMA are currently considering other actions to appeal the ruling.
16. Colorado — September 2010
Colorado Gov. Bill Ritter announced that Colorado would opt out of the physician supervision requirement in Sept. 2010. The decision followed a controversial study published in the Aug. 2010 issue of Health Affairs that claimed patients were not harmed when CRNAs provided anesthesia without physician supervision.
17. Kentucky — April 2012
Kentucky Gov. Steve Beshear wrote to CMS on April 25 that “it is in the best interest of Kentucky’s citizens to opt out of the current federal physician supervision requirement in order to improve access to critical services.”
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