Declining reimbursement rates have been the center of policy concerns shared by anesthesia providers across healthcare, especially in settings that rely more heavily on certified registered nurse anesthetists.
Melissa Croad, CRNA, APRN, president of the Massachusetts Association of Nurse Anesthesiology, recently joined Becker’s to discuss the federal policies she is paying attention to in 2026.
Question: What legal or regulatory developments are you watching most closely in the year ahead?
Ms. Croad: In the year ahead, MANA will be watching for HHS to implement regulations to enforce the provider non-discrimination clause of the Affordable Care Act.
Medicare (since 1986) and MassHealth (since 2017) reimburse CRNAs at 100% of the physician fee schedule.
The Affordable Care Act prohibits discriminatory reimbursement practices (ACA §2706(a)), but federal law lacks enforcement language. Because of this, many private, commercial, and [Employee Retirement Income Security Act] plans continue to reimburse CRNAs at reduced rates, despite identical services and outcomes. Reduced reimbursement eliminates the cost savings CRNAs provide, as CRNA salaries are approximately 50% of physician anesthesiologists.
Hospitals and anesthesia groups absorb the financial shortfall, leading to higher operating costs, OR delays, reduced anesthesia availability, and limited access for patients. The No Surprises Act, passed by Congress in 2020, required enforcement language to be drafted by January 2022, but HHS has not complied with the law. Some states are pursuing enforcement at the state level or by executive order of state governors.
