The Certified Registered Nurse Anesthetist (CRNA) is an advanced practice nurse who has met standards for certification from the California Board of Registered Nursing consistent with the standards of the National Board of Certification and Recertification for Nurse Anesthetists, who is licensed to practice nurse anesthesia by the BRN. The general scope of practice for CRNAs is governed by Business & Professions Code 2725. Anesthesia services can be provided in California by a nurse anesthetist when requested by a physician and without physician supervision or a requirement for standardized procedures.
The utilization of a nurse anesthetist to provide anesthesia services is at the discretion of the physician, dentist or podiatrist. These services are delivered during the perianesthesia time period which includes pre-operative, intra-operative, and post-operative care that encompasses presurgical testing where the patient is evaluated for their ability to tolerate an anesthetic through delivery of anesthesia and emerging from anesthesia where the patient is monitored and cared for until they are stable enough to safely transfer to other areas for care or is discharged.
Plaintiff American Association of Nurse Anesthesiology (AANA) is a professional association for nurse anesthesia providers and Certified Registered Nurse Anesthetists (CRNAs) comprising of more than 65,000 members across the United States. Its members provide patient care in all 50 states and territories and routinely provide nonmedically directed anesthesia.
CRNA filed a federal complaint in the United States District Court, Northern District of Ohio against the U.S. Department of Health and Human Services on Friday, to compel the Department of Health and Human Services (HHS), and its Secretary, Xavier Becerra, “to fulfill their duties to enforce the nondiscrimination provision of the Patient Protection and Affordable Care Act (ACA).”
“This case is being brought because multiple commercial insurance companies and health plans are discriminating against CRNAs by paying CRNAs less than physician anesthesia providers based solely upon their licensure. The law requires that the focus be on the degree of the care provided and not the degree of the care provider.”
The lawsuit goes on to allege “insurance companies and health plans have unilaterally and arbitrarily decided that CRNAs are worthy of less reimbursement than their physician counterparts, despite providing the same care to patients, with the same outcome, utilizing the same equipment, and employing the same processes.”
“Section 2706(a) of the Public Health Service Act prohibits discrimination against providers acting within the scope of their licensure. 42 U.S.C. § 300gg-5. Under the statute, CRNAs acting within their licensed capacity and providing the same care as a physician anesthesia provider warrant being reimbursed at the same rate. That has long since been the standard, and insurance companies’ and health care plans’ recent change in this practice is rationalized by nothing more than the distinction in the license of the care provider. These insurers have implemented a process by which they are openly and unabashedly discriminating against CRNAs by paying CRNAs less than the physician anesthesia providers performing the same task.”
“When insurers violate the ACA’s non-discrimination provision, HHS is obligated to enforce the law and take action against insurance companies that discriminate against providers based solely on their licensure. 42 U.S.C. § 300gg-22.”
“But HHS has simply failed to do so. In the near 15 years since the passage of the ACA (which created the nondiscrimination statute), HHS has never enforced the provider nondiscrimination provision of the ACA.”
“Emboldened by the government’s clear abdication of its duty, insurance companies have arbitrarily cut CRNA reimbursement rates. Major insurer Cigna was the first to implement this practice on March 12, 2023. Anthem Blue Cross Blue Shield announced such reductions on August 1, 2024, and others will follow suit.”
“CRNAs cannot take direct action. That is because the ACA precludes a private cause of action to address this discrimination. Only the government can enforce the statute. Indeed, it is the government’s duty to do so. And that is all Plaintiff asks for here: An order requiring HHS to implement Congress’s commands, evaluate the circumstances, and enforce the ACA against companies brashly discriminating against CRNAs.”
“Plaintiff thus brings this action under the Administrative Procedure Act and the mandamus statute, 28 U.S.C. § 1361, seeking an order requiring HHS to carry out its constitutionally required duty to enforce the law.”
According to Courthouse News “The association filed its complaint in Cleveland though its main offices are in the Chicago suburb of Rosemont. It chose the Northern District of Ohio as the venue partly because of a recent reimbursement policy change outlined by Anthem, an insurance provider with the Blue Cross Blue Shield group. “
The new policy reduces compensation by 15% for some anesthesia services provided by certified registered nurse anesthetists, while leaving reimbursement for physician anesthesia providers untouched. The policy was approved in June and will take effect in November, and the association says it will impact certified registered nurse anesthetists in northern Ohio.