[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 2310 Introduced in Senate (IS)]

103d CONGRESS
  2d Session
                                S. 2310

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 SENATE OF THE UNITED STATES

                July 21 (legislative day, July 20), 1994

Mr. Conrad (for himself and Mr. Inouye) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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--
                    (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 
                the 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 must be available in a timely manner for 
                consultation or assistance if indicated.
    (b) Consultation Required.--The Secretary shall revise the 
regulations referred to in subsection (a)(2) only after consultation 
with representatives from professional associations of certified 
registered nurse anesthetists and anesthesiologists.
    (c) Effective Dates.--
            (1) In general.--The revisions to the regulations referred 
        to in subsection (a) shall apply to anesthesia services 
        furnished on or after January 1, 1995.
            (2) Termination of regulations on medical direction or 
        supervision.--The revised regulations referred to in subsection 
        (a)(2) shall not apply to services furnished on or after 
        January 1, 1998.

SEC. 2. ENSURING PAYMENT FOR PHYSICIAN AND CERTIFIED REGISTERED NURSE 
              ANESTHETIST 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.--
                            ``(i) In general.--Notwithstanding section 
                        1862(a)(1)(A), if--
                                    ``(I) physicians' services 
                                consisting of the furnishing of 
                                anesthesia services for a single case 
                                are furnished jointly with a certified 
                                registered nurse anesthetist, and
                                    ``(II) the carrier determines that 
                                the use of both the physician and the 
                                certified registered nurse anesthetist 
                                was not medically necessary,
                        the fee schedule amount for the physicians' 
                        services shall be equal to the applicable 
                        percentage of the fee schedule amount 
                        applicable under this section for anesthesia 
                        services personally performed by the physician 
                        alone (determined without regard to this 
                        subparagraph).
                            ``(ii) Applicable percentage.--For purposes 
                        of clause (i), the applicable percentage is the 
                        percentage (as determined in a manner to be 
                        provided by the Secretary) of the jointly 
                        furnished anesthesia services which were 
                        actually furnished by the physician.
                            ``(iii) Limitation.--The Secretary shall 
                        establish procedures that ensure that the sum 
                        of the fee schedule amounts determined under 
                        clause (i) and section 1833(l)(4)(B)(iv) for a 
                        jointly furnished anesthesia service shall not 
                        exceed 100 percent of the fee schedule amount 
                        applicable under this section for anesthesia 
                        services personally performed by the physician 
                        alone (determined without regard to this 
                        subparagraph).''.
            (2) Payment for crna.--Section 1833(l)(4)(B) of such Act 
        (42 U.S.C. 13951(l)(4)(B)), as added by section 13516(b) of 
        OBRA-1993, is amended by adding at the end the following new 
        clause:
    ``(iv)(I) Notwithstanding section 1862(a)(1)(A), if--
            ``(aa) certified registered nurse anesthetist services 
        consisting of the furnishing of anesthesia services for a 
        single case are furnished jointly with a physician, and
            ``(bb) the carrier determines that the use of both the 
        certified registered nurse anesthetist physician and the 
        physician was not medically necessary,
the fee schedule amount for the services furnished by the certified 
registered nurse anesthetist shall be equal to the applicable 
percentage of the fee schedule amount applicable under section 1848 for 
anesthesia services personally performed by the physician alone 
(determined without regard to section 1848(a)(4)(C)).
    ``(II) For purposes of subclause (I), the applicable percentage is 
the percentage (as determined in a manner to be provided by the 
Secretary) of the jointly furnished anesthesia services which were 
actually furnished by the certified registered nurse anesthetist.
    ``(III) The Secretary shall determine the fee schedule amount under 
subclause (I) in accordance with the procedures established by the 
Secretary under section 1848(a)(4)(C)(iii).''.
            (3) Effective date.--The amendments made by paragraphs (1) 
        and (2) shall apply to services furnished on or after January 
        1, 1995.
    (b) Uniform Treatment of All Multiple Concurrent Cases.--
            (1) In general.--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--
                    (A) by striking ``two, three, or four'' each place 
                it appears and inserting ``two or more''; and
                    (B) by inserting ``or medical supervision'' after 
                ``medical direction'' each place it appears.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to services furnished on or after January 1, 1998.
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