[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6184 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 6184

To amend title XVIII of the Social Security Act to provide for improved 
    payments under the Medicare Program for academic anesthesiology 
programs for resident physicians and for academic programs for student 
                     registered nurse anesthetists.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 26, 2006

 Mr. English of Pennsylvania (for himself, Ms. Hart, Mr. Pomeroy, and 
 Mr. Stupak) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for improved 
    payments under the Medicare Program for academic anesthesiology 
programs for resident physicians and for academic programs for student 
                     registered nurse anesthetists.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Academic Anesthesiology and 
CRNA Payment Improvement Act of 2006''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Since 1991, the Medicare program has reduced 
        reimbursements for anesthesia services provided to Medicare 
        beneficiaries by 50 percent in certain instances when education 
        of student nurse anesthetists or anesthesiology medical 
        residents is involved, imposing financial disincentives against 
        anesthesia education. These Medicare payment policies are known 
        as anesthesia teaching rules.
            (2) In 2002, the Centers for Medicare & Medicaid Services 
        (CMS) authorized an alternative payment system for certain 
        cases involving nurse anesthesia education and subsequently for 
        anesthesiology resident education, in which the agency allowed 
        reimbursement for base units plus discontinuous time. However, 
        the alternative has not propagated in the marketplace and CMS 
        has declined to reform the anesthesia teaching rules further 
        without an Act of Congress.
            (3) To ensure the access of patients to safe, high quality 
        anesthesia care, society has a strong interest in providing for 
        high quality anesthesia educational institutions. The 
        population of the United States is aging, resulting in an 
        increase in demand for health care requiring anesthesia and 
        pain management services provided by anesthesiologists and 
        certified registered nurse anesthetists (CRNAs).
            (4) Though the Institute of Medicine in 2000 found the 
        provision of anesthesia in such year to be 50 times safer than 
        the provision of anesthesia during the 20 years previous to 
        such year, continued evaluation, innovation, and quality 
        improvements in anesthesia are required to further enhance 
        patient safety.
            (5) As of August 2006, there are 130 anesthesiology 
        residency programs and 102 programs accredited by the Council 
        on Accreditation of Nurse Anesthesia Educational Programs in 
        the United States. Under the current payment rules under the 
        Medicare program, both anesthesiology residency and nurse 
        anesthesia educational programs report challenges recruiting 
        and retaining faculty.
            (6) Since part B under the Medicare program provides for 
        reimbursement for the services of anesthesiologists and the 
        services of CRNAs, reforms to the anesthesia teaching rules 
        under the Medicare program should treat teaching 
        anesthesiologists and teaching CRNAs similarly with respect to 
        anesthesiology medical residents and student registered nurse 
        anesthetists, respectively, and should not favor one provider 
        over another.

SEC. 3. PURPOSE.

    The purpose of this Act is to ensure financial stability of nurse 
anesthesia and anesthesiology educational programs to provide 
sufficient opportunities for student nurse anesthetists and medical 
residents to pursue the specialty of anesthesia so that patients 
continue to have access to quality health care.

SEC. 4. SPECIAL PAYMENT RULE FOR TEACHING ANESTHESIOLOGISTS AND 
              TEACHING CERTIFIED REGISTERED NURSE ANESTHETISTS.

    (a) For Physicians' Services.--Section 1848(a) of the Social 
Security Act (42 U.S.C. 1395w-4(a)) is amended--
            (1) in paragraph (4)(A), by inserting ``except as provided 
        in paragraph (5)(A)'' after ``anesthesia cases,''; and
            (2) by adding at the end of paragraph (4) the following new 
        paragraph:
            ``(5) Special rule for teaching anesthesiologists.--
                    ``(A) In general.--With respect to physicians' 
                services furnished by a teaching anesthesiologist 
                involved in the training of physician residents or 
                student nurse anesthetists in a single anesthesia case 
                or two concurrent anesthesia cases, notwithstanding 
                paragraph (4), the fee schedule amount to be applied 
                for each such case shall be the amount described in 
                subparagraph (B) if both of the following conditions 
                are met:
                            ``(i) The teaching anesthesiologist is 
                        present during all critical or key portions of 
                        the anesthesia service or case involved.
                            ``(ii) At least one of the following 
                        individuals is immediately available to furnish 
                        anesthesia services during the entire case:
                                    ``(I) The teaching 
                                anesthesiologist.
                                    ``(II) An anesthesiologist with 
                                whom the teaching anesthesiologist has 
                                entered into an arrangement for such 
                                purpose.
                                    ``(III) In the case of the training 
                                of student nurse anesthetists, a 
                                certified registered nurse anesthetist 
                                with whom the teaching anesthesiologist 
                                has entered into an arrangement with 
                                respect to such training.
                    ``(B) Amount described.--For purposes of 
                subparagraph (A), the amount described in this 
                subparagraph, with respect to anesthesia services 
                furnished by a teaching anesthesiologist described in 
                such subparagraph, is 100 percent of the fee schedule 
                amount otherwise applicable under this section if the 
                anesthesia services were personally performed by the 
                teaching anesthesiologist alone.
                    ``(C) Clarification for anesthesiologists who 
                medically direct teaching certified registered nurse 
                anesthetists.--Subparagraph (A) shall not apply in the 
                case of physician services furnished by an 
                anesthesiologist who medically directs a certified 
                registered nurse anesthetist who is involved in the 
                training of student nurse anesthetists in a single 
                anesthesia case or two concurrent anesthesia cases.''.
    (b) For Services of Certified Registered Nurse Anesthetists.--
Section 1833(l) of such Act (42 U.S.C. 1395l(l)) is amended--
            (1) in paragraph (4)(B)(iii)--
                    (A) by striking ``In the case of'' and inserting 
                ``(I) Subject to clause (II), in the case of'';
                    (B) by striking ``1848(a)(5)(B)'' and inserting 
                ``1848(a)(4)(B)''; and
                    (C) by adding at the end the following new 
                subclause:
    ``(II) Subclause (I) shall apply to a certified registered nurse 
anesthetist who is medically directed or medically supervised by a 
physician notwithstanding whether or not such certified registered 
nurse anesthetist is involved in the training of student nurse 
anesthetists in a single case or two concurrent cases.''; and
            (2) by adding at the end the following new paragraph:
    ``(7)(A) With respect to services furnished by a teaching certified 
registered nurse anesthetist who is not medically directed and who is 
involved in the training of student nurse anesthetists in a single 
anesthesia case or two concurrent anesthesia cases, the fee schedule 
amount to be applied for each such case shall be the amount described 
in subparagraph (B) if both of the following conditions are met:
            ``(i) The teaching certified registered nurse anesthetist 
        is present during all critical or key portions of the 
        anesthesia service or case involved.
            ``(ii) The teaching certified registered nurse anesthetist 
        (or other certified registered nurse anesthetist or 
        anesthesiologist with whom the teaching certified registered 
        nurse anesthetist has entered into an arrangement) is 
        immediately available to furnish anesthesia services during the 
        entire case.
    ``(B) For purposes of subparagraph (A), the amount described in 
this subparagraph, with respect to services furnished by a teaching 
certified registered nurse anesthetist described in such subparagraph, 
is 100 percent of the fee schedule amount otherwise applicable under 
this subsection if the services were personally performed by the 
teaching certified registered nurse anesthetist alone.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2007.
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