CRNA “opt-out” requested by governor

Posted on: 8/14/20

On May 7, Gov. Stitt signed SB 801 into law that modified the relationship between CRNAs and physicians in Oklahoma. This change in state law allowed the governor to pursue what is known as the CRNA “opt-out” provision with CMS, as provided for in 42 C.F.R. § 482.52(a)(4). In 2001, a CMS rule amended the Medicare Anesthesia CoPs for hospitals, CAHs, and ASCs. The amended rule maintained the requirement for physician supervision of CRNAs, but it also allowed state governors to “opt-out” of this requirement if certain conditions were met, including that the “opt-out” is consistent with state law. The passage of SB 801 was a qualifying condition for the state to pursue an “opt-out.” The provision does not change state scope of practice requirements and concerns reimbursement only. Nor does the provision prohibit an individual facility from still requiring CRNAs to be supervised by a physician.

On July 28, the OHA submitted a letter to the governor, requesting the governor to pursue the “opt-out” provision as to eliminate any ambiguity between state and federal law for our hospitals. All hospitals certified by CMS must follow federal guidance to meet Conditions of Participation to maintain Medicare certification. Additionally, hospitals must comply with state hospital requirements. If Medicare and state requirements are not congruent, as is the case if only SB801 is implemented without federal opt out, the more stringent requirement prevails.  

The governor submitted his “opt-out” request to CMS Administrator Seema Verma on July 29, making Oklahoma an “opt-out” state, as of the date of the letter. As of the writing of this article, the Board of Nursing does not anticipate promulgating any rules to implement SB 801. (Scott Tohlen)