CRNA Expanded Scope of Practice Begins in October

On July 13, 2021, Governor Whitmer signed House Bill 4359 expanding the scope of practice for certified registered nurse anesthetists (CRNAs). Michigan joins 42 other states that have passed similar legislation. HB 4359, Public Act 53 of 2021, amends section 17210 of the public health code which covers specialty certification of registered professional nurses. The amendment becomes effective on October 11, 2021, and will also require the governor to notify the Centers for Medicare and Medicaid Services (CMS) and formally exercise exemption of the federal supervision requirement for CRNAs when the federal emergency related to the COVID-19 pandemic expires. The bill was sponsored by Rep. Mary Whiteford, R- Casco Township and intended to improve access to anesthesia services and reduce health care costs for patients.

While the amendment provides more latitude for CRNAs in the areas of planning and administering anesthesia and analgesia services, there are some practice settings such as pain management services that still require physician supervision and oversight. The expanded scope of practice allows for:

1. Development of a plan of care;
2. Performance of all patient assessments, procedures and monitoring to implement the plan of care or to address emergencies that arise during the implementation of the plan of care; and
3. The selection, ordering, prescribing and administration of anesthesia and analgesic agents, which include pharmacologic agents and controlled substances.

The services may be performed for and during the perioperative, periobstetrical, or periprocedural period. The expanded scope of practice does not include any activity allowing a patient to self-administer, obtain or receive pharmacologic agents outside of the facility in which the CRNA is providing services, and all services must be performed in accordance with the American Association of Nurse Anesthetists Standards for Nurse Anesthesia Practice.

In order to practice without physician supervision CRNAs must have either practiced in the health profession specialty field of nurse anesthetist for 3 years or more with a minimum, of 4,000 hours in a health care facility, or hold a doctor of nurse anesthesia practice degree or doctor of nursing practice degree and must be collaboratively participating in a patient-centered care team. The expanded services may only be performed in a facility if there are policies in place relating to the provision of anesthesia and analgesia services and a qualified health care professional is immediately available in person or via telemedicine to address any urgent or emergent clinical concerns. Any CRNA who is not an employee of the facility who provides the expanded services must maintain their own malpractice insurance.

The implementation of expanded practice for CRNAs will certainly bring new opportunities and considerations for providers in areas such as reimbursement, risk management, contracting and patient communication and education. Any facility considering moving towards this new delivery of care model should be certain to make sure that patients are fully aware of the licensure status of the individuals providing anesthesia and analgesia services, obtain fully informed and written consent and be prepared to address any concerns or issues that may arise. For additional information or assistance please contact Rolf Lowe of Wachler & Associates at (248) 544-0888.