The Opt Out Provides Options

What is Opt-Out?

In 2001, a federal rule was published allowing states to “opt out” or be “exempted” from the CMS federal requirement that CRNAs be supervised by a physician as it relates to reimbursement of facilities. The opt-out is not a practice issue, rather a reimbursement issue.

Facilities may still require physician supervision of CRNAs per the bylaws of the facility.

For a state to “opt-out” of the federal supervision requirement, the state’s governor must send a letter of attestation to CMS. The letter must attest that:

• The state’s governor has consulted with the state’s boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state; and
• That it is in the best interests of the state’s citizens to opt-out of the current federal physician supervision requirement; and
• That the opt-out is consistent with state law.

In 2005, Wisconsin became the 14th state to opt out of the physician supervision requirement.

In 2007, a Wisconsin administrative law judge determined:

• The administration of anesthesia is, under Wisconsin law, both part of the practice of medicine and is also within the practice of professional nursing.
• CRNAs who are certified as Advanced Practice Nurse Prescribers (APNPs) may lawfully administer anesthesia without physician supervision. As is the case for all APNPs, the CRNA must maintain and document a collaborative relationship with a physician.
• CRNAs who are not certified as APNPs may administer anesthesia only under the supervision of a physician.

The Wisconsin Opt-Out provides flexibility or options for facilities to determine the best model to provide anesthesia services.