Nurse anesthetists hope to expand their scope of practice, under budget bill

Courtesy of the New York State Association of Nurse Anesthetists

The budget proposal includes a provision to amend the Education Law, recognizing Certified Registered Nurse Anesthetists as Advanced Practice Nurses, which would allow them to expand their role in health care settings across the state.

Modeled in part after the Nurse Practitioner Modernization Act of 2014, similar education policy has been enacted in New York for other advanced nursing specialties, including Nurse Practitioners and Clinical Nurse Specialists.

Legislation affording CRNAs full scope of practice has been introduced in the state Legislature for close to 20 years. Assembly Health Committee Chair Richard Gottfried has sponsored the legislation in an effort to promote patient safety and well-being by increasing accessibility, dependability and cost effectiveness of anesthesia.

“Granting CRNAs their full scope of practice will increase patient access in the most cost-effective manner while maintaining quality and opening up resources to invest in other operations.” Gottfried said. “There is increasing demand for anesthesia services in New York, especially in rural and under-served areas. We are committed to providing patients in New York state with the best anesthesia care possible.

CRNAs are currently only recognized in New York as registered nurses, although many of them have their masters and doctorate degrees. In the same way nurse practitioners are recognized as advanced practice registered nurses in New York, this new legislation would allow CRNAs to be recognized state-wide as advanced practice nurses.

Supporters say the bill would open up doors and opportunities that don’t exist now for CRNAs in New York, including allowing them to work with dentists, for example.

Currently, CRNAs cannot provide anesthesia services with a dentist because dentists are not considered physicians in New York. CRNA practice is limited to working with physicians, and as a result, CRNAs are earning degrees and then leaving New York for states that allow to practice in more settings.

The governor’s bill also includes provisions to affirmatively permit CRNAs to work in office-based surgery settings. Currently, the state’s public health regulations authorize CRNAs to practice in hospitals and licensed ambulatory surgery centers.

While nothing in state law or regulations prohibit CRNAs from working in office-based surgery facilities, lack of state recognition has created barriers and disincentives to hiring CRNAs in some settings, particularly in an office-based surgery setting. The primary obstacle is that it is very difficult for physicians to bill for CRNA services.

The budget proposal would provide the state Medicaid program with a mechanism to enroll CRNAs in their provider network and allow reimbursement directly for their services. Although CRNAs have been authorized providers under the federal Medicare program since 1986, the New York Medicaid program has failed to follow due to lack of legislative action in codifying CRNA practice in state law.

Proponents of the bill say Medicaid provider status would positively impact other payers to also accept CRNAs into their networks and directly bill for their services, including managed care and commercial insurers.

Specifically, this new legislation will authorize CRNAs with more than 3,600 hours of experience to practice in collaboration with a physician without requiring a written practice agreement, as Nurse Practitioners currently practice. CRNAs with this level of experience will be permitted to practice in collaboration with one or more physicians in order to provide more timely, cost-effective treatments to patients receiving anesthetic care.

New York offers three of the top CRNA programs in the United States. Education and experience
required to become a CRNA include:

  • Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree;
  • A current license as a registered nurse and at least one year of experience as a registered nurse in an acute care setting;
  • Graduation with a minimum of a master’s degree (doctoral degree in 2025) from an accredited nurse anesthesia educational program; and
  • Passing of the national certification exam following graduation.

In order to be re-certified, CRNAs must obtain a minimum of 60 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure, and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia. CRNAs must also complete and pass a re-certification exam, assuring they are up to date on the most recent practice trends and evidence-based research.

“We appreciate Governor Cuomo’s decision toward advancing healthcare accessibility and efficiency. We hope that legislators will fight to keep advanced nurses in this state and give this issue thoughtful consideration on behalf of patients receiving anesthetic care, and graduate nursing students considering careers as a CRNA,” said Cheryl Spulecki, president of the New York State Association of Nurse Anesthetists. “We’re confident that given the opportunity to practice within their full scope, CRNAs will be able to contribute to the affordability, efficiency and accessibility of anesthesia services in New York state.”