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Provision of Care, Treatment, and Services (PC) Standards

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Element of Performance

In cases in which a non-physician administers the anesthesia, the anesthetist (unless exempt) must be under the supervision of the operating physician and, in the case of an anesthesiologist’s assistant, under the supervision of an anesthesiologist.
An ambulatory surgical center may be exempt from the requirement for physician supervision of certified registered nurse anesthetists as described in paragraph (b)(2) of 42 CFR 416.42 if the state in which the ambulatory surgical center is located submits a letter to the Centers for Medicare & Medicaid Services (CMS) signed by the governor, following consultation with the state’s Boards of Medicine and Nursing, requesting exemption from physician supervision of CRNAs.
The letter from the governor must attest that he or she has consulted with state Boards of Medicine and Nursing about issues related to access to and the quality of anesthesia services in the state and has concluded that it is in the best interests of the state’s citizens to opt-out of the current physician supervision requirement, and that the opt-out is consistent with state law.
The request for exemption and recognition of state laws as well as the withdrawal of the request may be submitted at any time, and they are effective upon submission.


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