D.C. Joins 27 States to Opt-Out from Physician Supervision

South Carolina should continue efforts to follow suit, as more states take action.

Washington, D.C., became the latest jurisdiction to opt out of the federal physician supervision requirement for Certified Registered Nurse Anesthetists (CRNAs), joining a growing number of states that have taken similar action.

South Carolina has not yet opted out of the federal requirement. S.C.A.N.A. continues to advocate for policies that modernize CRNA practice and give healthcare facilities greater flexibility to meet the needs of their patients and communities — and we will continue the push.

South Carolina’s path to an opt-out is more complicated.

Under current state law, CRNAs must practice under provisions that expressly require physician or dentist supervision. Because the Centers for Medicare & Medicaid Services (CMS) requires a governor seeking an opt-out to certify that doing so is consistent with state law, South Carolina would first need to change its statutes governing CRNA practice before the state could move forward with the federal opt-out process.

That means the first step is at the state level.

Legislation would need to remove South Carolina’s statutory supervision requirements for CRNAs. Only after those requirements are addressed could the governor then pursue an exemption from the federal CMS supervision rule.

There is value in the action. The CMS opt-out gives healthcare facilities greater flexibility to utilize CRNAs consistent with state law, their full education and training, clinical needs and facility policies.

The District of Columbia’s decision to join 27 other jurisdictions demonstrates the momentum around modernizing outdated restrictions on CRNA practice. As more states embrace greater flexibility in anesthesia care, S.C.A.N.A. will continue working to ensure patients in our state can benefit from the full range of skills and expertise that CRNAs bring to communities every day.

CRNAs provide anesthesia care in hospitals, surgery centers, physician offices and rural and critical access hospitals. In many rural and underserved communities, they play an especially important role in maintaining access to essential surgical and anesthesia services.

We congratulate Washington, D.C., and its CRNAs on this important milestone and look forward to continuing the conversation about expanding access to anesthesia care in South Carolina.