article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Medicare Academic Anesthesiology and CRNA Payment Improvement Act of 2006''. SEC. 2. FINDINGS. Congress finds the following: (1) Since 1991, the Medicare program has reduced reimbursements for anesthesia services provided to Medicare beneficiaries by 50 percent in certain instances when education of student nurse anesthetists or anesthesiology medical residents is involved, imposing financial disincentives against anesthesia education. These Medicare payment policies are known as anesthesia teaching rules. (2) In 2002, the Centers for Medicare & Medicaid Services (CMS) authorized an alternative payment system for certain cases involving nurse anesthesia education and subsequently for anesthesiology resident education, in which the agency allowed reimbursement for base units plus discontinuous time. However, the alternative has not propagated in the marketplace and CMS has declined to reform the anesthesia teaching rules further without an Act of Congress. (3) To ensure the access of patients to safe, high quality anesthesia care, society has a strong interest in providing for high quality anesthesia educational institutions. The population of the United States is aging, resulting in an increase in demand for health care requiring anesthesia and pain management services provided by anesthesiologists and certified registered nurse anesthetists (CRNAs). (4) Though the Institute of Medicine in 2000 found the provision of anesthesia in such year to be 50 times safer than the provision of anesthesia during the 20 years previous to such year, continued evaluation, innovation, and quality improvements in anesthesia are required to further enhance patient safety. (5) As of August 2006, there are 130 anesthesiology residency programs and 102 programs accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs in the United States. Under the current payment rules under the Medicare program, both anesthesiology residency and nurse anesthesia educational programs report challenges recruiting and retaining faculty. (6) Since part B under the Medicare program provides for reimbursement for the services of anesthesiologists and the services of CRNAs, reforms to the anesthesia teaching rules under the Medicare program should treat teaching anesthesiologists and teaching CRNAs similarly with respect to anesthesiology medical residents and student registered nurse anesthetists, respectively, and should not favor one provider over another. SEC. 3. PURPOSE. The purpose of this Act is to ensure financial stability of nurse anesthesia and anesthesiology educational programs to provide sufficient opportunities for student nurse anesthetists and medical residents to pursue the specialty of anesthesia so that patients continue to have access to quality health care. SEC. 4. SPECIAL PAYMENT RULE FOR TEACHING ANESTHESIOLOGISTS AND TEACHING CERTIFIED REGISTERED NURSE ANESTHETISTS. (a) For Physicians' Services.--Section 1848(a) of the Social Security Act (42 U.S.C. 1395w-4(a)) is amended-- (1) in paragraph (4)(A), by inserting ``except as provided in paragraph (5)(A)'' after ``anesthesia cases,''; and (2) by adding at the end of paragraph (4) the following new paragraph: ``(5) Special rule for teaching anesthesiologists.-- ``(A) In general.--With respect to physicians' services furnished by a teaching anesthesiologist involved in the training of physician residents or student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases, notwithstanding paragraph (4), the fee schedule amount to be applied for each such case shall be the amount described in subparagraph (B) if both of the following conditions are met: ``(i) The teaching anesthesiologist is present during all critical or key portions of the anesthesia service or case involved. ``(ii) At least one of the following individuals is immediately available to furnish anesthesia services during the entire case: ``(I) The teaching anesthesiologist. ``(II) An anesthesiologist with whom the teaching anesthesiologist has entered into an arrangement for such purpose. ``(III) In the case of the training of student nurse anesthetists, a certified registered nurse anesthetist with whom the teaching anesthesiologist has entered into an arrangement with respect to such training. ``(B) Amount described.--For purposes of subparagraph (A), the amount described in this subparagraph, with respect to anesthesia services furnished by a teaching anesthesiologist described in such subparagraph, is 100 percent of the fee schedule amount otherwise applicable under this section if the anesthesia services were personally performed by the teaching anesthesiologist alone. ``(C) Clarification for anesthesiologists who medically direct teaching certified registered nurse anesthetists.--Subparagraph (A) shall not apply in the case of physician services furnished by an anesthesiologist who medically directs a certified registered nurse anesthetist who is involved in the training of student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases.''. (b) For Services of Certified Registered Nurse Anesthetists.-- Section 1833(l) of such Act (42 U.S.C. 1395l(l)) is amended-- (1) in paragraph (4)(B)(iii)-- (A) by striking ``In the case of'' and inserting ``(I) Subject to clause (II), in the case of''; (B) by striking ``1848(a)(5)(B)'' and inserting ``1848(a)(4)(B)''; and (C) by adding at the end the following new subclause: ``(II) Subclause (I) shall apply to a certified registered nurse anesthetist who is medically directed or medically supervised by a physician notwithstanding whether or not such certified registered nurse anesthetist is involved in the training of student nurse anesthetists in a single case or two concurrent cases.''; and (2) by adding at the end the following new paragraph: ``(7)(A) With respect to services furnished by a teaching certified registered nurse anesthetist who is not medically directed and who is involved in the training of student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases, the fee schedule amount to be applied for each such case shall be the amount described in subparagraph (B) if both of the following conditions are met: ``(i) The teaching certified registered nurse anesthetist is present during all critical or key portions of the anesthesia service or case involved. ``(ii) The teaching certified registered nurse anesthetist (or other certified registered nurse anesthetist or anesthesiologist with whom the teaching certified registered nurse anesthetist has entered into an arrangement) is immediately available to furnish anesthesia services during the entire case. ``(B) For purposes of subparagraph (A), the amount described in this subparagraph, with respect to services furnished by a teaching certified registered nurse anesthetist described in such subparagraph, is 100 percent of the fee schedule amount otherwise applicable under this subsection if the services were personally performed by the teaching certified registered nurse anesthetist alone.''. (c) Effective Date.--The amendments made by this section shall apply to services furnished on or after January 1, 2007.
summary: Medicare Academic Anesthesiology and CRNA Payment Improvement Act of 2006 - Amends title XVIII (Medicare) part B (Supplementary Medical Insurance Benefits for the Aged and Disabled) of the Social Security Act to set forth a special payment rule for teaching anesthesiologists (TAs) and teaching certified registered nurse anesthetists (CRNAs). Requires payment of 100% of the fee schedule amount otherwise applicable for anesthesia services personally performed by the TA alone when the TA is training physician residents or student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases, if: (1) the TA is present during all critical or key portions of the anesthesia service or case involved; and (2) either the TA or an anesthesiologist or a CRNA with whom the TA has made special arrangements is immediately available to furnish anesthesia services during the entire case. States that this special payment rule shall not apply in the case of physician services furnished by an anesthesiologist who medically directs a CRNA involved in the training of student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases. Applies to a CRNA medically directed or medically supervised by a physician in the performance of anesthesia services the current fee schedule amount of one-half of the amount for a physician's medical direction of the performance of such services, regardless of whether or not the CRNA is involved in the training of student nurse anesthetists in a single case or two concurrent cases. Requires payment, however, of 100% of the fee schedule amount otherwise applicable for anesthesia services personally performed by a teaching CRNA alone when the teaching CRNA is not medically directed but is involved in the training of student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases, if: (1) the teaching CRNA is present during all critical or key portions of the anesthesia service or case involved; and (2) the teaching CRNA (or other CRNA or anesthesiologist with whom the CRNA has made special arrangements) is immediately available to furnish anesthesia services during the entire case.