CERTIFIED NURSE ANESTHETISTS

SCOPE OF PRACTICE

Senate Bill 1019 as passed by the Senate w/o amendment

Sponsor:  Sen. Mike Kowall

House Committee:  Health Policy

Senate Committee:  Michigan Competitiveness

Complete to 11-27-16

SUMMARY:

Senate Bill 1019 would amend the Public Health Code to prescribe the scope of practice for a registered professional nurse who holds a specialty certification as a nurse anesthetist, or certified nurse anesthetist (CRNA). 

Scope of practice

A CRNA's scope of practice includes any of the following anesthesia and analgesia services:

·         Development of a plan of care;

·         Performance of all patient assessments, procedures, and monitoring to implement the plan of care or to address patient emergencies that arise; and

·         Selection, ordering, or prescribing and the administration of anesthesia and analgesic agents, including prescription drugs or controlled substances.  These services may be provided on the CRNA's own initiative in certain instances, described below. 

If the CRNA is part of a "patient-centered care team" in a hospital inpatient or outpatient facility, a freestanding surgical outpatient facility, an office of an allopathic or osteopathic physician or podiatrist, or any other office or facility in which diagnostic imaging, endoscopy, or cystoscopy services are provided, the CRNA may provide the anesthesia or analgesia services as the sole and independent anesthesia provider.   

·         Patient-centered care team means the patient and an interdisciplinary group of health care professionals that includes those who are directly involved in an operative, obstetrical, or diagnostic procedure performed on the patient.  It may include physicians, RNs, licensed practical nurses, or any other type of health care professional.

Periods when the CRNA may perform anesthesia and analgesia services

A CRNA may provide services for operative, obstetrical, interventional, or diagnostic purposes during the preoperative, intraoperative, and postoperative service period or the obstetrical service period, as applicable.

            Pain management services

The scope of practice outlined above does not include chronic pain management services, but the CRNA may perform chronic pain management services under delegation pursuant to Section 16215 of the Code.  (That section allows a licensee under the Code to delegate functions the licensee is licensed to perform to a person who is otherwise qualified by education training or experience, and who performs the act under the supervision of the licensee.)   

CRNA a "prescriber"

Section 17708 of the Code would add a CRNA to the list of prescribers, to the extent described above. 

The bill would not require new or additional third party reimbursement or mandated worker's competition benefits for anesthesia and analgesia services provided by a certified nurse anesthetist.  It would take effect 90 days after enactment.

MCL 333.17210 and 333.17708

FISCAL IMPACT:

Senate Bill 1019 would not have a significant fiscal impact on units of state or local government.

           

                                                                                        Legislative Analyst:   Jenny McInerney

                                                                                                Fiscal Analyst:   Marcus Coffin

■ This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their deliberations, and does not constitute an official statement of legislative intent.