Nurse Anesthetists Decry De Facto Medicare Exclusion

CHICAGO (CN) – Nurse anesthetists sued Medicare administrator Novitas Solutions, claiming a new rule will bar them from receiving Medicare reimbursements, effectively denying many patients’ access to pain treatment.

The American Association of Nurse Anesthetists represents over 50,000 nurse anesthetists nationwide.

The organization, along with nurse anesthetist Lisa Pearson, filed suit Tuesday in Chicago federal court to block a local coverage rule announced by Novitas Solutions, a Pennsylvania-based administrative contractor that processes Medicare claims.

Purportedly motivated to improve patient safety, the anesthetists say the rule, named L36920, will limit the number of people who can be reimbursed by Medicare for epidural chronic pain treatment to licensed doctors, or medical staff who complete certain accredited non-physician curricula.

“[Certified Registered Nurse Anesthetists’, or CRNA’s] education and experience fulfill the categories of training requirements set forth in L36920,” according to the complaint, “but, inexplicably, their certification is not included in the list of acceptable evidence of training.”

The rule is scheduled to go into effect next month.

“L36920 provides a path for CRNAs that leads nowhere,” the association claims. “It excludes them from reimbursements that they are specifically authorized to receive. For CRNAs whose practices are reliant upon the reimbursement generated by the performance of these procedures, it acts as a de facto revocation from participation in the Medicare Program.”

The nurses say that Novitas exceeded its authority by engaging in rule-making, a role normally reserved for the Centers for Medicare and Medicaid, which is also named as a defendant in the lawsuit.

They claim its “patient safety” rationale for the rule is pretextual.

“Researchers studying anesthesia have found no measurable difference in the quality of care or in patient outcomes between CRNAs and physician anesthesia providers,” their complaint asserts. “Rather, they have found that incidents occur because of a lack of attention or underlying patient comorbidities, not from a lack of or difference in education.”

Nurses suffer irreparable harm to their livelihoods if the rule goes into effect, the association claims, and patients in need will be deprived of quality pain care.

“If CRNAs are foreclosed from meaningful participation in Medicare, vulnerable populations, such as rural communities, military veterans, troops in combat, and those suffering from chronic pain will be deprived of access to care,” the lawsuit states.

The nurses are represented by Mark Silberman with Benesch, Friedlander, Coplan & Aronoff in Chicago.

Novitas did not immediately respond to a request for comment made after hours Tuesday.

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