CRNA Independent Practice States 

CCI Anesthesia manages numerous CRNA-only practices and hires experienced CRNAs who want to work independently at the top of their skillsets. Sometimes, certain scenarios necessitate an all-CRNA practice, and we have seen these practices provide lifelines to underserved patients and keep budgets balanced for rural hospitals. Familiarizing yourself with your state’s practice laws for anesthesia departments and CRNAs is important in understanding your employment options as a CRNA. 

The Case for All-CRNA Practices

CRNAs represent more than 80% of the anesthesia providers in rural communities. Many rural hospitals are critical-access hospitals that rely on independently practicing CRNAs for anesthesia care. Half of U.S. rural hospitals use a CRNA-only model for obstetric care. CRNAs safely deliver pain management care, particularly where no physician providers are available, saving patients long drives of 75 miles or more. All-CRNA practices are essential to delivering lifesaving care to rural and underserved populations, and CCI Anesthesia is proud to manage several of these practices. 

The History of CRNA Independent Practice States

In 2001, a final rule was adopted that amended the Medicare and Medicaid Anesthesia Conditions of Participation for hospitals, critical access hospitals and ambulatory surgical centers. The final rule continued the requirement for physician supervision of nurse anesthetists but allowed state governors to “opt-out” of this requirement under certain circumstances. Since amending the Medicare safety rule, governors in 22 states have opted out. 

Since becoming law in 1966, Medicare has supported a team approach to anesthesia care, requiring that it be performed by a physician, a physician-supervised nurse anesthetist or a physician anesthesiologist-supervised anesthesiologist assistant. The role of the physician anesthesiologist is to medically evaluate the patient’s fitness for surgery and anesthesia, determine potential risk, manage the patient’s medical condition during surgery, treat any medical complications and supervise post-operative care. In the absence of a physician anesthesiologist, there is only one other medical professional in the operating room with the education and training to perform these services: the surgeon. 

The 22 Opt-Out States

The 22 states that have opted out of the requirement for physician supervision of nurse anesthetists include: 

  • Iowa (December 2001) 
  • Nebraska (February 2002) 
  • Idaho (March 2002) 
  • Minnesota (April 2002) 
  • New Hampshire (June 2002) 
  • New Mexico (November 2002) 
  • Kansas (March 2003) 
  • North Dakota (October 2003) 
  • Washington (October 2003) 
  • Alaska (October 2003) 
  • Oregon (December 2003)
  • Montana (January 2004)
  • South Dakota (March 2005) 
  • Wisconsin (June 2005)
  • California (July 2009) 
  • Colorado (September 2010: partial opt-out limited to Critical Access Hospitals and specified rural hospitals) 
  • Kentucky (April 2012) 
  • Arizona (March 2020) 
  • Oklahoma (November 2020) 
  • Utah (February 2022: partial opt-out limited to Critical Access Hospitals and specified rural hospitals) 
  • Michigan (May 2022) 
  • Arkansas (May 2022) 

Benefits of All-CRNA Practices

In addition to improving access to care in rural areas, there are numerous other benefits of all-CRNA practices. In many situations, running an all-CRNA practice can be more cost-effective than including anesthesiologists in the staffing mix. Since anesthesiologist compensation packages are significantly higher than CRNAs, the most cost-effective anesthesia delivery model typically involves a CRNA working as the sole anesthesia provider. CRNAs can provide most types of anesthesia in various practice settings, including pain management services. Even in densely populated cities, it often makes sense for an independent CRNA to meet the anesthesia-related needs of office-based practices, such as plastic surgery practices. 

If you are an experienced CRNA looking for independent practice opportunities, contact us today at 800-494-3948. Our recruiters would love to discuss your career and lifestyle goals to find the perfect position for your unique needs.