For the 2021 legislative session, AZANA is working on two important piece of legislation.
SB1300 - Discharge. Many of CRNAs stay with our patients in ASCs until they are ready to leave. Unfortunately, the current rules are unclear as to if a physician or a CRNA are both authorized to perform this function. SB 1300 adds this ability for administrators to select CRNAs for this function, in addition to physicians. This approach was taken to ensure access to care and after hearing from many stakeholders in the ASC community.
SB1372 - Dental Permits. CRNAs already have legal authority to practice in dental offices, but the Arizona Board of Dentistry is currently restricting CRNAs from doing so, in a way that is not consistent with legal standards. SB 1372 would ensure that dentists and patients have access to CRNA anesthesiology services, without burdensome restrictions. This is a needed policy to ensure some of Arizona’s most vulnerable patients have access to anesthesiology services.
SB 1300 Fact Sheet
The Problem:
Current Arizona Administrative Code (AAC) discharge regulations for Ambulatory/Outpatient Surgical Centers (ASCs) AAC R9-10-911 states: “An administrator shall ensure that a physician remains on the ASC premises until all patients are discharged from the recovery room”.
However, “discharged” is defined as the written “termination of services” which is being interpreted as a "written discharge order”, which would indicate the physician must be physically present until they write a discharge order.
This is a problematic policy on multiple fronts:
Intent. Per conversations with DHS, the intent of this rule is to have the surgeon available for surgical complications. However, that is not common practice across the state, according to multiple facility administrators, regardless of who is administering the anesthesia, either a physician anesthesiologist or a CRNA.
Out of compliance with CMS and other accreditation bodies. CMS specifically requires and authorizes the surgeon to discharge the patient from surgical services and the CRNA to discharge from anesthesia services. Both AAAASF and AAAHC have similar approaches.
Should SB 1300 pass, CMS Requires both post-surgical discharge and post-anesthesia discharge, and DHS also will still require post-surgical services from the surgeon/physician Please reference this explanation
The lack of clarity has already had a negative impact on access to surgical services.
The Solution:
SB 1300 clearly and simply addresses the issue by allowing facilities to have either a physician or CRNA present until the patients are discharged. This doesn’t remove physicians from the process (as a recent false claim was made), but is in line with common practice and adds flexibility.
SB1372 Fact Sheet
The Problem:
Current BODEX regulations are most likely out of compliance with state law as they indirectly regulate CRNAs (and, MDs and DOs). Their approach limits dentists from utilizing CRNA services, which are key in increasing access and decreasing costs.
The Details:
Permit structure. Currently BODEX utilizes a permit structure that allows dentist anesthesiologists and oral surgeons a “1301” permit, whereas they do not offer this permit to CRNAs/MDs. Instead, they make a dentist acquire a 1304 permit.
Access. The 1304 permit is problematic because when a dentist has a difficult patient that requires CRNA anesthesiology services, they are not able to utilize the service. Instead, they are forced to go to other providers, which are more expensive, but also often have no availability.
Harm to patients. This means that patient must wait for their needed procedure, or see another dentist altogether. This delay is extremely harmful for some of Arizona’s most needy patients for essential dental care.
The legal problem. Per NC v FTC, BODEXs (and other boards) are not authorized to regulate (directly or indirectly) other professions - that is not their authority. The current structure has BODEX indirectly regulating CRNAs, which they are not permitted to do, and the Arizona Legislature has already given CRNAs legal authority to practice in dentist’s offices.
The Solution:
SB 1372 succinctly addresses this problem by authorizing in statute the ability for CRNAs and MDs. It does not remove sedation from the dental board’s authority, instead, it stops the dental board from inhibiting access to anesthesia services from CRNAs and MDs, and still allows them to promote rules for patient safety.
Key added patient safety bonus:
SB 1372 will require BODEX to report any patient safety issues with either MDs, DOs, or CRNAs, to the respective board - a key requirement that is not currently in place.
Your engagement will be needed to make sure these two importance, patient-focused initiatives pass! Please reach out to us with any questions.
Image Credit: Gage Skidmore
