CHICAGO — New payment rules effectively leave nurse anesthetists unable to be paid for care rendered to Medicare patients in a dozen states, according to a lawsuit brought by a nursing industry association, and the group says this could mean beneficiaries in those states may be forced to turn to self-medication to treat chronic pain. 

In April, the American Association of Nurse Anesthetists (AANA) filed a complaint for declaratory and injunctive relief in Chicago federal court against Medicare Administrative Contractor (MAC) Novitas Solutions Inc.

A Novitas local coverage determination (LCD), which was to become effective May 4, prevents Certified Registered Nurse Anesthetists (CRNAs) from being reimbursed for their treatment of Medicare beneficiaries who suffer from chronic pain. Novitas covers patients in Washington, D.C., Pennsylvania, New Jersey, Maryland, Delaware, Colorado, Oklahoma, New Mexico, Arkansas, Texas, Louisiana and Mississippi.

“Arbitrarily denying CRNAs reimbursement for care they are qualified to provide could have a devastating impact on patient access to these critical services, especially in rural counties in Novitas states,” said Mark Silberman, a partner at Benesch Attorneys at Law in Chicago, which is representing the AANA.

“If Novitas moves forward with this arbitrary decision, patients could no longer have access to interventional pain management services," Silberman said. "These patients could then be forced to choose between ensuring their pain, traveling unacceptable distances to obtain care, or potentially turning to greater reliance on opioids.”

Silberman said the LCD creates a situation where CRNAs, despite the fact that they have been safely performing this procedure and being reimbursed for them, will suddenly be ineligible for reimbursement due to the arbitrary and unsupported claim that CRNAs are not qualified providers.

According to the suit, the LCD requires CRNAs to get specific training in order to be reimbursed for procedures. However, Novitas admits it is “not aware of any available training/certification programs for non-physician practitioners that would enable them to meet the stated requirements," Silberman said.

“CRNAs are well qualified to provide acute and chronic pain management services, including image-guided epidural steroid injections through their entry-to-practice educational program and/or additional clinical experience or subspecialty education and certification,” Silberman said.

The core of the issue is not a question of CRNAs being reimbursed, but a question of “Novitas arbitrarily undermining the scope of practice of CRNAs by refusing to reimburse them for procedures they are authorized to perform in the states in which they are being performed—with the justification being a lack of skill—and inconsistent with CMS regulations,” Silberman said.

According to the AANA, CRNAs are the primary providers of anesthesia care in rural America, enabling health care facilities in these medically underserved areas to offer obstetrical, surgical, pain management and trauma stabilization services. CRNAs are the sole providers in nearly 100 percent of the rural hospitals in some states.

If other MACs follow suit, Silberman said patients will suffer due to lack of access to care and chronic pain management services.

“This is not only possible, it is expected," Silberman said. "Part of the concern for our patients is that those suffering from chronic pain, especially those in rural America, will be denied access to necessary care from quality providers. If other MACs decide to follow suit in arbitrarily redefining the scope of health care professionals with the goal of saving money, it could leave thousands of patients in hundreds of rural counties without access to critical chronic pain services.”

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