September 30, 2024

Dear Colleagues,

This weekend while some of us watched the devastation caused by Hurricane Helene on screens in our homes, many of our colleagues and friends experienced the power of nature directly and are still without water or electricity. Our hearts go out to all impacted by the unprecedented flooding and winds.  AANA is working closely with COA on what support can be offered to regional programs. If you would like to help directly, please consider a donation to the American Red Cross. 

We also have news to share in this message regarding our efforts to ensure enforcement of the provider nondiscrimination provision of the Affordable Care Act. 

Last week, AANA took important action in its advocacy for fair reimbursement for CRNAs and unhindered access to excellent, cost-effective healthcare for our patients.  

On Friday, AANA filed a lawsuit against Secretary Xavier Becerra of Health and Human Services (HHS) Secretary compelling him to enforce the provider nondiscrimination provision of the Affordable Care Act.  Because of the Secretary’s lack of action, health plans and insurers, such as Cigna and Anthem Blue Cross Blue Shield, have reduced CRNA reimbursement by 15% for providing the same service as a physician anesthesia providers. This blatant discrimination encourages higher cost healthcare delivery models without improving quality and may impede access to care for patients.    

In addition to this litigation, AANA continues to work with the Administration and Congress to ensure enforcement of the nondiscrimination provision as well as promulgation of a rule. AANA is engaging in stakeholder outreach at both the state and federal level to engage other organizations in our advocacy efforts.  AANA will also continue to attempt communications with Cigna and Anthem on these issues. 

If you are considering filing a lawsuit of your own against Anthem or Cigna, consult with your own counsel about potential legal rights. If you have a contract with either company you should also review your contract with your counsel to understand your specific rights to pursue a formal legal process against Anthem or Cigna.   

AANA will keep you up to date on any significant decisions made by the court. 

As always, thank you for all that you do and for supporting your colleagues and AANA. 

Sincerely, 

The AANA Board of Directors 

IN THIS ISSUE

• AANA Files Petition to Compel HHS to Enforce ACA Provider Non-Discrimination Provision 

• AANA Responds to ASA Legal Challenge to Anesthesiology Trademark 

• AANA Urges Agency to Alleviate Anesthesia Payment Cuts in Comment Letter on Physician Fee Schedule 

• In Comments on Hospital Outpatient and ASC Payment Rules, AANA Urges that the Conditions of Participation (CoPs) for Obstetrical Services Recognize CRNAs Operating at the Top of Their Scope 

• AANA Attends Governor Meetings 

• AANA Joins NCC Congressional Letter on Priorities 

• AANA Announces New RN/APRN Membership Category 

• Protect Your Career: The Truth About NPDB Reports and Malpractice Insurance  

• Diversity and Inclusion in Action: Helping Students Envision a Future in Healthcare 

• Castillo Named President-Elect of NCSBN 

• AANA Applauds CRNA Desirée Chappell’s Appointment to the APSF’s Board of Directors 

ADVOCACY UPDATES

AANA Files Petition to Compel HHS to Enforce ACA Provider Non-Discrimination Provision

The AANA took action on Friday, September 27, to ensure access to high-quality, affordable anesthesia care for all patients. AANA filed a petition for a writ of mandamus in the United States District Court Northern District of Ohio asking the court to compel Xavier Beccera, Secretary of Health and Human Services (HHS), and perform a duty he is legally obligated to perform -- enforce the provider non-discrimination provision of the Affordable Care Act against insurance companies and health plans.  

In 2010, the provider nondiscrimination provision in the Affordable Care Act was passed to prohibit health plans/health insurance companies (commercial payors) from discriminating against providers on the basis of licensure, including setting up different reimbursement policies for those providers delivering the same high-quality healthcare services. In 2020, the No Surprises Act required the HHS, the Department of Labor (DOL), and the Department of Treasury to issue rules and enforcement policies within one year. However, there is still no level of enforcement in place. Until this is completed, commercial payors can jeopardize patients’ access to care through discriminatory policies. 

Both Anthem Blue Cross Blue Shield and Cigna have recently announced that Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists or nurse anesthetists will receive 15% less than other anesthesia providers for delivering the same anesthesia services. Read the AANA Press Release.  

AANA Responds to ASA Legal Challenge to Anesthesiology Trademark

In June 2024, the American Society of Anesthesiologists (ASA) filed a trademark complaint with the US Trademark Trail and Appeal Board against the American Association of Nurse Anesthesiology (AANA), alleging its use of the word "anesthesiology" is "deceptively misdescriptive." Two trademarks are being challenged: “American Association of Nurse Anesthesiologists” and “American Association of Nurse Anesthetists and Nurse Anesthesiologists.”  Members should know that AANA’s trademark for “American Association of Nurse Anesthesiology” and related trademarks are fully registered and are not part of this challenge. 

Through legal counsel, AANA has responded to the complaint, denying ASA’s allegations. The timeline for resolution is unknown, however, AANA defends the trademarks in question and will be keeping members up to date on any significant decisions that occur. 

Nurse anesthesiology is the first profession to own the responsibility of anesthesia delivery with a 150-year history of safe, comfortable and compassionate anesthesia care. In fact, certified registered nurse anesthetists (CRNAs) safely administer more than 50 million anesthetics to patients each year in the United States. Not only are CRNAs highly trained and capable, but they also use the exact same techniques to provide anesthesia as other anesthesiology professionals.  

AANA stands proudly to advance the science and art of nurse anesthesiology and advocate for CRNAs and their patients. 

AANA Urges Agency to Alleviate Anesthesia Payment Cuts in Comment Letter on Physician Fee Schedule

In comments to the Physician Fee Schedule proposed rule for Calendar Year (CY) 2025, AANA urged the Centers for Medicare & Medicaid Services (CMS) to alleviate cuts in reimbursement to anesthesia providers, such as CRNAs. As stated in a letter signed by AANA President Janet Setnor, MSN, CRNA, Col. (Ret), USAFR, NC, “While we do appreciate that the Centers for Medicare & Medicaid Services (CMS) has proposed payment policy changes in this proposed rule that will have a positive impact on CRNA payment, we were disappointed to see a proposed 2.1 percent decrease over last year’s anesthesia conversion factor (CF) in this proposed rule. The positive impact on payment is not enough to make up for this cut to the anesthesia CF, as these constant cuts in reimbursement have not kept with inflation. These effects are compounded by the fact that private payers are cutting rates for CRNA anesthesia services…we ask that CMS help lessen the impact of this decrease in the anesthesia CF and to work with Congress to establish an answer. AANA would be happy to work with the agency in these efforts.” 

In Comments on Hospital Outpatient and ASC Payment Rules, AANA Urges that the Conditions of Participation (CoPs) for Obstetrical Services Recognize CRNAs Operating at the Top of Their Scope

In comments on the Centers for Medicare & Medicaid Services (CMS) Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems (OPPS) proposed rule for Calendar Year (CY) 2025, AANA requested that any final rule and corresponding sub-regulatory guidance regarding the Condition of Participations (CoPs) for obstetrical services for hospitals and critical access hospitals recognize CRNAs operating at the top of their scope with respect to the delivery of obstetrical anesthesia. The OPPS reimburses hospitals for outpatient services and ambulatory surgery centers, but also includes policies affecting inpatient hospitals that could have implications for CRNAs. AANA’s comment letter also acknowledged that the proposed regulatory text for the CoP was not problematic, but did request that the final regulations and sub-regulatory guidance not impose standards that are not based on evidence, such as the 2019 Levels of Maternal Care (LoMC) published by the American College of Obstetricians and Gynecologists. The letter also requested that AANA be included in CMS’s development of sub-regulatory guidance as it relates to obstetrical anesthesia. 

AANA Attends Governor Meetings

AANA State Government Affairs staff attended the Republican Governors Association Senior Staff Retreat in September. Chiefs of Staff and Policy Directors were in attendance from every Republican Governor’s office. SGA staff met with several states and used the opportunity to educate them on CRNA practice. In October, SGA staff will be attending the Democratic Governors Association Fall Policy Conference in Philadelphia. These meetings help the AANA to continue advocating for CRNA practice in the states. 

AANA Joins NCC Congressional Letter on Priorities

On Monday, September 16, the AANA along with 63 other national nursing organizations joined a letter to Congressional leadership outlining key legislative priorities for the Nursing Community Coalition (NCC). Included in the letter was a request for at least $310 million for Title VIII Nursing Workforce Development funding, which includes programs like Advanced Nursing Education and the Nurse Anesthetist Traineeship (NAT). This reflects the funding provided in the Senate's FY25 Labor-HHS-Education bill that passed out of committee. The letter also asked for a minimum of $197 million for the National Institutes of Nursing Research (NINR). Congress has not yet passed the appropriations bills for FY25, which starts on October 1, 2025.  

SIGNIFICANT NEWS

AANA Announces New RN/APRN Membership Category 

AANA has announced the creation of a new membership category for registered nurses (RNs) and advanced practice registered nurses (APRNs). Read more. 

Protect Your Career: The Truth About NPDB Reports and Malpractice Insurance

Discover how the National Practitioner Data Bank (NPDB) impacts your career and why having your own malpractice insurance with a pure consent-to-settle provision is crucial. Don’t let your employer's decisions harm your reputation. Read more and learn how to safeguard your professional future and ensure you're fully informed.  

MEMBER HIGHLIGHTS

Diversity and Inclusion in Action: Helping Students Envision a Future in Healthcare

Maria Earl, DNP, CRNA, moved to the United States with her parents at the age of 10 from Hermosillo, Sonora, Mexico. She and her family had a difficult journey, but her mother and teachers always emphasized the importance of education. Role models and mentorship were crucial on her path to becoming first a nurse, then a CRNA.  

“When I was younger, I never would have imagined that I could have become a CRNA and gotten a doctorate degree, but mentorships and role models that I had in my life as a student showed me a path forward,” Earl said. “My motivation and my willingness to move forward was because I had mentors myself.”  

For that reason, when she became the chair of the Arizona Association of Nurse Anesthesiology (AZANA)’s Diversity, Equity, and Inclusion (DEI) Committee, she and her fellow committee members made it a priority to reach out to students of diverse backgrounds to talk about becoming a CRNA and provide mentorship opportunities for them. Read more. 

Castillo Named President-Elect of NCSBN

Jose D. Castillo III, PhD, CRNA, APRN, FAANA, has been elected as president-elect of the National Council of State Boards of Nursing (NCSBN) for 2024-2026. Read more. 

AANA Applauds CRNA Desirée Chappell’s Appointment to the APSF’s Board of Directors

The AANA congratulates Desirée Chappell, MSNA, CRNA, FAANA, for her appointment to the Anesthesia Patient Safety Foundation (APSF) Board of Directors. Read more. 

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