[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR416.42]



[Page 813]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 416_AMBULATORY SURGICAL SERVICES--Table of Contents

 

               Subpart C_Specific Conditions for Coverage

 

Sec. 416.42  Condition for coverage--Surgical services.



    Surgical procedures must be performed in a safe manner by qualified 

physicians who have been granted clinical privileges by the governing 

body of the ASC in accordance with approved policies and procedures of 

the ASC.

    (a) Standard: Anesthetic risk and evaluation. A physician must 

examine the patient immediately before surgery to evaluate the risk of 

anesthesia and of the procedure to be performed. Before discharge from 

the ASC, each patient must be evaluated by a physician for proper 

anesthesia recovery.

    (b) Standard: Administration of anesthesia. Anesthetics must be 

administered by only--

    (1) A qualified anesthesiologist; or

    (2) A physician qualified to administer anesthesia, a certified 

registered nurse anesthetist (CRNA) or an anesthesiologist's assistant 

as defined in Sec. 410.69(b) of this chapter, or a supervised trainee 

in an approved educational program. In those cases in which a non-

physician administers the anesthesia, unless exempted in accordance with 

paragraph (d) of this section, the anesthetist must be under the 

supervision of the operating physician, and in the case of an 

anesthesiologist's assistant, under the supervision of an 

anesthesiologist.

    (c) Standard: Discharge. All patients are discharged in the company 

of a responsible adult, except those exempted by the attending 

physician.

    (d) Standard: State exemption. (1) An ASC may be exempted from the 

requirement for physician supervision of CRNAs as described in paragraph 

(b)(2) of this section, if the State in which the ASC is located submits 

a letter to CMS signed by the Governor, following consultation with the 

State's Boards of Medicine and Nursing, requesting exemption from 

physician supervision of CRNAs. The letter from the Governor must attest 

that he or she has consulted with State Boards of Medicine and Nursing 

about issues related to access to and the quality of anesthesia services 

in the State and has concluded that it is in the best interests of the 

State's citizens to opt-out of the current physician supervision 

requirement, and that the opt-out is consistent with State law.

    (2) The request for exemption and recognition of State laws, and the 

withdrawal of the request may be submitted at any time, and are 

effective upon submission.



[57 FR 33899, July 31, 1992, as amended at 66 FR 56768, Nov. 13, 2001.]