[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

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

[CITE: 42CFR482.52]



[Page 499-500]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 482_CONDITIONS OF PARTICIPATION FOR HOSPITALS--Table of Contents

 

                  Subpart D_Optional Hospital Services

 

Sec. 482.52  Condition of participation: Anesthesia services.



    If the hospital furnishes anesthesia services, they must be provided 

in a well-organized manner under the direction of a qualified doctor of 

medicine or osteopathy. The service is responsible for all anesthesia 

administered in the hospital.

    (a) Standard: Organization and staffing. The organization of 

anesthesia services must be appropriate to the scope of the services 

offered. Anesthesia must be administered only by--

    (1) A qualified anesthesiologist;

    (2) A doctor of medicine or osteopathy (other than an 

anesthesiologist);



[[Page 500]]



    (3) A dentist, oral surgeon, or podiatrist who is qualified to 

administer anesthesia under State law;

    (4) A certified registered nurse anesthetist (CRNA), as defined in 

Sec. 410.69(b) of this chapter, who, unless exempted in accordance with 

paragraph (c)of this section, is under the supervision of the operating 

practitioner or of an anesthesiologist who is immediately available if 

needed; or

    (5) An anesthesiologist's assistant, as defined in Sec. 410.69(b) 

of this chapter, who is under the supervision of an anesthesiologist who 

is immediately available if needed.

    (b) Standard: Delivery of services. Anesthesia services must be 

consistent with needs and resources. Policies on anesthesia procedures 

must include the delineation of preanesthesia and post anesthesia 

responsibilities. The policies must ensure that the following are 

provided for each patient:

    (1) A preanesthesia evaluation by an individual qualified to 

administer anesthesia under paragraph (a) of this section performed 

within 48 hours prior to surgery.

    (2) An intraoperative anesthesia record.

    (3) With respect to inpatients, a postanesthesia followup report by 

the individual who administers the anesthesia that is written within 48 

hours after surgery.

    (4) With respect to outpatients, a postanesthesia evaluation for 

proper anesthesia recovery performed in accordance with policies and 

procedures approved by the medical staff.

    (c) Standard: State exemption. (1) A hospital may be exempted from 

the requirement for physician supervision of CRNAs as described in 

paragraph (a)(4) of this section, if the State in which the hospital 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.



[51 FR 22042, June 17, 1986 as amended at 57 FR 33900, July 31, 1992; 66 

FR 56769, Nov. 13, 2001]