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Colorado Advanced Practice Psychiatric Nurses

Implementation of HB15-1182

Posted over 3 years ago by Linda Dwyer

Supreme Court Upholds Opt-Out

In a resounding victory for state nurse anesthetists, the Colorado Supreme Court has upheld the legality of Colorado's 2010 opt-out from Medicare's facility reimbursement rule requiring physician supervision of Certified Registered Nurse Anesthetists (CRNAs), effectively ending the legal challenges by the Colorado Society of Anesthesiologists (CSA) and Colorado Medical Society (CMS).

The Supreme Court, following the decisions by the trial and appellate courts to uphold former Gov. Bill Ritter's opt-out from the Medicare reimbursement rule, denied the appeal brought by the CSA and CMS. The lower courts had held that CRNAs who administer anesthesia are conducting independent nursing functions within the scope of nursing standards, and the state had the authority to opt out of the Medicare reimbursement rule.

"Colorado's scope of practice has always allowed for the independent administration of anesthesia by CRNAs," said Sarah Fredrikkson, DNAP, CRNA, president of the Colorado Association of Nurse Anesthetists and Colorado Nurses Association member. "We are pleased that the Colorado Supreme Court has upheld the continued independent practice of CRNAs," Fredrikkson said, emphasizing that the opt-out ensures patient access to safe, cost-effective anesthesia care for all Coloradoans, especially in rural and other medically underserved communities.

The opt-out was strongly supported by the Colorado Hospital Association and the Colorado Nurses Association. It is consistent with a 2010 Institute of Medicine report recommending the removal of scope of practice barriers so that advanced practice nurses can practice to the full extent of their education and training. The opt-out also alleviates the misperception held by some physicians that  their liability is increased when working  with CRNAs.

A 2010 national study evaluating anesthesia outcomes in opt-out states demonstrated no statistically significant differences in mortality or morbidity when anesthesia is provided by a CRNA working independently, an anesthesiologist working independently, or a CRNA and anesthesiologist working together.
Thank you to CNA members and Legal Defense Fund contributors for your important work and support in the success.



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