SECTION 354.1301. Benefits and Limitations

(a) Anesthesia services provided by a Certified Registered Nurse Anesthetist (CRNA) are covered by the Texas Medical Assistance Program and are subject to the specifications, conditions, requirements, and limitations specified in this section and established by the Texas Health and Human Services Commission (HHSC) or its designee.

(b) To be payable, the services must be:

(1) Provided by a CRNA practicing in accordance with the Nursing Practice Act and the rules and regulations promulgated by the Board of Nurse Examiners;

(2) Reasonable and medically necessary as determined by HHSC or its designee;

(3) Ordered and supervised by a physician (MD or DO), dentist, or podiatrist, to the extent allowed by state law, who must be licensed in the state in which he or she practices; and

(4) Provided under one of the following conditions:

(A) No physician anesthesiologist is on the medical staff of the facility where the services are provided;

(B) As determined in accordance with the policies of the facility in which the services are provided, no physician anesthesiologist is available to provide the services;

(C) The physician, dentist, or podiatrist performing the procedure requiring the services specifically requests the services of a CRNA;

(D) The eligible recipient requiring the services specifically requests the services of a CRNA;

(E) The CRNA is scheduled or assigned to provide the services in accordance with policies of the facility in which the services are provided; or

(F) The services are provided by the CRNA in connection with a medical emergency.

(c) The Texas Medical Assistance Program will not reimburse the CRNA for equipment or supplies. Equipment and supplies are the responsibility of the facility in which the CRNA services are provided. If the equipment and supplies are covered and reimbursable by the Texas Medical Assistance Program, payment may be made to the facility if the facility is approved for participation in the Texas Medical Assistance Program. The basis and amount of reimbursement depends on the reimbursement methodology utilized by the Texas Medical Assistance Program for the services and providers involved.

(d) The scope of this section is limited to reimbursement policy for anesthesia services under the Texas Medical Assistance Program. Nothing contained in this section shall be construed to modify, supersede, or otherwise affect any other existing federal or state law or regulation or institutional practice regarding the administration of anesthesia.

(e) Reimbursement for covered CRNA services may be made to the CRNA actually performing the services or, provided that federal requirements related to reassignment of claims are met, to a hospital, physician, dentist, podiatrist, group practice, or ambulatory surgical center with which the CRNA has an employment or contractual relationship.

(f) Physician reimbursement for supervision of CRNAs is governed by the Health and Human Service Commission's policies regarding physician services.

(g) HHSC or its designee reimburses Texas Medical Assistance Program allowable CRNA services only when the services are submitted for payment under a CRNA provider number.

Source Note: The provisions of this §354.1301 adopted to be effective September 1, 1991, 15 TexReg 7618; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective July 1, 2006, 31 TexReg 5071