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  • Summary date: Mar 28 2023 - View Summary

    Enacts new GS 90-18.8, providing as follows. Requires, consistent with the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) that an anesthesiologist supervising a certified registered nurse anesthetist performing anesthesia care must comply with all of the following in order to bill any third-party payor for medical direction services: (1) perform a pre-anesthetic examination and evaluation and document it in the medical record; (2) prescribe the anesthesia plan; (3) personally participate in and document the most demanding procedures in the anesthesia plan; (4) ensure that any procedures in the anesthesia plan that the anesthesiologist does not perform are performed by a certified nurse anesthetist or anesthesiologist assistant, as appropriate; (5) monitor the course of anesthesia administration at frequent intervals and document that they were present during some portion of the monitoring; and (6) remain physically present and available for immediate diagnosis and treatment of emergencies. Enacts new GS 58-3-301 requiring an insurer offering a health benefit plan in this State to reimburse claims for medical direction of a nurse anesthetist at 50% of the rate of reimbursement the anesthesiologist would have received for services if the services had been performed without the nurse anesthetist. Also requires, consistent with TEFRA, that the insurer require that any anesthesiologist supervising a certified registered nurse anesthetist performing anesthesia care comply with the same requirements set out in new GS 90-18.8. Defines the terms anesthesia care, anesthesiologist, certified registered nurse anesthetist, medical direction and supervision as they are used in both statutes.

    Amends GS 135-48.51 to make new GS 58-3-301 applicable to the State Health Plan.

    The above changes are applicable October 1, 2023.

    Amends GS 58-93-120 to make new GS 58-3-3-1 applicable to prepaid health plans in the manner in which it applies to insurers.

    Requires the Department of Health and Human Services, Division of Health Benefits (DHB), to review the Medicaid State Plan and all applicable Medicaid clinical coverage policies to ensure that the Medicaid program is paying anesthesiologists for medical direction of nurse anesthetists at 50% of the reimbursement the anesthesiologist would receive if they performed the work alone. Also requires DHB to ensure that all requirements for reimbursement of anesthesiologist medical direction services comply with TEFRA.