text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Medicare Academic Anesthesiology and 
  CRNA Payment Improvement Act of 2006''.
  
  SEC. 2. FINDINGS.
  
      Congress finds the following:
              (1) Since 1991, the Medicare program has reduced 
          reimbursements for anesthesia services provided to Medicare 
          beneficiaries by 50 percent in certain instances when education 
          of student nurse anesthetists or anesthesiology medical 
          residents is involved, imposing financial disincentives against 
          anesthesia education. These Medicare payment policies are known 
          as anesthesia teaching rules.
              (2) In 2002, the Centers for Medicare & Medicaid Services 
          (CMS) authorized an alternative payment system for certain 
          cases involving nurse anesthesia education and subsequently for 
          anesthesiology resident education, in which the agency allowed 
          reimbursement for base units plus discontinuous time. However, 
          the alternative has not propagated in the marketplace and CMS 
          has declined to reform the anesthesia teaching rules further 
          without an Act of Congress.
              (3) To ensure the access of patients to safe, high quality 
          anesthesia care, society has a strong interest in providing for 
          high quality anesthesia educational institutions. The 
          population of the United States is aging, resulting in an 
          increase in demand for health care requiring anesthesia and 
          pain management services provided by anesthesiologists and 
          certified registered nurse anesthetists (CRNAs).
              (4) Though the Institute of Medicine in 2000 found the 
          provision of anesthesia in such year to be 50 times safer than 
          the provision of anesthesia during the 20 years previous to 
          such year, continued evaluation, innovation, and quality 
          improvements in anesthesia are required to further enhance 
          patient safety.
              (5) As of August 2006, there are 130 anesthesiology 
          residency programs and 102 programs accredited by the Council 
          on Accreditation of Nurse Anesthesia Educational Programs in 
          the United States. Under the current payment rules under the 
          Medicare program, both anesthesiology residency and nurse 
          anesthesia educational programs report challenges recruiting 
          and retaining faculty.
              (6) Since part B under the Medicare program provides for 
          reimbursement for the services of anesthesiologists and the 
          services of CRNAs, reforms to the anesthesia teaching rules 
          under the Medicare program should treat teaching 
          anesthesiologists and teaching CRNAs similarly with respect to 
          anesthesiology medical residents and student registered nurse 
          anesthetists, respectively, and should not favor one provider 
          over another.
  
  SEC. 3. PURPOSE.
  
      The purpose of this Act is to ensure financial stability of nurse 
  anesthesia and anesthesiology educational programs to provide 
  sufficient opportunities for student nurse anesthetists and medical 
  residents to pursue the specialty of anesthesia so that patients 
  continue to have access to quality health care.
  
  SEC. 4. SPECIAL PAYMENT RULE FOR TEACHING ANESTHESIOLOGISTS AND 
                TEACHING CERTIFIED REGISTERED NURSE ANESTHETISTS.
  
      (a) For Physicians' Services.--Section 1848(a) of the Social 
  Security Act (42 U.S.C. 1395w-4(a)) is amended--
              (1) in paragraph (4)(A), by inserting ``except as provided 
          in paragraph (5)(A)'' after ``anesthesia cases,''; and
              (2) by adding at the end of paragraph (4) the following new 
          paragraph:
              ``(5) Special rule for teaching anesthesiologists.--
                      ``(A) In general.--With respect to physicians' 
                  services furnished by a teaching anesthesiologist 
                  involved in the training of physician residents or 
                  student nurse anesthetists in a single anesthesia case 
                  or two concurrent anesthesia cases, notwithstanding 
                  paragraph (4), the fee schedule amount to be applied 
                  for each such case shall be the amount described in 
                  subparagraph (B) if both of the following conditions 
                  are met:
                              ``(i) The teaching anesthesiologist is 
                          present during all critical or key portions of 
                          the anesthesia service or case involved.
                              ``(ii) At least one of the following 
                          individuals is immediately available to furnish 
                          anesthesia services during the entire case:
                                      ``(I) The teaching 
                                  anesthesiologist.
                                      ``(II) An anesthesiologist with 
                                  whom the teaching anesthesiologist has 
                                  entered into an arrangement for such 
                                  purpose.
                                      ``(III) In the case of the training 
                                  of student nurse anesthetists, a 
                                  certified registered nurse anesthetist 
                                  with whom the teaching anesthesiologist 
                                  has entered into an arrangement with 
                                  respect to such training.
                      ``(B) Amount described.--For purposes of 
                  subparagraph (A), the amount described in this 
                  subparagraph, with respect to anesthesia services 
                  furnished by a teaching anesthesiologist described in 
                  such subparagraph, is 100 percent of the fee schedule 
                  amount otherwise applicable under this section if the 
                  anesthesia services were personally performed by the 
                  teaching anesthesiologist alone.
                      ``(C) Clarification for anesthesiologists who 
                  medically direct teaching certified registered nurse 
                  anesthetists.--Subparagraph (A) shall not apply in the 
                  case of physician services furnished by an 
                  anesthesiologist who medically directs a certified 
                  registered nurse anesthetist who is involved in the 
                  training of student nurse anesthetists in a single 
                  anesthesia case or two concurrent anesthesia cases.''.
      (b) For Services of Certified Registered Nurse Anesthetists.--
  Section 1833(l) of such Act (42 U.S.C. 1395l(l)) is amended--
              (1) in paragraph (4)(B)(iii)--
                      (A) by striking ``In the case of'' and inserting 
                  ``(I) Subject to clause (II), in the case of'';
                      (B) by striking ``1848(a)(5)(B)'' and inserting 
                  ``1848(a)(4)(B)''; and
                      (C) by adding at the end the following new 
                  subclause:
      ``(II) Subclause (I) shall apply to a certified registered nurse 
  anesthetist who is medically directed or medically supervised by a 
  physician notwithstanding whether or not such certified registered 
  nurse anesthetist is involved in the training of student nurse 
  anesthetists in a single case or two concurrent cases.''; and
              (2) by adding at the end the following new paragraph:
      ``(7)(A) With respect to services furnished by a teaching certified 
  registered nurse anesthetist who is not medically directed and who is 
  involved in the training of student nurse anesthetists in a single 
  anesthesia case or two concurrent anesthesia cases, the fee schedule 
  amount to be applied for each such case shall be the amount described 
  in subparagraph (B) if both of the following conditions are met:
              ``(i) The teaching certified registered nurse anesthetist 
          is present during all critical or key portions of the 
          anesthesia service or case involved.
              ``(ii) The teaching certified registered nurse anesthetist 
          (or other certified registered nurse anesthetist or 
          anesthesiologist with whom the teaching certified registered 
          nurse anesthetist has entered into an arrangement) is 
          immediately available to furnish anesthesia services during the 
          entire case.
      ``(B) For purposes of subparagraph (A), the amount described in 
  this subparagraph, with respect to services furnished by a teaching 
  certified registered nurse anesthetist described in such subparagraph, 
  is 100 percent of the fee schedule amount otherwise applicable under 
  this subsection if the services were personally performed by the 
  teaching certified registered nurse anesthetist alone.''.
      (c) Effective Date.--The amendments made by this section shall 
  apply to services furnished on or after January 1, 2007.
target: Medicare Academic Anesthesiology and CRNA Payment Improvement Act of 2006 - Amends title XVIII (Medicare) part B (Supplementary Medical Insurance Benefits for the Aged and Disabled) of the Social Security Act to set forth a special payment rule for teaching anesthesiologists (TAs) and teaching certified registered nurse anesthetists (CRNAs).
  
  Requires payment of 100% of the fee schedule amount otherwise applicable for anesthesia services personally performed by the TA alone when the TA is training physician residents or student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases, if: (1) the TA is present during all critical or key portions of the anesthesia service or case involved; and (2) either the TA or an anesthesiologist or a CRNA with whom the TA has made special arrangements is immediately available to furnish anesthesia services during the entire case.
  
  States that this special payment rule shall not apply in the case of physician services furnished by an anesthesiologist who medically directs a CRNA involved in the training of student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases.
  
  Applies to a CRNA medically directed or medically supervised by a physician in the performance of anesthesia services the current fee schedule amount of one-half of the amount for a physician's medical direction of the performance of such services, regardless of whether or not the CRNA is involved in the training of student nurse anesthetists in a single case or two concurrent cases.
  
  Requires payment, however, of 100% of the fee schedule amount otherwise applicable for anesthesia services personally performed by a teaching CRNA alone when the teaching CRNA is not medically directed but is involved in the training of student nurse anesthetists in a single anesthesia case or two concurrent anesthesia cases, if: (1) the teaching CRNA is present during all critical or key portions of the anesthesia service or case involved; and (2) the teaching CRNA (or other CRNA or anesthesiologist with whom the CRNA has made special arrangements) is immediately available to furnish anesthesia services during the entire case.
feat_title: To amend title XVIII of the Social Security Act to provide for improved payments under the Medicare Program for academic anesthesiology programs for resident physicians and for academic programs for student registered nurse anesthetists.