CMS SOM App. W, Tag C-1145

The CAH designates the person who is allowed to administer anesthesia to CAH

patients in accordance with its approved policies and procedures and with State

scope-of-practice laws.

(1) Anesthesia must be administered by only--

(i)A qualified anesthesiologist;

(ii) A doctor of medicine or osteopathy other than an anesthesiologist; including

an osteopathic practitioner recognized under section 1101(a)(7) of the Act;

(iii) A doctor of dental surgery or dental medicine;

(iv) A doctor of podiatric medicine;

(v) A certified registered nurse anesthetist (CRNA), as defined in Sec. 410.69(b)

of this chapter;

(vi) An anesthesiologist’s assistant, as defined in Sec. 410.69(b) of this chapter;

or

(vii) A supervised trainee in an approved educational program, as described in

§§ 413.85 or 413.86 of this chapter.

Interpretive Guidelines §485.639(c)(1)

The medical staff bylaws must include criteria for determining the privileges to be

granted to an individual practitioner and a procedure for applying the criteria to

individuals requesting privileges. The CAH must specify the anesthesia privileges for

each practitioner that administers anesthesia, or who supervises the administration of

anesthesia by another practitioner. The privileges granted must be in accordance with

State law and CAH policy. The type and complexity of procedures for which the

practitioner may administer anesthesia, or supervise another practitioner supervising

anesthesia, must be specified in the privileges granted to the individual practitioner.

A dentist, oral surgeon, or podiatrist may administer anesthesia in accordance with State

law, their scope of practice and CAH policy. The anesthesia privileges of each

practitioner must be specified. Anesthesia privileges are granted in accordance with the

practitioner’s scope of practice, State law, the individual competencies of the practitioner

and the practitioner’s compliance with the CAH’S credentialing criteria.

When a CAH permits operating practitioners to supervise CRNA administering

anesthesia, the medical staff must specify in the statement of privileges for each category

of operating practitioner, the type and complexity of procedures they may supervise.

A CRNA may administer anesthesia when under the supervision of the operating

practitioner or of an anesthesiologist who is immediately available if needed (unless

supervision is exempted in accordance with §485.639(e)). An anesthesiologist’s assistant

may administer anesthesia when under the supervision of an anesthesiologist who is

immediately available if needed. Available to immediately intervene includes at a

minimum, that the supervising anesthesiologist or operating practitioner, as applicable, is:

• Physically located within the operative suite or in the labor and delivery unit; and

• Is prepared to immediately conduct hands-on intervention if needed; and

• Is not engaged in activities that could prevent the supervising practitioner from

being able to immediately intervene and conduct hands-on interventions if needed

Survey Procedures §485.639(c)(1)

• Review the qualifications of individuals authorized to deliver anesthesia.

• Determine that there is documentation of current licensure or current certification

status for all persons administering anesthesia.