Achieving the opt out for Medicare physician supervision for nurse anesthetists.

With California's July 2009 opt-out from the Medicare physician supervision requirement for nurse anesthetists, 15 states have now opted out since 2001. The work of the American Association of Nurse Anesthetists (AANA) that led to the supervision opt-out rule being implemented has a long history. Beginning in 1994, when the Health Care Financing Administration (HCFA) first proposed deferring to the states on the supervision issue, the AANA worked for 7 years with HCFA and members of Congress to lay the groundwork for the opt-out rule that ultimately enabled the California governor's recent action.