In Colorado Medical Society v. Hickenlooper, a Colorado appeals court ruled the state of Colorado may op-out of the CMS rules requiring physician supervision of CRNAs in hospitals, ambulatory surgery centers, and critical access hospitals. 

The case is actually about the Medicare regulations for hospital participation, but it is based upon the concept of private practice of CRNAs. CMS Medicare participation rules require physician supervision of CRNAs in order to allow hospitals to participate in the Medicare program. However, states may op-out of that requirement if the state law authorizes independent practice by CRNAs and the governor of the state requests to opt-out and certifies that the state law allows such independent practice. 

Governor Hickenlooper did that in Colorado. The Colorado Medical Society sought an injunction prohibiting Colorado from opting-out of the Medicare participation rules. The appeals court affirmed the trial court decision denying the injunction.

The court ruled that the state of Colorado had satisfied the opt-out requirements, which would apply to 14 hospitals in Colorado. The governor thought it critical to opt-out of the physician supervision rule to improve access to care in rural and underserved areas of Colorado.


There are 15 other states which allow independent practice by CRNAs:

Alaska                          California

Idaho                            Iowa

Kansas                         Minnesota

Montana                       Nebraska

New Hampshire             New Mexico

North Dakota                Oregon

Sough Dakota              Washington