Certified registered nurse anesthetists and their representatives told the Joint Committee on Financial Services that some commercial insurers pay CRNAs far less than physicians for the same anesthesia services and urged state action to enforce federal nondiscrimination provisions.

Sarah Frederiksen, president of the Massachusetts Association of Nurse Anesthesiology, described federal history and Massachusetts policy changes that grant CRNAs full practice authority and said Medicare has reimbursed CRNAs on parity with physician anesthesiologists since the 1980s. "CRNAs and physician anesthesiologists provide the same services at the same standard of care," she said, and testified that recent insurer actions have reduced reimbursement for CRNAs in some contracts to levels as low as 34 percent of the physician rate.

Witnesses referenced federal law and industry practice: Melissa Crode, president-elect of the association, cited the provider nondiscrimination clause in the Affordable Care Act and said that, although federal law bars differential reimbursement for identical services, enforcement has been limited and state action is needed. She noted that UnitedHealthcare announced a 15 percent reduction in CRNA reimbursement in several states on July 1 and that other major carriers have taken similar actions in recent years.

Speakers said the effect is not lower wages for clinicians but reduced facility revenue and fewer hiring dollars for providers, which can reduce access to anesthesia services. "The patients do not see a reduction in their premiums," Crode said. "The only benefactor here are the insurance companies."

Testimony described recent state action elsewhere: Ohio enacted a state-level provider nondiscrimination law in June. Massachusetts witnesses asked the committee to consider similar statute language to bar insurers from reimbursing CRNAs at lower rates than physicians for the same services and to clarify enforcement mechanisms.

No committee vote was taken; witnesses sought a favorable report on the companion bills (S.783, H.1142).