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New Legislation Could be Game Changer for CRNAs in Rural States

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Key Takeaways

  • The United States saw more rural hospitals close their doors in 2020 than any other year since 2005.
  • Legislation in order to save rural hospitals as well as increase practice privileges among CRNAs is being proposed in order to ensure rural hospitals can remain open.
  • CRNAs specifically often lead the charge in their units in rural areas and provide anesthesia for the entire hospital unit, making them an irreplaceable position in a healthcare team.

Last year was an incredibly hard year, but it was especially difficult for rural hospitals and healthcare systems. Almost 20 hospitals in the country’s rural corners had to shut their doors due to lack of staff, outdated prescribing practices, and a low patient population. The closures from 2020 had set a new record for the most hospitals closed in a year since 2005.1

Because of these closures, people living in the surrounding area need to travel farther in order to access the care they need. In emergency situations, this certainly isn’t ideal. The median distance to access some of the more common healthcare services has increased about 20 miles from 2012 to 2018.1

Not only does this impact patient care, but hospital closures affect the livelihood of many residents. In rural areas, where jobs may be more scarce, hospitals provide opportunities for both medical and non-medical positions. The medical staff who lost their jobs due to hospital closures have to relocate in order to find work, and non-medical workers have to find alternative means to support themselves without uprooting their lives.1

Fortunately, legislation is currently in place in order to prevent more hospitals in rural areas from closing. One example of this is the American Rescue Plan Act of 2021, which will be providing $8.5 billion to reimburse rural healthcare providers for healthcare-related expenses and lost revenues attributable to the COVID-19 pandemic.1

Additionally, a group of Senators introduced the Save Rural Hospitals Act of 2021. The proposed legislation helps curb the trend of hospital closures in rural communities by making sure hospitals are fairly reimbursed for their services by the federal government. The legislation would establish an appropriate national minimum (0.85) for the Medicare Area Wage Index to ensure that rural hospitals receive fair payment for the care they provide, while preserving the existing reimbursements for urban hospitals. This legislation would also help ensure fairness in reimbursements for hospitals across the country – including the many hospitals that are facing closures in rural areas – and fix severe and disproportionate disadvantages that unfairly penalize hundreds of communities and hospitals across the United States.2 

The House has also introduced the Rural Hospital Support Act, bipartisan legislation that would extend and modernize critical federal programs that rural hospitals rely on to properly serve their communities. This includes renewing the Medicare-dependent Hospital (MDH) and Low Volume Adjustment programs, as well as updating Medicare reimbursement formulas for Sole Community Hospitals (SCHs) and MDHs.3

Another important solution gaining momentum among policymakers, and a game changer for advanced nursing staff, is to pass legislation that allows advanced practice nurses such as Certified Registered Nurse Anesthetists (CRNAs) and other nonphysician providers to practice to the full scope of their education and expertise.1

CRNAs are often the sole clinicians in rural hospitals who are able to administer anesthesia, which, in turn, enables the hospital to offer surgical, obstetrical, trauma stabilization, interventional diagnostic, and pain management services. Despite the fact that they are often in charge of overseeing highly specialized patients, they are limited in their abilities to prescribe, with one study finding that only 30% of CRNAs in the country have the ability to write prescriptions.4

President Biden’s proposed Fiscal Year 2022 budget calls for added funding for the U.S. Department of Health and Human Services (HHS) to protect rural healthcare access and expand the pipeline of rural providers like CRNAs. “The discretionary request also funds efforts to increase the number of individuals from rural areas going to medical school or other training programs, and returning or staying in rural communities to provide care, with a focus on primary care physicians, nurses, nurse practitioners, nurse anesthetists, and other in-demand providers.”5

Physician assistants (PAs) were allowed increased practice abilities at the onset of COVID-19 when the Centers for Medicare & Medicaid Services (CMS) temporarily removed physician supervision of PAs as well as advanced practice nurses to increase the capacity of the U.S. healthcare delivery system. While also benefiting PAS, this removal allowed CRNAs to step forward as indispensable providers in the healthcare system. The waiver was extended by 90 days in April 2021 and HHS has indicated it is likely to remain through the year.1

As we move forward in a post-pandemic world, healthcare leaders need to take a closer look at who is leading the charge among their rural hospitals in order to prevent more closures of these necessary medical centers. 


  1. Moore RD. New legislation could be game changer for CRNAs in rural states. The Daily Nurse. Published July 6, 2021. Accessed July 27, 2021. 
  2. Warner MR, Cornyn J, Blackburn M, Warnock R. Save Rural Hospital Acts of 2021. From the desk of Mark R. Warner, U.S. Senator from the Commonwealth of Virginia.
  3. Reps. Reed, Sewell Introduce Rural Hospital Support Act [news release]. Washington, D.C.: Congressman Tom Reed. Published March 15, 2021. Accessed July 27, 2021. 
  4. Kaplan L, Brown MA, Simonson D. CRNA prescribing practices: the Washington State experience. AANA Journal. 2011;79(1):24-29. 
  5. Ritacco M, Mackey R. President Biden’s FY 2022 Full Budget Request. NACo Executive Summary. Published June 4, 2021. Accessed July 27, 2021.

2 Responses

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