Medicare CRNA payment limits overhaul

Summary#

The Rural Surgery Sustainability Act of 2026 would amend an existing Medicare law on payment for certain certified registered nurse anesthetist (CRNA) services; it would not create a new program. It aims to adjust payment limits as surgical activity changes. It has been introduced and referred to the House Committee on Ways and Means, so it is not law.

  • The bill would raise a surgical-procedure limit from 500 to 1,250. It says that limit would not apply to a hospital with an active labor and delivery unit that year.
  • The Secretary of Health and Human Services (HHS) would have to review the procedure and anesthetist-hours limits at least every two years, consult the American Association of Nurse Anesthetists, and update the limits to reflect general increases in procedure frequency, including increases due to new procedures.
  • For services in 2027 and later, HHS would have to remove the anesthetist-hours limit for hospitals with an active labor and delivery unit. HHS would also have to revise the hours limit from 2027 to reflect the higher procedure limit.
  • Annual limits on reasonable-cost payments would have to rise from the prior year’s limit by the percentage increase in the Medicare Economic Index (MEI), a measure named in the bill.
  • The Medicare Payment Advisory Commission would have to report to Congress within a year of enactment on whether to include on-call CRNA services in these payments and on possible sustainable payment changes. The report would not itself make those changes.

What it means for you#

  • Hospitals covered by the existing payment provision: The bill would change the procedure and hours limits that apply to certain CRNA services. Which hospitals qualify, and the full effect of the limits, depend on existing law and rules.
  • Hospitals with an active labor and delivery unit: The bill would remove the specified procedure limit and, from 2027 onward, the specified anesthetist-hours limit. The bill does not define “active labor and delivery unit.”
  • CRNAs: The bill changes limits on payments to hospitals for services; it does not set a direct payment or benefit for individual CRNAs. It asks for a study of on-call services but does not make them payable.
  • Medicare patients: The bill does not directly change patient eligibility, covered services, or what patients pay. Any effect on access to care is not guaranteed by the bill.

Money#

No publicly available information.

  • The bill could increase Medicare payments by raising limits and requiring annual increases tied to the MEI, but the materials give no spending estimate.
  • HHS would have to conduct reviews and revise a regulation, and the commission would have to prepare a report. The bill gives no cost estimate or funding amount for this work.

What is unclear#

  • The existing Act and related rules were not supplied, so the current eligibility rules and full effect of the 500-procedure limit could not be verified against current law.
  • The bill does not define “active labor and delivery unit” or explain how HHS would measure general increases in procedure frequency.
  • It does not set out how the updated limits would be calculated beyond the stated requirements, or explain oversight of those updates.
  • The commission’s report could inform later action, but the bill does not require Congress or HHS to adopt its recommendations.
  • The bill says its amendments apply to services on or after January 1, 2027, but it does not say what happens if it becomes law after that date.

Case for#

  • A possible argument for the bill is that a 500-procedure limit may not reflect hospitals’ current surgical activity. Raising it could let more qualifying services be paid under the provision.
  • Exempting hospitals with labor and delivery units from the specified limits could account for their need to provide anesthesia services for births as well as surgery.
  • Regular reviews and updates could help keep limits in step with more frequent procedures, including new procedures.
  • Tying annual payment limits to the MEI gives a defined way for those limits to rise over time.

Case against#

  • The bill could increase Medicare spending, but the available material gives no estimate of the amount.
  • The MEI increase would apply each year, while the bill does not set a separate spending cap for these payments.
  • The terms and update method leave important details to HHS, and the bill does not specify a process for reviewing or challenging those decisions.
  • The bill changes payment limits without showing how many hospitals or services would be affected under current eligibility rules.