Waiver that Suspends Physician Supervision of CRNAs Extended Again

The commonwealth once again has extended several regulatory waivers designed to give health-care providers greater flexibility in their response to COVID-19.

Among the waivers is a provision that suspends the physician supervision requirement of a certified registered nurse anesthetist in a hospital setting.

Lawmakers unanimously approved the measure (H.B. 2401) on June 30, the last day of the state’s 2021-22 fiscal year, and the governor signed it immediately.

The governor announced the original temporary blanket waiver for advanced practice nurses and CRNAs on May 6, 2020, as part of an executive order to enhance the state’s response to the emerging health-care crisis.

The waivers have been extended several times since then, most recently in March. This latest extension means the waivers will remain in effect through Oct. 31, 2022.

Removing the supervision requirement and allowing CRNAs to practice to the fullest extent of their education and training has availed more physicians to provide hands-on care, expanded the capacity of both CRNA and physician providers, and augmented the state’s health-care system during this pandemic.

State Regulatory Waivers That Helped Hospitals, Health Care Providers During Pandemic Set To Expire

Published September 16, 2021 at 9:15 AM EDT

🎧 LISTEN • 22:30

📸: Jae C. Hong / AP

On today’s program: We hear how waivers that provided more flexibility and eased administrative burdens helped medical facilities face the pandemic, but they’re set to expire later this month; an obstetrician-gynecologist explains why a new bereavement leave policy for city employees will help those facing pregnancy loss; and a conversation about the increasing mental health needs of children and teenagers in the pandemic.

Medical waivers that lowered administrative barriers for health care workers set to expire (0:00 - 8:14)

Last year in the early weeks and months of the pandemic, hospitals and health care providers were swamped with patients who contracted COVID-19. Gov. Tom Wolf approved waivers to keep medical workers on the job and help bring in others, but those waivers are set to expire on Sept. 30.

“They were supposed to give a little bit of flexibility to people … [whose] jobs were upended or they were on the frontlines of fighting COVID,” says Danielle Ohl, a reporter with Spotlight PA.

One example of how these waivers worked is nurses or doctors with lapsed licenses could return to work in facilities, removing some administrative barriers.

Nearly 100 such waivers were implemented, however, Ohl says there isn’t good data on how many people used them.

Should the waivers not be extended, Ohl says boards that govern professions with waivers will be overwhelmed.

“In the most dire case, a nurse could be pulled off the floor because their paperwork didn’t go through or it expired,” says Ohl. “There is just a fear that the administrative burden isn’t going to be dealt with and they don’t really know what that means, and they don’t want to take a chance in breaking the law.”

Ohl says the legislature could extend the waivers, but it’s unclear if that will happen while the legislature is currently out of session.

Editorial: State waivers let Pa. health care function in the pandemic

TRIBUNE-REVIEW | Tuesday, Sept. 14, 2021 5:01 a.m.

A worker shortage in the pandemic economy has been troubling employers for months.

But if you think scaled-back hours at your favorite pizza shop are difficult to handle, try staffing a long-term care home without enough nursing assistants. A short-staffed restaurant can cause irate customers. Not enough nurses for the patients can have much worse consequences.

Regulatory waivers from the state helped keep the medical industry’s wheels spinning, despite the staffing shortages. Those waivers expire Sept. 30.

The waivers in question allowed, for example, out-of-state doctors and nurses to practice in Pennsylvania without licensure issues. In-state medical professionals who had retired or let their licenses lapse as they went into other professions could return to jobs where they were desperately needed without having to jump through bureaucratic hoops.

They also helped those already at work. They made it possible for nurses who were too busy filling shifts to get their continuing education credits to keep going without license hurdles. They allowed nurse practitioners to work in a streamlined fashion with multiple doctors in a health system.

In normal times, a little red tape can be a good thing. These were good rules to have in place in 2019. They make the system accountable. Health care isn’t an area where you want to cut corners.

But in 2020, having enough people to perform the important tasks of testing for illness, treating people in the emergency room, manning the respirators and all of the other tasks the sick and vulnerable needed to be performed — that was the most important thing.

The question now is this: Is it time to let the waivers go, or is it too soon?

The state’s emergency orders came to an end after the May primary, when voters approved an amendment that changed the rules, requiring the Legislature to extend a governor’s order. However, the pandemic didn’t end just because the order did. The delta variant has prompted numbers to rise again, stressing hospitals once more.

The system gets stressed not because of a lack of hospital beds. It’s more about the lack of staff to handle the load, which is what makes the impending expiration problematic. And flu season has barely started.

The Legislature and Gov. Tom Wolf need to do what they are particularly bad at doing. They need to work together to find a smart, efficient solution to the state’s medical staffing problems.

More doctors and nurses and health professionals of all kinds are needed on the floors of hospitals and nursing homes. There are shortages that predate the pandemic and will live long after it is over, so getting together to address these issues is more than just an emergency. It’s a chronic condition, and someone has to manage it.