Panel advances bill to license anesthesiologist assistants after contested hearing on supervision and billing

The Labor, Health & Social Services Committee on Jan. 27 approved Senate File 112, a bill to establish licensure and a scope of practice for anesthesiologist assistants (AAs) in Wyoming. Sponsor Senator Schuler presented the bill as an optional staffing model hospitals could use to address local shortages of physician anesthesiologists. The committee adopted a technical amendment proposed by the Board of Medicine and passed the measure by roll call, three ayes and two nays.

Senator Schuler said AAs are "non‑physician health professionals who provide anesthesia care under the supervision of a licensed anesthesiologist," and described their educational path: a bachelor's degree plus a master's program of roughly 24–28 months with heavy clinical training. He told the committee CAAs typically complete more than 2,000 hours of clinical training and administer about 600 anesthetics during training.

Proponents included practicing AAs and the Wyoming Society of Anesthesiologists. Brandy Lunsford, a certified anesthesiologist assistant who said she grew up in Evanston, testified she wants the option to return and practice in Wyoming and said CAAs are recognized by Medicare, TRICARE and major insurers. Dr. Mansell, president of the Wyoming Society of Anesthesiologists, told the committee the society supports the bill and that CAAs already work at academic and tertiary centers nationwide.

Multiple CAAs who testified online said they work in mixed teams with certified registered nurse anesthetists (CRNAs) and physician anesthesiologists and asked Wyoming to add CAAs to the licensed labor pool. Testifying CAAs described supervisory models used in other states and said ratios of supervising anesthesiologists to AAs can be up to 4 to 1 in some systems; the bill grants the medical board authority to set and limit supervision and contains a line that the board "shall not allow supervision to more than 4 anesthesiologists during a shift," language discussed during the hearing.

Opponents included representatives of nurse anesthetists and hospital associations. The Wyoming Nurses Association voiced concern about Medicare billing and alleged risks of fraudulent billing if TEFRA (Tax Equity and Fiscal Responsibility Act of 1982) supervision rules are not met. Testimony from nurse anesthetist Tracy Richard contended that CAAs lack standardized national clinical training minimums comparable to CRNAs and warned that at higher supervision ratios TEFRA requirements may not be met; she cited testimony that, when anesthesiologists supervised two cases, TEFRA requirements were not met about 35% of the time and were not met in 99% of cases at a 1:3 oversight ratio (testimony presented as stakeholder evidence).

Kevin Bonham, executive director of the Board of Medicine, identified implementation tasks for the board, including an estimated first‑year cost of about $45,000 to add the profession to the board's information systems. Bonham also proposed a drafting amendment to align disciplinary citations in the bill with current medical-practice statutory numbering; the committee adopted that amendment.

After hearing the witnesses and debating scope, supervision and billing concerns, the committee adopted the Board of Medicine amendment and approved SF112 on a roll call vote recorded as three ayes and two nays.