,i  #aaith ,,congress  #ast ,session    
,h4 ,r4 #bbcd  ,,in ,,the ,,house ,,of  
,,representatives  ,march #ah1 #bjbe,ms4
 ,underwood 7for herself and ,mrs4      
,kiggans of ,virginia7 introduced the   
following bill2 which was referred to   
the ,committee on ,veterans' ,affairs   
,a ,,bill  ,to direct the ,secretary of 
,veterans ,affairs to update certain    
standards regarding anesthesia and pain 
management services in the ,veterans    
,health ,administration4  #a4 ,short    
title ,this ,act may be cited as the    
,ensuring ,veterans ,timely ,access to  
,anesthesia ,care ,act of #bjbe4  #b4   
,alignment of standards regarding       
certified registered nurse anesthetists 
in the ,veterans ,health ,administration
 with standards of the ,defense ,health 
,agency ,the ,secretary of ,veterans    
,affairs shall update ,,vha ,directive  
#aabc titled ,national ,anesthesia      
,program1 ,department of ,veterans      
,affairs ,certified ,registered ,nurse  
,anesthetists ,practice ,guidelines 7or 

any successor directive7 to recognize1  
in the ,veterans ,health                
,administration1 certified registered   
nurses anesthetists as licensed         
independent practitioners in a manner   
consistent with the practice standards  
described by section #c7;f77#b7 of      
,enclosure of ,defense ,health ,agency  
,administrative ,instruction #fjbe4jg1  
dated ,november #h1 #bjbc1 as amended4  
#c4 ,requirements of anesthesia         
providers in the ,veterans ,health      
,administration  7a7 ,certification ,the
 ,secretary of ,veterans ,affairs shall 
require an anesthesia professional      
employed by the ,secretary as-- 7#a7 a  
physician anesthesiologist to be        
certified by the ,american ,board of    
,anesthesiology or a similar body       
determined by the ,secretary2 and  7#b7 
a certified registered nurse anesthetist
 to be certified by the ,council on     
,certification of ,nurse ,anesthetists  
or the ,council on ,recertification of  
,nurse ,anesthetists or a similar body  

determined by the ,secretary4  7b7      
,direct care ,the ,secretary shall      
require an anesthesia professional      
described in subsection 7a7 to have     
completed at least #be hours of direct  
patient anesthesia care 7not including  
supervision of other anesthesia         
professionals74  7c7 ,enforcement ,the  
,secretary shall suspend from employment
 in the ,department of ,veterans        
,affairs an anesthesia professional     
described in subsection 7a7 who has not 
complied with the requirements of this  
section4  #d4 ,,gao report on anesthesia
 delivery in the ,veterans ,health      
,administration ,not later than one year
 after the date of the enactment of this
 ,act1 and annually thereafter1 the     
,comptroller ,general of the ,united    
,states shall submit to the ,committees 
on ,veterans' ,affairs of the ,house of 
,representatives and the ,senate a      
report that contains the following1 and 
which shall be made publicly available3 
7#a7 ,data regarding outcomes regarding 

the following anesthesia models used in 
the ,veterans ,health ,administration3  
7,a7 ,delivery by an anesthesiologist4  
7,b7 ,delivery by a certified registered
 nurse anesthetist under the supervision
 of a physician4  7,c7 ,delivery by a   
certified registered nurse anesthetist  
without supervision4  7#b7 ,a comparison
 of the cost effectiveness of the models
 described in paragraph 7#a71           
including-- 7,a7 the estimated cost to  
medical facilities of the ,department of
 ,veterans ,affairs and taxpayers for   
each such model2 and  7,b7 a breakdown  
of costs and savings to taxpayers and to
 veterans' households associated with   
each such model4