Skip to main content

Rural Pass Through Legislation

Advocating for You: Ensuring access to safe, physician-led anesthesia care in rural communities

Capitol Building DC

Why This Matters

ASA is committed to ensuring patients have access to safe, high-quality, physician-led anesthesia care. However, many states face ongoing challenges in assuring access to medical care services for their citizens living in rural areas. Insufficient Medicare payments and low patient volume have made it particularly difficult for many rural facilities to attract and retain qualified health care providers, including physician anesthesiologists.

What You Should Know

In response to these challenges, Congress has enacted a variety of incentive programs to encourage providers to practice in rural areas.
One such program is the anesthesia rural “pass-through” program – a program created as an incentive for anesthesia providers to practice in small rural hospitals.
Under the “pass-through” program, eligible hospitals may use reasonable-costs based Part A payments in lieu of the conventional Part B payments as a rural practice inducement for non-physician anesthesia providers such as anesthesiologist assistants (a type of physician assistant) and nurse anesthetists to practice in small, low volume rural hospitals. Under the Centers for Medicare and Medicaid Services (CMS) current interpretation of the current “pass-through” program, eligible small rural hospitals are not permitted to use the “pass-through” funds to hire physician anesthesiologists. Changes are necessary to expand rural access to the services of physician anesthesiologists.

What ASA is Doing For You

The American Society of Anesthesiologists, through formal comment, requested that CMS permit rural hospitals to use the rural pass-through arrangement for anesthesiologists, as well as the other providers. CMS responded that it cannot permit hospitals to use the pass-through arrangement for anesthesiologists without a change in the current law.
Last Congress, Rep. John Moolenaar (R-MI-2) and Rep. Jared Huffman (D-CA-2) introduced the bipartisan Medicare Access to Rural Anesthesiology Act which would reform the program and allow rural hospitals to use already available “pass-through” funds to employ or contract with all types of anesthesia providers – physician anesthesiologists, as well as anesthesiologist assistants and nurse anesthetists. ASA strongly supported this legislation.

What You Can Do Now

Resources and actions you can take today

Patient with breathing mask on operating table undergoing general anesthesia for surgery

Anesthesia Rural Pass-Through One-Pager

Explanation of the program that encourages anesthesia providers to practice in small rural hospitals.

See the PDF brief >

Answers to your PSH questions

Rural Pass-Through FAQ

Learn more about Rural Pass-Through and why it's important to include physician anesthesiologists.

Review the PDF >

Medicare

Eligible Hospitals List

Download to review the list of Rural Pass-Through hospitals (updated 2023).

See List PDF >

Physician talking to elderly patient

Medicare Access to Rural Anesthesiology Act Press Release

ASA-endorsed legislation would expand rural patients’ access to physician anesthesia care.

Read more >

The ASA Committee on Geriatric Anesthesia and the ASA Perioperative Brain Health Initiative undertook a survey of ASA members to characterize current practices related to perioperative care of older adults.

Legislation to Support Seniors

Legislation introduced last Congress would have allowed rural hospitals to use federal funding through Medicare to hire physician anesthesiologists.

See the details >

This page is curated by Amanda Cate, Associate Director of Governmental and Political Outreach, and was last updated September 2023.