American Association of Nurse Anesthesiology v. Secretary of the U.S. Department of Health and Human Services

CourtDistrict Court, N.D. Ohio
DecidedAugust 26, 2025
Docket1:24-cv-01657
StatusUnknown

This text of American Association of Nurse Anesthesiology v. Secretary of the U.S. Department of Health and Human Services (American Association of Nurse Anesthesiology v. Secretary of the U.S. Department of Health and Human Services) is published on Counsel Stack Legal Research, covering District Court, N.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
American Association of Nurse Anesthesiology v. Secretary of the U.S. Department of Health and Human Services, (N.D. Ohio 2025).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF OHIO EASTERN DIVISION

AMERICAN ASSOCIATION OF Case No. 1:24-CV-1657 NURSE ANESTHESIOLOGY,

Plaintiff, JUDGE PAMELA A. BARKER -vs-

ROBERT F. KENNEDY, JR., MEMORANDUM OPINION & ORDER SECRETARY OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, et al.,

Defendants

Pending before this Court is the Motion to Dismiss of Robert F. Kennedy, Secretary of Health and Human Services (the “Secretary”) and the United States Department of Health and Human Services (together, “Defendants”)1 (“Defendants’ Motion”), filed on December 26, 2024. (Doc. No. 11.) On January 27, 2025, Plaintiff American Association of Nurse Anesthesiology (“Plaintiff” or “AANA”) filed a Brief in Opposition to Defendants’ Motion (“AANA’s Opposition”). (Doc. No. 13.) On February 24, 2025, Defendants filed a Reply in Support of Defendants’ Motion (“Defendants’ Reply”). (Doc. No. 17.) Also pending before this Court is the Motion for Leave to File Amicus Curiae Brief of the American Society of Anesthesiologists In Support of Dismissal (“ASA’s Motion”) (Doc. No. 15), filed

1 Secretary Kennedy is substituted for Secretary Becerra as the named Defendant in this action. Under Fed. R. Civ. P. 25(d), when a public officer who is a party in an official capacity ceases to hold office while the action is pending, “the officer’s successor is automatically substituted as a party.” Fed. R. Civ. P. 25(d). on February 10, 2025, and the Motion for Leave to File Addendum to AANA’s Opposition, Instanter (“AANA’s Motion for Leave”), filed on August 13, 2025. (Doc. No. 22.) For the following reasons, Defendants’ Motion is GRANTED (Doc. No. 11), and ASA’s Motion (Doc. No. 15) and AANA’s Motion for Leave (Doc. No. 22) are DENIED as moot. I. Background A. Plaintiff’s Allegations

AANA is a “professional association for nurse anesthesia providers” and certified registered nurse anesthetists (“CRNAs”) “compris[ed] of more than 65,000 members across the United States.” (Doc. No. 1 at PageID# 4.) AANA alleges that “CRNAs provide quality anesthesia services equivalent to those performed by physician anesthesia providers, albeit, CRNAs actually administer the majority of anesthesia in the United States.” (Id. at PageID# 2.) “CRNAs are trained, credentialed, and licensed independent practitioners whose scope of practice enables them to administer anesthesia to all types of patients, for all types of procedures, in every setting in which anesthesia is administered.” (Id.) Both they and physician anesthesia providers (e.g., anesthesiologists) “administer the same procedures utilizing the same equipment with the same focus on patient care and producing the same quality outcomes.” (Id.)

AANA alleges that “CRNAs and physician anesthesia providers do the same thing at the same level, and they adhere to the same standards.” (Id. at PageID# 8.) In support, AANA contends that “[s]ometimes, CRNAs, physician anesthesia providers, and other professionals work collaboratively to deliver anesthesia to patients” and at “[o]ther times, CRNAs will administer anesthesia under the ‘medical direction’ of a physician anesthesia provider[.]” (Id. at PageID# 7.) However, the “[e]ducational differences between physicians and nurses play no role in and are entirely unrelated to

2 the safe and effective administration of anesthesia[,]” and “[p]atient outcomes are unaffected by whether a CRNA or physician administers the anesthesia independently or whether the anesthesia is administered utilizing an oversight or collaborative model.” (Id. at PageID# 7.) AANA alleges that Cigna (together with Anthem, the “Insurers”) “arbitrarily cut CRNA reimbursement rates” after deciding “that CRNAs are worthy of less reimbursement than their physician counterparts, despite providing the same care to patients, with the same outcome, utilizing

the same equipment, and employing the same processes.” (Id. at PageID#s 3-4.) Specifically, “Cigna announced that effective March 12, 2023, it would begin reimbursing nonmedically directed anesthesia services performed by CRNAs . . . at 85% of the Physician Fee Schedule.” (Id. at PageID# 14.) And “[o]n June 12, 2024, Anthem approved a policy change that updated its reimbursement policy . . . that mirrored Cigna’s approach.” 2 (Id. at PageID# 17.) AANA predicts that “others will follow suit.” (Id. at PageID#s 3-4.)3 According to AANA, the Insurers’ Reimbursement Policy “flatly discriminates against CRNAs for no reason other than the fact that CRNAs did not go to medical school.” (Id. at PageID#s 17, 19.)

2 Hereinafter, the Court uses the term “Reimbursement Policy” to refer to Cigna’s and Anthem’s policy of “reduced reimbursement for anesthesia procedures with the QZ modifier,” i.e., the policy of reimbursing healthcare providers for anesthesia services administered by CRNAs without ‘Medical Direction’ at only 85% of the rate at which they reimburse such providers for anesthesia administered by CRNAs under ‘Medical Direction’ or by a physician anesthesia provider. (Doc. No. 1 at PageID#s 10-11, 25)

3 In its Addendum to its Motion for Leave, AANA contends that another insurer, UnitedHealthcare, has since adopted the same policy. (Doc. No. 21 at PageID# 264.) 3 B. Relevant Statutory and Enforcement Background When Congress enacted the Patient Protection and Affordable Care Act (“ACA”) in 2010, it modified the Public Health Service Act (“PHS Act”) of 1944 by adding Section 2706, titled “Non- discrimination in health care,” which provides as follows: Providers. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.

42 U.S.C. § 300gg-5(a) (the “ACA Nondiscrimination Provision”). The ACA Nondiscrimination Provision does not create a private cause of action for healthcare providers to sue health insurance providers who discriminate against them.4 Rather, the Secretary and the states share enforcement authority: Failure to implement provisions. In the case of a determination by the Secretary that a State has failed to substantially enforce a provision (or provisions) in this part or part D with respect to health insurance issuers in the State, the Secretary shall enforce such provision (or provisions) under subsection (b) insofar as they relate to the issuance, sale, renewal, and offering of health insurance coverage in connection with group health plans or individual health insurance coverage in such State. 42 U.S.C. § 300gg-22(a)(2).5 The Secretary has delegated enforcement of the ACA Nondiscrimination Provision to a sub-agency of HHS, the “Centers for Medicare & Medicaid

4 See, e.g., Presque Isle Colon & Rectal Surgery v. Highmark Health, 391 F. Supp. 3d 485, 512 (W.D. Pa. 2019) (citing A.Z. by & through E.Z. v. Regence Blueshield, 333 F. Supp. 3d 1069, 1082–83 (W.D. Wash.

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American Association of Nurse Anesthesiology v. Secretary of the U.S. Department of Health and Human Services, Counsel Stack Legal Research, https://law.counselstack.com/opinion/american-association-of-nurse-anesthesiology-v-secretary-of-the-us-ohnd-2025.