Montana Administrative Register Notice 37-681 No. 23   12/11/2014    
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BEFORE THE Department of Public

health and human services of the



In the matter of the amendment of ARM 37.106.514 pertaining to the removal of references to anesthesiologist assistants in outpatient centers for surgical services








TO: All Concerned Persons


1. On July 24, 2014, the Department of Public Health and Human Services published MAR Notice No. 37-681 pertaining to the proposed amendment of the above-stated rule at page 1572 of the 2014 Montana Administrative Register, Issue Number 14.


2. The department has amended the above-stated rule as proposed.


3. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:


COMMENT #1: The department received 11 comments regarding this proposed rule.  In each case, the commenters opposed the amendment to ARM 37.106.514. There were three consistent issues in all 11 comments:


1. Commenters felt there was value in maintaining the rule as written as it serves to provide a description of the Anesthesiologist Assistants (AA) role as potential health care providers in Montana; and the rule as currently employed delineates the expectations and requirements and addresses supervision requirements.


2. With respect to (1), AAs can be seen as a vital part of the Anesthesia Care Team and, because of the supervision requirement, AA practice leads to higher quality outcomes than other current clinical nonphysician (licensed) anesthesia providers.


3. AAs can serve as physician extenders in the delivery of anesthesia and while acknowledging that AAs are not currently licensed in Montana, the proposed amendment (removing the reference to AAs as a health care provider), could negatively impact the future potential for AAs to become licensed and provide necessary services in Montana, especially in the most rural parts of the state.


For these reasons, the commenters request ARM 37.106.514 remain as originally written and the proposed amendment be reversed.


RESPONSE #1: The department disagrees.


As indicated in the statement of reasonable necessity, the department originally wrote the rule with respect to AAs, believing that all necessary legal thresholds had been met.  However, shortly after the adoption of the rule, the department learned that AAs currently are not licensed to practice in Montana.  After additional consultation and review, the department felt it necessary to propose the changes to ARM 37.106.514 because including AAs in the rule creates the impression that AAs can practice in Montana, and could create confusion.


Nothing has changed with respect to the licensure status of AAs in Montana; should that status change, the department will consider amending the rule to include AAs as providers of health care services operating within the scope of their license.



/s/ Susan Callaghan                                               /s/ Robert Runkel for                                  

Susan Callaghan, Attorney                                     Richard H. Opper, Director

Rule Reviewer                                                       Public Health and Human Services



Certified to the Secretary of State December 1, 2014.



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