Alaska removes physician supervision requirement for nurse anesthetists Alaska has become the tenth state in less than two years, and the third state in the last three weeks, to opt out of a federal physician supervision requirement for nurse anesthetists, according to a report in today's AONE e-News Update, published by the American Organization of Nurse Executives. The opt-out is effective immediately. Last month, North Dakota and Washington became the eighth and ninth states, respectively, to take this course of action. Other states that have opted out are Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico and Kansas. The anesthesia care rule that enables states to opt out of the supervision requirement was published by the Centers for Medicare & Medicaid Services in the Federal Register on Nov. 13, 2001. The rule allows a governor to notify CMS in writing of the state's desire to be exempt from the supervision requirement for certified registered nurse anesthetists after the governor meets the following prerequisites: consults with the state's boards of medicine and nursing, determines that opting out of the requirement is consistent with state law, and decides that it is in the best interests of the state's citizens.