Massachusetts opted out of the Medicare supervision rule in 2024. CRNAs without prescriptive authority give anesthesia on a prescriber's signed order, which is an order, not supervision (244 CMR 4.06). As of October 2026, 16 of the 50 states and D.C. give CRNAs full practice authority, 10 give partial authority, and 25 require physician supervision, direction or collaboration.
Reviewed October 2026 against state statutes and rules and the AANA state opt-out fact sheet. Hospitals and surgery centers can set stricter terms in their bylaws. This summary is general information, not legal advice.