CRNA · Massachusetts
Supervision Agreement for Certified Registered Nurse Anesthetists in Massachusetts
Yes, a written supervising-physician agreement is required. Massachusetts does not name a specific instrument.
No independent-practice pathway confirmed for CRNA anesthesia administration itself — 244 CMR 4.06 describes ongoing protocol-based practice with a 'registered prescriber,' unlike CNP's explicit independent-practice option. Whether CRNAs can attest to prescriptive independence under 4.07's pathway, and MA's CMS Medicare-opt-out status, could not be confirmed this pass.
Independent practice requires: 244 CMR 4.07 lists CRNA among the four APRN categories eligible for the same 2-year-supervised/3-year-prior-independent pathway to independent prescriptive practice as NP/PMHNP/CNM.
What the supervision must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
M.G.L. c. 94C §7 lists CRNA among practitioners authorized to prescribe; 244 CMR 4.06 ties non-independent CRNA practice to a signed order of, and protocols developed with, a registered prescriber — narrower and less clearly independence-eligible in practice than the parallel NP/PMHNP/CNM pathway. Requires DPH and/or DEA controlled-substance registration.
Written agreement
Required
A CRNA without independent prescriptive authority must act under a signed order of a registered prescriber and protocols mutually developed with one (244 CMR 4.06) — unlike NP/PMHNP/CNM, MA's regulatory text does not clearly describe an unsupervised practice option for the anesthesia-administration scope itself, only for prescribing.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same open item as the general `np` entry — Professional Corporation under M.G.L. c. 156A; nurse-owned PC/PLLC eligibility for CRNA-delivered care was not confirmed from primary text this pass.
Legal sources for these rules (3)
- 244 CMR 4.06 — Advanced Practice Registered Nursing, Scope of Practicesecondary
- 244 CMR 4.07 — Advanced Practice Registered Nursing, Prescriptive Practicesecondary
- M.G.L. c. 94C, §7 — Practitioners authorized to prescribe controlled substances
What a supervising physician costs here
Typical monthly cost in Massachusetts
$500 – $600
Estimate for one Certified Registered Nurse Anesthetist. This state's proximity rules add a small premium.
About Massachusetts's rules
Full practice authority (Acts 2020, c. 260, §36; 244 CMR 4.00) let NPs, PMHNPs, and CNMs practice independently in MA — CNMs immediately, NPs/PMHNPs after a Board-attested transition (244 CMR 4.07). PAs and CRNAs have no independent-practice pathway. MA's professional-corporation ownership rules (M.G.L. c. 156A) are notably strict; this file could not independently re-verify APRN/PA-specific PLLC eligibility this pass — treat CPOM entries as open items.
Other clinicians in Massachusetts: see the state overview.