50-State Practice Authority Map
CRNA practice authority varies dramatically across the United States. Click any state for detailed practice requirements, licensure info, CE requirements, and average salary data.
Click any state for detailed practice requirements, licensure, and salary data.
CAA practice authority — states to watch
CAA practice authority is the most active legislative front in anesthesia. 24 jurisdictions currently authorize practice (23 states + DC). Here's what we're tracking for 2026:
Recently added
- • Tennessee — licensure signed May 2025, in effect January 2026 (23rd state)
- • Virginia — licensure expanded 2025
- • Washington — WMC rulemaking finalized 2024–2025
- • Indiana — licensure enacted 2023
Active legislation
- • New York — A01072 (2025–2026 session) proposes CAA licensure
- • South Carolina — supervision ratio expanded 2025
- • Additional states with pending bills — see AAAA for the latest
Sources: AAAA Practice Map · ASA · NCCAA. Last verified April 2026.
New to practice authority?
Read our comprehensive guide covering all 50 states, legislative trends, and what it means for your career.
Alabama
Opt-Out / Collaborative
Alabama CRNAs practice under the direction of or in coordination with an immediately available physician, podiatrist,...
Alaska
Full Practice Authority
Alaska grants CRNAs full practice authority with independent prescriptive authority. One of the first states to opt out.
Arizona
Physician Supervision Required
Arizona opted out of the federal CMS supervision requirement, but state law requires CRNAs to practice under the...
Arkansas
Opt-Out / Collaborative
Arkansas has opted out of federal supervision requirements. CRNAs practice under collaborative agreements.
California
Opt-Out / Collaborative
California CRNAs administer anesthesia when ordered by a physician, dentist, or podiatrist — no supervision...
Colorado
Full Practice Authority
Colorado grants full practice authority to CRNAs. CAAs (Certified Anesthesiologist Assistants) are licensed by the...
Connecticut
Opt-Out / Collaborative
Connecticut CRNAs practice in collaboration with a physician. It has not opted out of the federal CMS supervision...
Delaware
Full Practice Authority
Delaware grants CRNAs full practice authority as APRNs and has opted out of the federal CMS supervision requirement.
District of Columbia
Full Practice Authority
DC grants full practice authority to CRNAs — the 2024 Health Occupations Revision General Amendment Act removed APRN...
Florida
Physician Supervision Required
Florida requires physician supervision for CRNAs. HB 375, which would have expanded CRNA practice authority, died in...
Georgia
Physician Supervision Required
Georgia requires physician supervision for CRNAs. One of the largest CAA populations in the country.
Hawaii
Full Practice Authority
Hawaii recognizes CRNAs as independent APRN practitioners under state rules. It has not opted out of the federal CMS...
Idaho
Full Practice Authority
Idaho grants full practice authority to CRNAs with independent prescriptive authority.
Illinois
Opt-Out / Collaborative
Illinois requires collaborative agreements between CRNAs and physicians. CAAs do not currently have practice authority...
Indiana
Physician Supervision Required
Indiana law requires CRNAs to practice under the direction of and in the immediate presence of a physician. Indiana has...
Iowa
Full Practice Authority
Iowa grants full practice authority to CRNAs.
Kansas
Full Practice Authority
Kansas grants full practice authority to CRNAs with independent practice. CAAs practice under delegatory authority...
Kentucky
Full Practice Authority
Kentucky requires no collaborative agreement for anesthesia care — only for prescribing — and has opted out of federal...
Louisiana
Physician Supervision Required
Louisiana law requires CRNAs to practice under a physician's or dentist's direction and supervision. Louisiana has not...
Maine
Opt-Out / Collaborative
Maine CRNAs are accountable to a physician or dentist, except in critical access and rural hospitals, where they...
Maryland
Opt-Out / Collaborative
Maryland requires collaborative agreements. Has not opted out of CMS supervision requirement. CAAs do not currently...
Massachusetts
Full Practice Authority
Massachusetts grants CRNAs independent practice (a transition period applies only to prescribing) and opted out of the...
Michigan
Full Practice Authority
Michigan law allows CRNAs to practice without supervision as the sole and independent anesthesia provider, and Michigan...
Minnesota
Full Practice Authority
Minnesota grants full practice authority to CRNAs with no supervision requirement.
Mississippi
Opt-Out / Collaborative
Mississippi has not opted out of the federal CMS supervision requirement. CRNAs work under collaborative agreements.
Missouri
Physician Supervision Required
Missouri requires CRNAs to provide anesthesia under the supervision of an immediately available physician, dentist, or...
Montana
Full Practice Authority
Montana grants full practice authority to CRNAs. Strong rural CRNA presence.
Nebraska
Opt-Out / Collaborative
Nebraska CRNAs provide anesthesia in consultation and collaboration with, and with the consent of, the responsible...
Nevada
Opt-Out / Collaborative
Nevada CRNAs administer anesthesia to patients under a physician's care once anesthesia is determined necessary — no...
New Hampshire
Full Practice Authority
New Hampshire grants full practice authority to CRNAs.
New Jersey
Physician Supervision Required
New Jersey requires physician supervision for CRNAs.
New Mexico
Opt-Out / Collaborative
New Mexico CRNAs practice in an interdependent role, collaborating with the physician, dentist, or podiatrist directing...
New York
Physician Supervision Required
New York requires physician supervision for CRNAs. One of the most restrictive states. CAAs do not currently have...
North Carolina
Opt-Out / Collaborative
North Carolina has not opted out of the federal CMS supervision requirement. CRNAs work under collaborative agreements....
North Dakota
Full Practice Authority
North Dakota grants full practice authority to CRNAs.
Ohio
Opt-Out / Collaborative
Ohio opted out of the federal CMS supervision requirement in July 2026 (27th state), and HB 52 (signed March 2026)...
Oklahoma
Opt-Out / Collaborative
Oklahoma has opted out of federal supervision. CRNAs practice under collaborative agreements. CAAs authorized.
Oregon
Full Practice Authority
Oregon grants full practice authority to CRNAs with independent prescriptive authority.
Pennsylvania
Opt-Out / Collaborative
Pennsylvania CRNAs practice in cooperation with a surgeon or dentist under the overall direction of the chief of...
Rhode Island
Physician Supervision Required
Rhode Island defines CRNA practice as under the supervision of anesthesiologists, physicians, or dentists; a 2026 bill...
South Carolina
Physician Supervision Required
South Carolina CRNAs practice under guidelines developed under physician or dentist supervision; 2025–26 repeal bills...
South Dakota
Opt-Out / Collaborative
South Dakota CRNAs must collaborate with a physician, dentist, podiatrist, NP, CNM, or PA. South Dakota has opted out...
Tennessee
Opt-Out / Collaborative
Tennessee CRNAs work in a cooperative working relationship with the ordering physician rather than under supervision....
Texas
Opt-Out / Collaborative
Texas CRNAs provide anesthesia in hospitals and ambulatory surgical centers pursuant to a physician's order — a...
Utah
Full Practice Authority
Utah CRNAs provide anesthesia upon the request of a licensed health care professional, with no consultation or referral...
Vermont
Full Practice Authority
Vermont grants full practice authority to CRNAs and opted out of the federal CMS supervision requirement in July 2026...
Virginia
Physician Supervision Required
Virginia law requires CRNAs to practice under the supervision of a physician, podiatrist, or dentist; a 2025 bill to...
Washington
Full Practice Authority
Washington grants full practice authority to CRNAs with independent practice. CAA licensure rules were finalized by the...
West Virginia
Opt-Out / Collaborative
West Virginia SB 810 (effective July 2025) replaced supervision with practice in cooperation with a physician, dentist,...
Wisconsin
Full Practice Authority
Wisconsin's 2025 Act 17, effective September 1, 2026, makes CRNAs APRNs with independent practice after required...
Wyoming
Full Practice Authority
Wyoming grants full practice authority to CRNAs. Critical for rural access. Its May 2023 CMS opt-out covers critical...