Senate Bill S5867A

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5867--A
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               March 3, 2025
                                ___________
 
 Introduced   by  Sens.  GOUNARDES,  ADDABBO,  ASHBY,  JACKSON,  KRUEGER,
   C. RYAN, SKOUFIS -- read twice and ordered printed, and  when  printed
   to be committed to the Committee on Higher Education -- recommitted to
   the  Committee  on  Higher Education in accordance with Senate Rule 6,
   sec. 8 -- committee discharged, bill  amended,  ordered  reprinted  as
   amended and recommitted to said committee
 
 AN  ACT  to  amend the education law, in relation to the registration of
   nurse anesthetists
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Section  6902 of the education law is amended by adding a
 new subdivision 4 to read as follows:
   4. (A) THE PRACTICE OF PROFESSIONAL  NURSING  BY  A  REGISTERED  NURSE
 ANESTHETIST, CERTIFIED UNDER SECTION SIXTY-NINE HUNDRED THIRTEEN OF THIS
 ARTICLE, SHALL:
   (I)  BE DEFINED BY A SCOPE OF PRACTICE TO INCLUDE PREOPERATIVE ASSESS-
 MENT AND EVALUATION, ADMINISTRATION OF ANESTHESIA, INTRAOPERATIVE  MONI-
 TORING  AND MANAGEMENT, AND POSTOPERATIVE CARE OF A PATIENT AS PART OF A
 PROCEDURE IN A HEALTH CARE FACILITY, IN THE OFFICE OF  A  DENTIST,  ORAL
 SURGEON OR PODIATRIST WHO IS AUTHORIZED BY LAW TO ADMINISTER ANESTHESIA,
 IN  CONNECTION  WITH  OFFICE BASED SURGERY, AS DEFINED UNDER SECTION TWO
 HUNDRED THIRTY-D OF THE PUBLIC HEALTH LAW, OR IN A FREE STANDING AMBULA-
 TORY SURGICAL CENTER, AS  DEFINED  UNDER  ARTICLE  TWENTY-EIGHT  OF  THE
 PUBLIC HEALTH LAW, TO THE EXTENT AUTHORIZED IN ACCORDANCE TO CREDENTIAL-
 ING  PROCEDURES  APPROVED  BY  THE GOVERNING BODY AND MEDICAL STAFF OF A
 HEALTHCARE FACILITY, OFFICE BASED SURGERY, AS DEFINED UNDER SECTION  TWO
 HUNDRED  THIRTY-D  OF THE PUBLIC HEALTH LAW, OR FREE STANDING AMBULATORY
 SURGICAL CENTER, AS DEFINED UNDER ARTICLE  TWENTY-EIGHT  OF  THE  PUBLIC
 HEALTH LAW.
   (II)  RECOGNIZING  THAT  THE ADMINISTRATION OF ANESTHESIA INCLUDES THE
 PRACTICE OF MEDICINE, SUCH PRACTICE SHALL BE PERFORMED  ONLY  UNDER  THE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07215-03-6
              

 S. 5867--A                          2
 
 SUPERVISION  OF A PHYSICIAN LICENSED IN NEW YORK STATE WHO HAS COMPLETED
 AN ACCREDITED ANESTHESIA RESIDENCY PROGRAM AND WHO IS PHYSICALLY PRESENT
 AND IMMEDIATELY AVAILABLE; OR UNDER THE  SUPERVISION  OF  THE  OPERATING
 PHYSICIAN  WHO IS PHYSICALLY PRESENT AND QUALIFIED BY THE GOVERNING BODY
 AND MEDICAL STAFF OF A HEALTH CARE FACILITY,  FREE  STANDING  AMBULATORY
 SURGICAL  CENTER,  AS  DEFINED  UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC
 HEALTH LAW, OR OFFICE  BASED  SURGERY,  AS  DEFINED  UNDER  SECTION  TWO
 HUNDRED  THIRTY-D  OF  THE  PUBLIC  HEALTH LAW, TO SUPERVISE A CERTIFIED
 REGISTERED NURSE ANESTHETIST; OR UNDER THE  SUPERVISION  OF  A  DENTIST,
 ORAL  SURGEON OR PODIATRIST WHO IS PHYSICALLY PRESENT AND WHO IS AUTHOR-
 IZED BY LAW TO ADMINISTER ANESTHESIA, TO THE EXTENT SUCH PERSON IS QUAL-
 IFIED BY LAW, REGULATION, HOSPITAL APPOINTMENT, OR PRIVILEGE GRANTED  BY
 THE  GOVERNING  BODY  OF  A FREE STANDING AMBULATORY SURGICAL CENTER, AS
 DEFINED UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW,  OR  OFFICE
 BASED  SURGERY,  AS  DEFINED  UNDER  SECTION TWO HUNDRED THIRTY-D OF THE
 PUBLIC HEALTH LAW, TO PERFORM AND SUPERVISE THE ADMINISTRATION OF  ANES-
 THESIA.
   (III)  BE  CONSISTENT  WITH  POLICIES  AND  PROCEDURES APPROVED BY THE
 MEDICAL STAFF AND GOVERNING BODY  OF  THE  HEALTH  CARE  FACILITY,  FREE
 STANDING  AMBULATORY  SURGICAL CENTER DEFINED UNDER ARTICLE TWENTY-EIGHT
 OF THE PUBLIC HEALTH LAW, OR OFFICE  BASED  SURGERY,  AS  DEFINED  UNDER
 SECTION TWO HUNDRED THIRTY-D OF THE PUBLIC HEALTH LAW, WHERE APPLICABLE,
 AND AS LEGALLY AUTHORIZED UNDER THIS TITLE AND IN ACCORDANCE WITH APPLI-
 CABLE REGULATIONS OF THE COMMISSIONER OF HEALTH.
   (B)  FOR  PURPOSES OF THIS SUBDIVISION, THE FOLLOWING TERMS SHALL HAVE
 THE FOLLOWING MEANINGS:
   (I) "PREOPERATIVE ASSESSMENT AND EVALUATION" MEANS PATIENT HISTORY AND
 ASSESSMENT, DEVELOPMENT OF AN ANESTHESIA PLAN, AND PATIENT EDUCATION.
   (A) "PATIENT HISTORY AND ASSESSMENT"  MEANS  ASSESSING  THE  PATIENT'S
 MEDICAL  HISTORY,  INCLUDING  CURRENT  MEDICATIONS,  ALLERGIES, COMORBID
 CONDITIONS, AND PREVIOUS ANESTHESIA EXPERIENCES.
   (B) "DEVELOPMENT OF AN ANESTHESIA PLAN" MEANS THE CERTIFIED REGISTERED
 NURSE ANESTHETIST DISCUSSES PREOPERATIVE FINDINGS WITH  THE  SUPERVISING
 PHYSICIAN  AND DEVELOPS AN INDIVIDUALIZED ANESTHESIA PLAN THAT CONSIDERS
 THE PATIENT'S HEALTH STATUS, SURGICAL PROCEDURE, AND ANESTHESIA REQUIRE-
 MENTS BASED ON THE PREOPERATIVE ASSESSMENT WHICH THE SUPERVISING  PHYSI-
 CIAN APPROVES.
   (C)  "PATIENT EDUCATION" MEANS PROVIDING EDUCATION TO PATIENTS REGARD-
 ING THE ANESTHETIC PROCESS, POTENTIAL RISKS, AND POST-OPERATIVE CARE.
   (II) "ADMINISTRATION OF ANESTHESIA" MEANS ANESTHESIA INDUCTION,  MONI-
 TORING  DURING  THE PROCEDURE, MAINTENANCE OF ANESTHESIA, AIRWAY MANAGE-
 MENT, AND EMERGENCE FROM ANESTHESIA.
   (A) "ANESTHESIA INDUCTION" MEANS BEING RESPONSIBLE FOR INDUCING  ANES-
 THESIA,  WHICH  CAN  INVOLVE  THE  ADMINISTRATION OF GENERAL ANESTHESIA,
 REGIONAL ANESTHESIA, OR SEDATION, DEPENDING ON THE PROCEDURE AND PATIENT
 NEEDS.
   (B) "MONITORING" MEANS THE CONTINUAL CLINICAL OBSERVATION OF A PATIENT
 AND THE USE OF INSTRUMENTS TO MEASURE, DISPLAY, AND RECORD THE VALUES OF
 CERTAIN PHYSIOLOGIC VARIABLES SUCH AS PULSE, OXYGEN SATURATION, LEVEL OF
 CONSCIOUSNESS, BLOOD PRESSURE, AND RESPIRATION.
   (C) "MAINTENANCE OF ANESTHESIA" MEANS MANAGEMENT AND ADJUSTMENT OF THE
 DELIVERY OF ANESTHESIA AGENTS TO ENSURE THE PATIENT REMAINS APPROPRIATE-
 LY ANESTHETIZED THROUGHOUT THE PROCEDURE.
   (D) "AIRWAY MANAGEMENT" MEANS ADVANCED AIRWAY  MANAGEMENT  TECHNIQUES,
 INCLUDING   ENDOTRACHEAL   INTUBATION,   LARYNGEAL   MASK  AIRWAY  (LMA)
 INSERTION, AND OTHER METHODS OF MAINTAINING A SECURE AIRWAY.
 S. 5867--A                          3
 
   (E) "EMERGENCE FROM ANESTHESIA" MEANS OVERSEEING  A  PATIENT  EMERGING
 FROM  ANESTHESIA  INCLUDING ENSURING THAT THE PATIENT REGAINS CONSCIOUS-
 NESS AND IS STABLE BEFORE TRANSFERRING TO A RECOVERY ROOM  OR  BEGINNING
 THE DISCHARGE PROCESS.
   (III)  "INTRAOPERATIVE  MONITORING AND MANAGEMENT" MEANS PATIENT VITAL
 SIGNS MONITORING, VASCULAR ACCESS, FLUID AND BLOOD MANAGEMENT,  TESTING,
 IMAGING, AND EMERGENT INTERVENTIONS.
   (A)  "PATIENT  VITAL SIGNS MONITORING" MEANS ASSESSING AND MAINTAINING
 THE PATIENT'S VITAL SIGNS THROUGHOUT THE SURGICAL PROCEDURE.
   (B) "VASCULAR ACCESS" MEANS INSERTION OF INDWELLING ARTERIAL CATHETERS
 AS WELL AS PERIPHERAL AND CENTRAL INTRAVENOUS CATHETERS.
   (C) "FLUID AND  BLOOD  MANAGEMENT"  MEANS  MANAGEMENT  OF  INTRAVENOUS
 FLUIDS  AND  ADMINISTRATION  OF BLOOD PRODUCTS AS NECESSARY BASED ON THE
 PATIENT'S CONDITION.
   (D) "TESTING" MEANS ORDERING AND EVALUATING, BUT NOT DIAGNOSING, LABO-
 RATORY AND DIAGNOSTIC TEST RESULTS AND PERFORMING POINT-OF-CARE  TESTING
 THAT THE CERTIFIED REGISTERED NURSE ANESTHETIST IS QUALIFIED TO PERFORM.
   (E) "IMAGING" MEANS ORDERING AND EVALUATING, BUT NOT DIAGNOSING, RADI-
 OGRAPHIC IMAGING STUDIES THAT THE CERTIFIED REGISTERED NURSE ANESTHETIST
 IS QUALIFIED TO ORDER AND INTERPRET.
   (F)  "EMERGENT  INTERVENTIONS"  MEANS  WHEN  CHANGES  IN THE PATIENT'S
 CONDITION ARE RECOGNIZED, INCLUDING  ADVERSE  REACTIONS  TO  ANESTHESIA,
 INTRAOPERATIVE  COMPLICATIONS,  AND  EMERGENCY  SITUATIONS THE CERTIFIED
 REGISTERED NURSE ANESTHETIST SHALL TAKE ACTION NECESSARY IN RESPONSE  TO
 THE  EMERGENCY AND INFORM THE SUPERVISING PHYSICIAN IMMEDIATELY, SO THAT
 A PLAN FOR FURTHER DIAGNOSTIC AND THERAPEUTIC MANAGEMENT CAN  BE  INITI-
 ATED.
   (IV) "POSTOPERATIVE CARE" MEANS POST-ANESTHESIA CARE, PAIN MANAGEMENT,
 AND DISCHARGE PROCESS.
   (A)  "POST-ANESTHESIA  CARE"  MEANS  MONITORING AND ASSESSING PATIENTS
 DURING THE RECOVERY PHASE AND MANAGING POST-ANESTHESIA CARE  UNIT  NEEDS
 SUCH AS PAIN MANAGEMENT, NAUSEA, AND RESPIRATORY FUNCTION.
   (B)  "PAIN  MANAGEMENT" MEANS DEVELOPING AND IMPLEMENTING PAIN MANAGE-
 MENT STRATEGIES, INCLUDING THE USE OF OPIOID AND NON-OPIOID  ANALGESICS,
 REGIONAL BLOCKS, OR OTHER METHODS TO CONTROL POSTOPERATIVE PAIN.
   (C)  "DISCHARGE  PROCESS"  MEANS  PHYSICIAN REVIEW AND APPROVAL OF THE
 FINAL DISCHARGE OF A PATIENT.
   (V) "SUPERVISION" MEANS THAT A PHYSICIAN,  DENTIST,  ORAL  SURGEON  OR
 PODIATRIST  IS PHYSICALLY PRESENT AND IMMEDIATELY AVAILABLE TO DIAGNOSE,
 TREAT, AND PROVIDE PATIENT CARE AS NEEDED.
   (VI) "PHYSICALLY PRESENT" BY A PHYSICIAN MEANS THE  ABILITY  TO  REACT
 AND  RESPOND IN AN IMMEDIATE AND APPROPRIATE MANNER SO AS TO MAKE POSSI-
 BLE THE CONTINUOUS EXERCISE OF MEDICAL JUDGMENT THROUGHOUT THE  ADMINIS-
 TRATION  OF  THE  ANESTHESIA.  "PHYSICALLY  PRESENT"  BY A DENTIST, ORAL
 SURGEON OR PODIATRIST MEANS THE ABILITY OF SUCH PERSON WHO IS PERFORMING
 THE PROCEDURE REQUIRING THE ADMINISTRATION OF ANESTHESIA  TO  REACT  AND
 RESPOND  IN  AN  IMMEDIATE AND APPROPRIATE MANNER SO AS TO MAKE POSSIBLE
 THE CONTINUOUS EXERCISE OF PROFESSIONAL JUDGMENT THROUGHOUT THE ADMINIS-
 TRATION OF THE ANESTHESIA.
   (VII) "IMMEDIATELY AVAILABLE" MEANS REMAINING IN PHYSICAL PROXIMITY SO
 AS TO ALLOW A PHYSICIAN LICENSED IN NEW YORK STATE WHO HAS COMPLETED  AN
 ACCREDITED ANESTHESIA RESIDENCY PROGRAM TO RETURN TO RE-ESTABLISH DIRECT
 CONTACT  WITH  THE  PATIENT IN ORDER TO MEET THE PATIENT'S MEDICAL NEEDS
 AND ADDRESS ANY URGENT OR EMERGENT CLINICAL PROBLEMS.
   § 2. The education law is amended by adding a new section 6913 to read
 as follows:
 S. 5867--A                          4
 
   § 6913. CERTIFICATION OF NURSE ANESTHETISTS.  1.  FOR  ISSUANCE  OF  A
 CERTIFICATE  TO  PRACTICE  AS  A  CERTIFIED REGISTERED NURSE ANESTHETIST
 UNDER SUBDIVISION FOUR OF SECTION SIXTY-NINE HUNDRED TWO OF  THIS  ARTI-
 CLE, THE APPLICANT SHALL FULFILL THE FOLLOWING REQUIREMENTS:
   (A)  APPLICATION: FILE AN APPLICATION WITH THE DEPARTMENT. SUCH APPLI-
 CATION SHALL BE IN SUCH FORM AS PROVIDED BY THE COMMISSIONER;
   (B) LICENSE: BE LICENSED AS A REGISTERED PROFESSIONAL  NURSE  IN  THIS
 STATE;
   (C)  EDUCATION:  (I) HAVE SATISFACTORILY COMPLETED A PRESCRIBED COURSE
 OF STUDY IN A SCHOOL OF NURSE ANESTHESIA ACCREDITED BY  THE  COUNCIL  ON
 ACCREDITATION OF NURSE ANESTHESIA EDUCATION PROGRAMS OR SCHOOLS OR OTHER
 ACCREDITING BODY WHICH THE COMMISSIONER FINDS TO BE SUBSTANTIALLY EQUIV-
 ALENT; AND
   (II)  HAVE  PASSED  THE  NATIONAL  CERTIFYING EXAMINATION GIVEN BY THE
 COUNCIL ON CERTIFICATION OF NURSE ANESTHETISTS OR OTHER CERTIFYING EXAM-
 INATION WHICH THE COMMISSIONER FINDS TO BE SUBSTANTIALLY EQUIVALENT; AND
   (III) IS CURRENTLY CERTIFIED BY THE COUNCIL ON CERTIFICATION OF  NURSE
 ANESTHETISTS  OR BY THE COUNCIL ON RECERTIFICATION OF NURSE ANESTHETISTS
 OR OTHER ACCREDITING BODY WHICH THE COMMISSIONER FINDS  TO  BE  SUBSTAN-
 TIALLY EQUIVALENT. A REGISTERED PROFESSIONAL NURSE LICENSED AND CURRENT-
 LY  REGISTERED WITH THE DEPARTMENT WHO DOES NOT MEET THE REQUIREMENTS AS
 SET FORTH IN THIS PARAGRAPH, SHALL BE PERMITTED TO CONTINUE THE PRACTICE
 OF NURSE ANESTHESIA ONLY UNDER THE SUPERVISION OF A  QUALIFIED  ANESTHE-
 SIOLOGIST  UNTIL  ONE  YEAR  AFTER  THE  EFFECTIVE DATE OF THIS SECTION.
 NOTWITHSTANDING ANYTHING TO THE CONTRARY IN  THIS  SECTION,  A  GRADUATE
 NURSE  ANESTHETIST AWAITING CERTIFICATION SHALL BE PERMITTED TO ADMINIS-
 TER ANESTHESIA ONLY  IN  THE  HOSPITAL  OR  AMBULATORY  SURGICAL  CENTER
 SETTING AS PROVIDED IN THIS SECTION;
   (D)  FEES:  PAY  TO  THE DEPARTMENT A FEE OF FIFTY DOLLARS FOR INITIAL
 CERTIFICATION AND A TRIENNIAL REGISTRATION FEE OF THIRTY DOLLARS.  AFTER
 A  CERTIFIED REGISTERED NURSE ANESTHETIST'S INITIAL REGISTRATION, REGIS-
 TRATION UNDER THIS SECTION  SHALL  BE  COTERMINOUS  WITH  THE  CERTIFIED
 REGISTERED NURSE ANESTHETIST'S REGISTRATION AS A PROFESSIONAL NURSE.
   2.  A  PERSON  CERTIFIED UNDER THIS SECTION SHALL USE THE TITLE "NURSE
 ANESTHETIST" OR "CERTIFIED REGISTERED NURSE ANESTHETIST" OR THE ABBREVI-
 ATION "CRNA".
   3. A REGISTERED PROFESSIONAL NURSE  DULY  ENROLLED  IN  A  PROGRAM  OF
 EDUCATIONAL PREPARATION UNDER SUBDIVISION ONE OF THIS SECTION MAY ADMIN-
 ISTER  ANESTHESIA  AS  A  STUDENT  NURSE  ANESTHETIST  UNDER  THE DIRECT
 PERSONAL SUPERVISION OF A CERTIFIED REGISTERED NURSE ANESTHETIST WHO  IS
 SUPERVISED  BY  A PHYSICIAN LICENSED IN NEW YORK STATE WHO HAS COMPLETED
 AN ACCREDITED ANESTHESIA RESIDENCY  PROGRAM.  THE  CERTIFIED  REGISTERED
 NURSE  ANESTHETIST  OR  PHYSICIAN  LICENSED  IN  NEW  YORK STATE WHO HAS
 COMPLETED AN ACCREDITED ANESTHESIA RESIDENCY PROGRAM  SHALL  BE  CONTIN-
 UOUSLY PRESENT.
   4.  THE  COMMISSIONER  MAY  PROMULGATE  REGULATIONS  TO IMPLEMENT THIS
 SECTION.
   § 3. Section 6522 of the education law, as added by chapter 987 of the
 laws of 1971, is amended to read as follows:
   § 6522. Practice of medicine and use of title  "physician".    Only  a
 person  licensed  or otherwise authorized under this article shall prac-
 tice medicine or use the title "physician".  NO PERSON  UNLESS  LICENSED
 OR OTHERWISE AUTHORIZED UNDER THIS ARTICLE SHALL USE THE TITLE "ANESTHE-
 SIOLOGIST"  OR  ANY  OTHER  TITLE OR ABBREVIATION OR IN COMBINATION WITH
 ANOTHER TITLE OR ABBREVIATION THAT WOULD REPRESENT TO  THE  PUBLIC  THAT
 THE PERSON IS AUTHORIZED TO PRACTICE MEDICINE UNDER THIS ARTICLE.
 S. 5867--A                          5

   §  4.  Section 6903 of the education law, as amended by chapter 323 of
 the laws of 2006, is amended to read as follows:
   § 6903. Practice  of nursing and use of title "registered professional
 nurse" [or], "licensed practical nurse", "NURSE ANESTHETIST" OR  "CERTI-
 FIED  REGISTERED  NURSE  ANESTHETIST" OR THE ABBREVIATION "CRNA". Only a
 person licensed or otherwise authorized under this article  shall  prac-
 tice nursing and only a person licensed under section sixty-nine hundred
 five of this article shall use the title "registered professional nurse"
 and  only a person licensed under section sixty-nine hundred six of this
 article shall use the title "licensed practical nurse" AND ONLY A PERSON
 LICENSED UNDER SECTION SIXTY-NINE HUNDRED THIRTEEN OF THIS ARTICLE SHALL
 USE ONLY THE TITLE "NURSE ANESTHETIST" OR  "CERTIFIED  REGISTERED  NURSE
 ANESTHETIST"  OR  THE ABBREVIATION "CRNA". No person shall use the title
 "nurse" or any other title or abbreviation that would represent  to  the
 public  that  the  person  is  authorized to practice nursing unless the
 person is licensed or otherwise authorized under this article.
   § 5. Section 6909 of the education law is  amended  by  adding  a  new
 subdivision 12 to read as follows:
   12.  A  NURSE  ANESTHETIST  OR  CERTIFIED REGISTERED NURSE ANESTHETIST
 SHALL NOT USE ANY TITLE OR REPRESENTATION THAT WOULD REASONABLY CAUSE  A
 PATIENT TO BELIEVE THAT SUCH INDIVIDUAL IS LICENSED TO PRACTICE MEDICINE
 DURING  PATIENT  INTERACTIONS  IN  A HEALTH CARE FACILITY, FREE STANDING
 AMBULATORY SURGICAL CENTER, OR OFFICE  BASED  SURGERY  CENTER.  A  NURSE
 ANESTHETIST  OR CERTIFIED REGISTERED NURSE ANESTHETIST SHALL NOT USE THE
 TITLE OR IDENTIFY AS A "RESIDENT" OR  "RESIDENT  NURSE  ANESTHETIST"  OR
 "FELLOW"  UNLESS  THE  PERSON  IS  A GRADUATE OF A MEDICAL SCHOOL AND IS
 RECEIVING GRADUATE MEDICAL TRAINING. A NURSE  ANESTHETIST  OR  CERTIFIED
 REGISTERED  NURSE  ANESTHETIST  WHO  VIOLATES  THIS SUBDIVISION SHALL BE
 SUBJECT TO LICENSE  REVOCATION  OR  SUSPENSION  AND  OTHER  DISCIPLINARY
 ACTION.
   §  6.  Notwithstanding  any  other provision of law to the contrary, a
 registered professional nurse certified as a certified registered  nurse
 anesthetist  on,  before  or within one year after the effective date of
 sections one and two of this act may administer anesthesia as  a  certi-
 fied  registered  nurse anesthetist, and shall be deemed to be certified
 as a certified registered nurse anesthetist under section  6913  of  the
 education  law as added by section two of this act, until one year after
 the effective date of sections one and two of this  act;  provided  that
 certification  under such section shall be by a national certifying body
 that has been certifying registered nurse anesthetists for at least five
 years prior to such section becoming a law.
   § 7. This act shall take effect immediately, provided,  however,  that
 sections one and two of this act shall take effect on the first of April
 next succeeding the date on which it shall have become a law.