are twelve anesthesiologist assistant training programs in the United States all of which offer degrees at the Master's level. Approximately 97% of currently practicing anesthesiologist assistants hold a master's degree (some early anesthesiologist assistant graduates held bachelor's degrees). All newly credentialed and future anesthesiologist assistants must complete an accredited Master's program for anesthesiologist assistants. Upon completion of the educational program, graduates must sit for a credentialing exam that is co-validated by the National Board of Medical Examiners and National Commission for Certification of Anesthesiologist Assistants. All anesthesiologist assistant programs are credentialed by the Commission on Accreditation of Allied Health Educational Programs (CAAHEP) CMS "Opt-Out" Federal Supervision Requirement Effective November 13, 2001, CMS established an exemption for Certified Registered Nurse Anesthetists (CRNAs) from the physician supervision requirement. This exemption recognized a Governor's written request to CMS attesting that he or she is aware of the state's right to an exemption of the requirement for CRNA to be supervised by a physician. The attestation recognizes that it is in the best interests of the State's citizens to exercise this option in order to provide safe, cost-effective, valuable anesthesia services and especially helps assure the provision of those services to all citizens. Requirements for “Opt-Out” Of Federal Supervision Requirement • The federal requirement has been that CRNAs must be supervised by a physician. The November 13, 2001 rule allows states to "opt-out" or be "exempted" (the terms are used synonymously in the November 13 rule) from the federal supervision requirement. • For a state to "opt-out" of the federal supervision requirement, the state's governor must send a letter of attestation to CMS. The letter must attest that: a. The state's governor has consulted with the state's boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state; and b. That it is in the best interests of the state's citizens to opt-out of the current federal physician supervision requirement; and c. That the opt-out is consistent with state law. As of March 2020, nineteen states have chosen to opt-out of the CRNA physician supervision regulation. The states are: Alaska, Arizona, Colorado, California, Idaho, Iowa, Kansas, Kentucky, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oregon, Oklahoma, South Dakota, Washington, and Wisconsin. Anesthesia Care Teams According to the ASA statement on the Anesthesia Care Team, anesthesia care personally performed or medically directed by an