Brown

I.

INTRODUCTION

In order for hospitals, ambulatory surgical centers, and critical access hospitals to receive reimbursement under Medicare when a certified registered nurse anesthetist (CRNA) administers anesthesia, federal regulations *395 require that the CRNA must be supervised by a physician. ( 42 C.F.R. §§ 482.52 (a)(4) (2011), 416.42(b)(2) (2011), 485.639(c)(2) (2011).) However, other federal regulations provide that a state’s governor has the discretion to make a request on behalf of the state to opt out of the physician supervision requirement after concluding, among other things, that the opt out is “consistent with State law.” ( 42 C.F.R. §§ 482.52 (c)(1) (2011), 416.42(c)(1) (2011), 485.639(e)(1) (2011).) On June 10, 2009, former Governor Arnold Schwarzenegger (the Governor) exercised his discretion under federal law and opted California out of the federal physician supervision Medicare reimbursement requirement.

Eight months later, the California Society of Anesthesiologists and the California Medical Association (collectively, appellants) filed a petition for writ of mandate and request for declaratory relief contending that the Governor “acted contrary…