[NPInfo] Can NPs order home health care?

[David Mittman]

> I have been fighting the Home Health Agencies regarding not  
> accepting PA sigs for Home Health. Turns out that PAs can not order  
> home health care, see http://www.aapa.org/gandp/factsheets/post- 
> hospital-care.html   but it we are working on it. Can NPs order  
> home health?
>
> Blaine
>
>
> Ensuring Access and Continuity of Care for Medicare Beneficiaries
> Who Receive Medical Care by PAs
> (Home Health, Hospice, & Skilled Nursing Facility Care)
>
>
> Relevant Legislation and Congressional Committees
> The Senate Finance Committee, the House Committee on Ways and  
> Means, and the House Committee on Energy and Commerce exercise  
> jurisdiction on Medicare legislation and provide oversight on the  
> Medicare Program.
>
> H.R. 1178, the Physician Assistants Continuity of Care Act, allows  
> physician assistants, as delegated by a physician, to order home  
> health, hospice, and skilled nursing facility care for Medicare  
> beneficiaries, and allow PAs to provide hospice care to their  
> patients who elect Medicare’s hospice benefit. The bill does not  
> change the current structure of the physician-PA relationship or  
> PAs’ scope of practice.  H.R. 1178 was introduced by Rep. Ed Towns  
> (D-NY) on February 16, 2007, with Rep. Phil English (R-PA) as an  
> original cosponsor. Introduced by Sen. Kent Conrad (D-ND), S. 1605,  
> the Craig Thomas Rural Hospital and Provider Equity Act of 2007,  
> would allow PAs to order home health and hospice care for Medicare  
> beneficiaries. Introduced by Sen. Susan Collins (R-ME), S. 1678,  
> the Home Health Care Planning Improvement Act of 2007, would allow  
> PAs to order home health care.
>
>
> Background
> Medicare coverage was originally extended to physician assistants  
> (PAs) through the 1977 Rural Health Clinic Services Act. Congress  
> acknowledged that PAs had the education and skills needed to  
> provide a wide range of primary care physician services to Medicare  
> beneficiaries living in areas experiencing a shortage of  
> physicians. Congress’ aim was to extend medical services to rural  
> Medicare beneficiaries. Subsequent Congresses steadily expanded  
> Medicare coverage for services provided by PAs. In 1997, the 105th  
> Congress passed the Balanced Budget Act (BBA). The BBA made it  
> clear that medical services provided by PAs, as allowed by state  
> law, are covered by Medicare in all settings at one uniform rate.
>
> Unfortunately, the former Health Care Financing Administration (now  
> the Centers for Medicare and Medicaid Services) decided that the  
> BBA’s Medicare provisions regarding coverage of services provided  
> by PAs did not apply to home health care, hospice care, or skilled  
> nursing facility care. As a result, PAs are currently not allowed  
> to order home health or hospice care services for patients who are  
> Medicare beneficiaries. PAs are also not allowed to order post- 
> hospital extended care services in skilled nursing facilities or  
> provide hospice care to beneficiaries who elect the hospice  
> benefit. It is unconscionable that Medicare beneficiaries who  
> routinely receive care from a PA and who elect to receive the  
> hospice benefit are not able to receive hospice care provided by  
> their PA.
>
> PAs jump through hoops to obtain physician signatures on Medicare  
> orders for home health, hospice, and skilled nursing facility care.  
> The physician, however, is not always available, and access to  
> needed care is delayed. The coverage problems disrupt continuity of  
> care and decrease the availability of care, especially in medically  
> underserved communities. The inability of PAs to provide hospice  
> care disrupts continuity of care at a time when the Medicare  
> patient is most vulnerable.
>
> Recommendation
> The American Academy of Physician Assistants recommends that the  
> 110th Congress enact H.R. 1178, the Physician Assistants Continuity  
> of Care Act, enabling PAs to order home health, hospice, and  
> skilled nursing facility care for Medicare beneficiaries, and  
> allowing PAs to provide hospice care to their patients who elect  
> Medicare’s hospice benefit. (H.R.1178 provides broader Medicare  
> coverage of services provided by PAs than S. 1605 and S. 1678.)
>
>
> Justification
> The 1997 BBA broadly authorizes PAs to deliver physician medical  
> services if allowed by state law and delegated by the supervising  
> physician. The law makes it clear that state law, not federal  
> coverage policies, determines the conditions of PA practice.  
> However, since HCFA determined that the BBA provisions regarding  
> PAs do not apply to certain sections of the Social Security Act,  
> such as certifying the need for skilled nursing facility care and  
> home health services, it is necessary to enact a technical  
> correction to clarify Congress’ original intent through the 1997 BBA.
>
> In the absence of the technical correction to counter the coverage  
> decisions, beneficiaries face unnecessary delays and denial of  
> medically necessary care covered by Medicare.
>
> For further information, please contact:
>
> Sandy Harding, Director of Federal Affairs
> American Academy of Physician Assistants
> Telephone:  703/836-2272, ext. 3205
> E-mail:   sandra at aapa.org
>
>
> Kristin Butterfield, Assistant Director of Federal Affairs
> American Academy of Physician Assistants
> Telephone:   703/836-2272, ext. 3223
> E-mail:   kbutterfield at aapa.org
>
> 2/08