[NPInfo] Can NPs order home health care?

[suernfnp at iwon.com]

NPs can't order Home Health Care in Michigan. No signs that this will change anytime soon. 

Sue D in MI




 --- On Sun 06/15, David Mittman < dmittman at comcast.net > wrote:
From: David Mittman [mailto: dmittman at comcast.net]
To: acc-circle at listserve.com, NPinfo at nurse.net
Date: Sun, 15 Jun 2008 00:15:31 -0400
Subject: [NPInfo] Can NPs order home health care?

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