[NPInfo] Can NPs order home health care?

[Joyce Fontana]

Agree. I do all the discharges at the SNF where I practice. I "write" the 
home health orders (so the social worker can initiate the referral. But I 
note next to the orders that so-and-so MD will sign the home health portion. 
Ridiculous.
I can write a Hospice Consult, but not Admit to Hospice.
Joyce


----- Original Message ----- 
From: "Barbara C. Phillips" <bphillips at olderwiserwomen.com>
To: "'NP Info'" <npinfo at nurse.net>
Sent: Sunday, June 15, 2008 3:04 PM
Subject: RE: [NPInfo] Can NPs order home health care?


>
>
> This is one of the most frustrating things in my practice. I cannot write
> home health or hospice orders. Period.  Apparently it's a federal thing 
> and
> will literally take an act of congress to change.
>
> Fortunately, our local hospice director here also thinks its ridiculous 
> and
> will write orders for me.
>
> BTW...we also cannot admit to a nursing home and medicare requires 
> physician
> involvement every 30-90 days depending on the program (level of acuity) 
> that
> individual is on.
>
> Barbara
>
>
> Barbara C. Phillips, NP
> www.NPBusiness.ORG
> www.NPInterviews.com
> www.NPBusinessOwner.com
>
>
> -----Original Message-----
> From: David Mittman [mailto:dmittman at comcast.net]
> Sent: Saturday, June 14, 2008 9:16 PM
> To: ACC; NPinfo Info
> Subject: [NPInfo] Can NPs order home health care?
>
>> 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
>
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