[NPInfo] Can NPs order home health care?

[Lisa Meyer]

This might seem like an irrelevant question, but does anyone know how or why 
it came to be that NP's can't order home health or hospice?  They seem like 
odd exceptions...

Lisa

----- Original Message ----- 
From: "Barbara C. Phillips" <bphillips at olderwiserwomen.com>
To: "'NP Info'" <npinfo at nurse.net>
Sent: Sunday, June 15, 2008 4:04 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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