[NPInfo] Can NPs order home health care?

Sun Jun 15 18:35:31 PDT 2008

Seems like something NPs and PAs should work together on.
:=)

On Jun 15, 2008, at 7:11 PM, Deb Kiley wrote:

> It is old; these rules are the remnants of the original Medicare
> regulations. When Medicare was born, only physicians were providing  
> care.
> AANP has been working diligently to change these regulations for at  
> least 10
> years--- there are people who are not happy with what ANPs are  
> "allowed" to
> do, and this is an example of an area where they have been  
> successful in
> blocking progress.
> It would be helpful if everyone on this list sent an email to their
> legislator and told them a specific story about why this (not being  
> able to
> order home health) creates problems for your patients, and how they  
> could
> fix it by supporting this change.
> Deb Kiley
> Anchorage
>
> -----Original Message-----
> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On  
> Behalf
> Of Lisa Meyer
> Sent: Sunday, June 15, 2008 3:04 PM
> To: NP Info
> Subject: Re: [NPInfo] Can NPs order home health care?
>
> 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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