The Missouri Senate Committee on Seniors, Families, Veterans and Military Affairs held a hearing on Wednesday to draft a bill to expand the rules governing home health licenses.
Senate Draft 177, sponsored by Senator Justin Brown, R-Rolla, would remove the requirement that “a physician must sign off certification for home health or that Medicare approve care” and instead “allow a nurse to certify a doctor as a home nurse Health when it is needed … and giving patients the right to choose their home as a place of recovery. “
Only when a doctor is allowed to sign off home health care are delays, Brown said. “These delays in getting signatures, and thus delays in care, can make a chronic condition worse (and cause unnecessary emergency room visits).”
The first witness to speak in support of the law, Carol Hudspeth of the Missouri Alliance for Home Care, said these provisions had already been implemented at the federal level due to the COVID-19 pandemic.
“At the federal level, Medicare requirements allow it. The Missouri Home Health Act forbids it because it uses the word “doctor”. A doctor’s written, signed care plan. So we need to change that to include nurses, clinical nurse specialists, and medical assistants to reflect federal regulation, ”said Hudspeth.
She clarified: “(The bill) does not in any way alter the Missouri collaboration arrangements. It just follows the change of covenant. “
The final witness, Shantel Dooling, contradicted Hudspeth’s testimony that it would still be cooperative.
“I don’t think that would be the case,” she said. “If there is already a collaborative practice … if you still have to wait for the doctor, what is this legislation about?”
Dooling is the director of legislative affairs for the Missouri State Medical Association. Your main problem with the bill is that “there is a huge difference between managing a treatment plan and creating a treatment plan.”
The MSMA, Dooling said, “rarely gets many of our member physicians to contact us when a bill comes in. In general, we make them aware of this and learn what their concerns are. However, on this bill we had many members who turned to us. They think this could potentially be a big problem. “
Governor Mike Parson signed Executive Orders in March 2020 temporarily waiving certain licensing requirements for doctors, anesthesiologists, perfusionists, physical therapists, physiotherapy assistants, and medical assistants.
“Since then … home health officials have been able to use nurses and medical assistants to order the home health services,” said Hudspeth.
MSMA agencies in areas such as Kansas City, Rolla, Springfield and southeast Missouri have benefited from these assignments, particularly in time-sensitive situations, Hudspeth said.
“(The waiver) allows us to speak directly to the patient’s primary caregiver when we get orders, rather than consulting the doctor who has never seen the patient,” said Hudspeth. “This leads to an improved coordination of care.”
The work of the Missouri News Network was authored by students and editors of the Missouri School of Journalism for publication by member newspapers of the Missouri Press Association.
