In recent years, it seems like the home health industry has gotten closer and closer to getting rid of Medicare’s stringent doctor certification guidelines. Thanks to the CARES Act, Nurses (NPs), Medical Assistants (PAs) and Clinical Nursing Specialists (CNS) can now certify eligibility for home health.
While Congress paved the way for non-doctor certification In March, a closer look, with support from the Centers for Medicare & Medicaid Services (CMS), shows that states ultimately have the final say on this matter.
Home health industry insiders have long spoken about Medicare’s guidelines for certifying physicians – a rule that many consider outdated and overly rigid. In general, these critics argue that the policy has created roadblocks that have made it difficult for older adults to access home health care, which in turn affects the bottom line of providers.
Before the CARES Act, home health services had to be certified and recertified by a doctor. This process often resulted in severe delays, especially when the doctors were busy.
PAs in particular are quite autonomous in terms of their ability to practice. Often times, they’re not in the same place as the doctor they’re collaborating or collaborating with, according to Michael Powe, vice president of reimbursement and professional advocacy at the American Academy of PAs (AAPA).
“Because of this, it’s important that PAs are able to take care of the full range of services their patients need,” said Powe. “If you are a PA in a satellite clinic, that may be 25 miles from the cooperating doctor. You don’t want to have to run to that doctor for a home health certification. ”
AAPA is an Alexandria, Virginia-based not-for-profit advocacy group serving more than 131,000 PAs in the United States
When patients are unable to receive timely home health care, these delays add to costs and lead to negative health outcomes.
“They may find themselves in a different situation, such as spending an extra day or two in the hospital, if they aren’t getting the home health services they need,” Powe said. “It just adds to the health care cost of the entire system. If those [home health services] If you don’t receive timely care, the more likely you will have a patient suffering from adverse medical consequences. “
The CARES Act was an attempt to correct and avoid these problems. It was derived from the Act to Improve Home Health Planning of April 2019, which was previously intended to give NPs, PAs and CNS the opportunity to permanently certify home health.
“This makes the relationship between the home health authority and the treating physician much easier for the patient,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News. “Everything from the original care plan to changing orders to signing documents in good time to submit and pay for them reduces some administrative and nursing barriers.”
Despite state regulations, there are a number of state-level challenges that stand in the way of NPs, PAs, and CNAs.
For example, the scope of practice for NPs is a problem in some states. NPs are divided into two classes: independent practice and collaborative practice with a doctor. Less than half of the states allow full, independent practice, according to Dombi.
Meanwhile, most states require PAs to work under the supervision of a doctor. PAs are allowed to take over the tasks of nursing care and certification of authorization, provided that the supervisory status exists.
Another problem, according to Dombi, is licensing in the States.
“[About] 35 states have a full license to home health authorities, ”he said. “This license is generally in accordance with the Medicare Conditions of Participation (CoPs). While [CoPs] As Medicare has changed, states must take the step of changing and updating their own licensing standards to reflect them. ”
Another challenge comes from the Medicaid side. There are many states that need to update Medicaid payment rules to allow a doctor, not just a doctor, to approve care plans and certify eligibility.
Dombi pointed out that the issues related to Medicaid payment rules and state CoPs likely have more to do with timing, which means that state governments may be slow to keep up with federal changes than disagreements over those Politics.
On the other hand, Dombi emphasizes that the scope of the exercise problems is more serious.
“Some states may not allow non-medical doctors to have independent practices, and that is the state authority to do,” he said.
From today’s perspective, larger vendors operating with multiple states will have the primary role of figuring out the rules and regulations in each state.
“You definitely have many risks in believing that a non-doctor can do anything in all states,” said Dombi. “Having to regulate this from state to state means a kind of burden for them. When you’re a small business in a single state, find out what the rules are – and follow them. ”
Dombi believes the legal profession will continue to be important in getting government policies to keep up with federal law.
“We have worked with many government home care associations that are taking the step,” he said. “These voices in home health care and in the non-doctor community need to grow … and advocacy to get that happening.”
A total of 30 states have recently taken temporary or permanent measures to authorize NPs to order home health services. In the last week alone, both California and New Mexico updated their regulations to permanently authorize NPs to order home health services, according to the American Association of Nurse Practitioners (AANP).
AANP, based in Austin, Texas, is a national advocacy group that represents the interests of more than 270,000 NPs.
NAHC has so far worked with state associations in Massachusetts, New York, and California, according to Dombi.
In addition, organizations such as NAHC, AAPA, the American Academy of Home Care Medicine, LeadingAge, the Visiting Nurses Association of America, and others worked together on a letter to the National Governors Association to encourage policy makers to recognize and recognize federal change To offer flexibility.