MedPAC Addresses Role of APNs and PAs: Home Health & Hospice Certification Advocated
May 14, 2013 08:58 AM
The Medicare Payment Advisory Commission’s (MedPAC) April 2013 meeting included discussion by the commissions of the role of and Medicare payments for advanced-practice nurses (ANP) and physician assistants (PA). The Medicare program generally covers all medically necessary APN and PA services, as long as the services are provided by licensed APNs and PAs and that the services are within the APN and PA’s scope of practice under state law. According to MedPAC staff, the major goal of discussion was to see that advanced-practice nurses are able “to function at the top of their license and at their full scope of preparation."
Commissioners were charged with reviewing the paper prepared by MedPAC staff prior to the meeting about Medicare’s coverage and billing policies for APN and PA services, claims analysis of the types of services and settings that APNs and PAs bill for under Medicare. The paper also included details about state licensure, state scope-of-practice laws, provider policies, and other payer policies that affect the services APNs and PAs provide.
MedPAC commissioners provided feedback on the paper, with specific recommendations about future research on this topic. Commissioner discussion focused on state, provider, and payer policies that affect service delivery and payment methodology to APNs and PAs. Commissioners examined state-to-state variations in the scope of practice, training requirements, and physician collaboration requirements. Ways in which APNs and PAs might serve to remedy problems with access to care, particularly in rural areas of the country, were addressed.
Of the few Medicare limitations on scope of practice of ANPs and PAs are home health & hospice certification. Several commissioners raised concern about these limitations, stating that these restrictions could negatively impact access to care and create delays of care to patients.
Reference was made to the Institute of Medicine’s (IOM) recommendations to changing Medicare coverage rules and authorizing APNs to certify patients for home health and hospice.
Discussions on the roles of ANP and PAs will be resumed during future MedPAC meetings. The Transcript of this meeting can be accessed here.