Acting on Executive Order #13890, “Protecting and Improving Medicare for Our Nation’s Seniors,” the Centers for Medicare & Medicaid Services (“CMS”) will consider new regulations designed to eliminate the regulatory barriers that constrain advanced practice providers (i.e., physician assistants and advanced practice nurses) from practicing at the top of their professional licenses. These barriers include burdensome billing requirements, conditions of participation, and supervision requirements that are more stringent than applicable federal or state laws. The reform effort, which aims to revamp regulations by October 2020, will include a comprehensive review of regulatory policies that create disparities in reimbursement between physicians and non-physician practitioners, and the promulgation of new regulations to ensure that eligible items and services are appropriately reimbursed in accordance with the actual work performed, and not based solely on the provider’s occupation/level of licensure.
CMS is inviting public comments to help identify Medicare regulations that contain more restrictive supervision requirements than state laws. For example, Medicare currently requires direct supervision by a licensed-physician for an advanced practice nurse to render medical services during a house call in order to bill the services “incident to” the physician; however, some state laws do not require a physician to directly supervise an advanced practice registered nurse. In this example, removing the more stringent supervision requirement under federal law would afford advanced practice nurses greater flexibility to attend to the growing number of patients who require home visits. Such reform would benefit patients, advanced practice providers and the physician practices that employ (and/or collaborate with, in accordance with applicable state law) such providers.
Public comments on this topic must be submitted to PatientsOverPaperwork@cms.hhs.gov with the phrase “Scope of Practice” in the subject line by January 17, 2020. For assistance in the preparation of a comment, or more information about how these proposed changes may affect your practice, contact Frier Levitt to speak to an attorney.