Home Health & Hospice Week

Keep an eye on a potential problem regarding NPs and home health orders.

On April 27, the Centers for Medicare & Medicaid Services issued a transmittal updating the Medicare Benefit Policy’s Chapter 7 on Home Health Services. In addition to addressing Notices of Admission and Requests for Anticipated Payment, the update “provides corrections and clarifications regarding who may sign the certification and recertification for home health beneficiaries,” CMS says in CR 12615.

The problem: In a “Definition of Allowed Practitioners” section of the transmittal, CMS indicates that Nurse Practitioners and Clinical Nurse Specialists must be “working in collaboration with the physician.” The memo also says that “in the absence of State law governing collaboration, collaboration is to be evidenced by NPs documenting their scope of practice in the medical record, and indicating the relationships that they have with physicians to deal with issues outside their scope of practice.”

“CMS’ policy is both confusing and concerning regarding what CMS might be requiring of NPs in terms of collaboration in states where NPs have full practice authority (FPA),” criticizes the National Association for Home Care & Hospice in its member newsletter.

When NAHC asked what medical review guidance CMS is providing to Medicare Administrative Contractors on the topic, CMS said “…the contractors will only be looking for a statement in the medical record documenting the NPs scope of practice and indicating the relationships that they have with physicians to deal with issues outside their scope of practice, when the NP is NOT required to have a collaborative agreement. In other words, in states that do not govern collaboration,” according to NAHC. “CMS further clarified that it considers states with full practice authority NPs to be states that do not have laws that govern collaborative agreements.”

NAHC disagrees and “is working with the American Association for Nurse Practitioners to bring our concerns to CMS in order to reach an acceptable resolution,” the trade group says.

The nine-page transmittal is at www.cms.gov/files/ document/r11386bp.pdf.