Dec 18, 2019

In 2019, Slow but Sure Progress in Laws, Policy

The past 12 months have seen shifts in the legal landscape that mean more people have, and might soon have, greater options in their health care.

At the federal level:

  • The Centers for Medicare and Medicaid Services (CMS) on November 1 announced a final ruling on the hospital outpatient prospective payment system and ambulatory surgical center payment system. The result is a change in the minimum level of supervision required of advanced practice registered nurses—from direct supervision by a physician, to general supervision for all hospital outpatient therapeutic services provided by hospitals and critical access hospitals. This increases the public’s access to lifesaving therapeutic services, including cardiac and pulmonary rehabilitation, chemotherapy, and radiation therapy. The rule goes into effect on January 1.
  • Data released in May 2019 from the American Association of Nurse Practitioners show that Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act is working. That 2018 legislation authorized nurse practitioners to prescribe medication-assisted treatment once they have obtained a buprenorphine waiver from the Substance Abuse and Mental Health Services. As of May 2019, data show, over 11,000 nurse practitioners have obtained waivers.
  • In January, the Medicare Payment Advisory Commission (MedPAC) unanimously recommended to Congress that all care provided by nurse practitioners to Medicare beneficiaries be billed directly under the nurse practitioners’ Medicare provider number rather than through a “supervising” physician. Current law already requires that billing for new patients, or with new health conditions for an existing patient, or if a physician is not present in the office suite. But MedPAC estimates that, were the recommendation to be approved for all visits to nurse practitioners, this would reduce federal spending $50 million to $250 million in one year. Congress has not yet taken action.

In 2019, 18 states considered legislation to improve the public’s access to APRN care. Here are some bills that became law, which, when combined, improve access to 37 million people:

  • Arizona now provides prescribing authority to clinical nurse specialists. These specialists are among the health professionals that often treat older adults and other people with chronic health conditions.
  • Montana now allows advanced practice registered nurses (APRNs) to sign any health care document that a physician can sign, including all state health forms. This gives patients greater choice in providers, and reduces the time that families waste searching for, or waiting for, physicians to sign basic health forms.
  • Texas chipped away at physician contract requirements. These changes will free up more time for clinicians (APRNs and physicians) to spend with their patients.
  • Utah modernized its health care laws so that more patients can access the prescription drugs they need directly from APRNs.

One more piece of good news for the consumer lies at the intersection of federal and state policy. On November 1, CMS approved a federal waiver that will enable all Medicare-enrolled nurse practitioners in the state of Maryland to certify home health services for Medicare beneficiaries, effective as of January 1. Currently, Medicare will pay  for home health services only if a physician certifies the beneficiary’s eligibility for the home health benefit. This waiver is limited to the state of Maryland, which has a Total Cost of Care Model. Look for more information about this on the Campaign blog in the new year.