Allowed Practitioners

In June, CMS made a clarification to a previous transmittal which allows clinical nurse specialists, physician assistants, and nurse practitioners to certify eligibility and order services under the Medicare home health benefit.  These individuals, of course, are defined as allowed practitioners.  The CMS Transmittal 11447 replaced Transmittal 11386 (previously released in April 2022) and stated nurse practitioners and clinical nurse specialists, in the absence of state practice laws regarding collaboration with a physician, must show documentation of physician collaboration and scope of practice in the medical record.  The National Association of Home Care & Hospice and the American Association for Nurse Practitioners met with CMS regarding this change in policy.  According to an article released from NAHC on June 9, 2022, CMS clarified to NAHC that “it interprets states that allow full practice authority for nurse practitioners and certified nurse specialists (CNSs) to be states that are absent state laws governing collaboration, and therefore, these practitioners would need to document in the medical record their scope of practice and the relationships that they have with physicians”.  The NAHC article went on to affirm it will continue to advocate for reasonable policies for non-physician practitioners who order and certify Medicare home health services. 

So, what are agencies to do with this information? As of this moment, the implementation date of this change is May 26, 2022.  Agencies are encouraged to examine the NPP practice acts in their state and discuss these requirements with NPPs who are ordering and certifying home health care for Medicare beneficiaries.  Begin to instruct NPPs to include information on what physician they are utilizing for the collaboration requirement, and the NPPs scope of practice.

For more information, see Update to Chapter 7, “Home Health Services”, of the Medicare Benefit Policy Manual (Pub 100-02)