Briefing
Materials
| Ensuring
Access and Continuity of Care for Medicare Beneficiaries who receive
Medical Care by PAs |
The
1997 Balanced Budget Act stated that medical services provided by PAs,
as allowed by state law, are covered by Medicare in all settings at
one uniform rate. Unfortunately, the Centers for Medicare and Medicaid
Services determined that the law does not allow PAs to order home health,
skilled nursing facility, or hospice care, or to provide the hospice
benefit for Medicare beneficiaries. The coverage limitations disrupt
continuity of care and decrease the availability of care for Medicare
beneficiaries, particularly in medically underserved communities. The
inability of PAs to provide hospice care disrupts continuity of care
at a time when the Medicare patient is most vulnerable.
PAs
jump through hoops to obtain physician signatures on Medicare orders
for home health, hospice, and skilled facility care. The physician,
however, is not always available, and access to needed care is delayed.
The AAPA seeks legislative changes to the Medicare statute to ensure
that PAs may order home health, hospice, and skilled nursing facility
care for Medicare beneficiaries, as well as to ensure that PAs may provide
hospice care for Medicare patients.
| Updating
the Federal Workers' Compensation Program to Allow PAs to Diagnose
and Treat Federal Employees who are Injured on the Job |
PAs
are legally regulated in all States, the District of Columbia , and
Guam . Forty-seven states, the District of Columbia , and Guam authorize
physicians to delegate prescriptive privileges to the PAs they supervise.
PAs work in virtually every area of medicine and surgery and are covered
providers within Medicare, Tri-Care, and most private insurance plans.
Additionally, PAs are employed by the federal government to provide
medical care, including the Department of Veterans Affairs, the Department
of Defense, and the Public and Indian Health Services. PAs are designated
as covered providers in the overwhelming majority of State workers'
compensation programs. Yet, federal workers may not be treated by a
PA for a workers' compensation-related injury.
Medical
care provided by physician assistants is not included in the Federal
Employees Compensation Act's (FECA's) definition of "medical, surgical,
and hospital services and supplies," and claims signed by PAs have been
denied. Unnecessary restrictions on the ability of PAs to diagnose and
treat injuries and illnesses covered by the Federal Workers' Compensation
Program unnecessarily limits patients' access to medical care. The AAPA
seeks cosponsors to and passage of Improving Access to Workers'
Compensation for Injured Federal Workers (S. 1795), which
amends FECA to allow PAs to treat federal workers who are injured on
the job.
| Restoring
Federal Funding Support for the Public Health Service Act's (PHSA's)
Health Professions Programs |
The
PHSA's Health Professions Programs are safety net programs. The programs
are essential to the development and training of primary health care
professionals and contribute to the nation's overall efforts to increase
access to care by promoting health care delivery in medically underserved
communities. The program supports clinical training opportunities for
PA students and others in medically underserved communities, where health
care may otherwise be unavailable.
Targeted
federal support for PA educational programs is authorized through section
747 of the PHSA and is the only federal funding available, on a competitive
grant basis, to PA programs. This funding is specifically targeted for
primary care education programs and is designed to educate PAs for practice
in urban or rural medically underserved areas.
Continued
federal funding support for these essential programs is threatened.
The AAPA recommends that funding for the Title VII Health Professions
Programs be restored, at a minimum, to their fiscal year 2005 funding
levels.
| Optimizing
Patient Care in the Department of Veterans Affairs (VA) by Elevating
the PA Advisor to a Full-Time Position in the VA's Central Office |
P.L.
106-419 required the VA to establish a PA Advisor to the VA's Under
Secretary for Health. The Department of Veterans Affairs is the single
largest employer of physician assistants. However, prior to the enactment
of the law in 2000, the VA had never had a PA within the Veterans Health
Administration to advise on such issues as PAs' education, qualifications,
clinical privileges, scope of practice, or third party reimbursement
for services provided by PAs. The absence of a knowledgeable resource
in the VA to advise on these issues resulted in unnecessary restrictions
on PAs' ability to provide medical care to the veteran population.
The
VA chose to implement the PA Advisor provision within P.L. 106-419 as
a part-time, field position, with a very limited travel budget. Although
the PAs who have served in the position have made progress on the utilization
of PAs within the agency, there continues to be inconsistency in the
way that local medical facilities utilize PAs. In one instance, the
AAPA was informed that a local facility determined that a PA could not
write outpatient prescriptions, despite licensure in the state allowing
prescriptive authority. Other PAs report that VA medical facilities
will not hire PAs.
Inefficient
utilization of PAs employed by the VA reduces available patient care
for veterans. The AAPA seeks passage of H.R. 2790, a bill to amend Title 38, Unite States Code, to establish the position of Director of Physician Assistant Services within the Office of the Undersecretary of Veterans Affairs for Health.
