August 7, 2020
Legislation Introduced to Authorize Direct Pay to PAs Under Medicare
HR 5506 Levels the Playing Field
April 16, 2018
On April 13, Representatives Adrian Smith (R-NE) and Terri Sewell (D-AL) introduced HR 5506, the Physician Assistant Direct Payment Act, to authorize PAs to receive direct payment under Medicare. If enacted, this legislation would advance AAPA’s Optimal Team Practice for those PAs billing under Medicare.
PAs are the only health professionals that cannot receive direct payment from Medicare. As a result, PAs can face administrative burdens and unnecessary red tape when they work in retail clinics, rural health clinics, medical groups that contract with a hospital, or other clinical arrangements.
As emerging healthcare delivery models replace traditional practice models, there is an increased need for PAs to be authorized to receive direct payment. Emerging healthcare models may include models in which PAs, physicians and other healthcare team members work in hospitals and health systems in more innovative, patient-centered arrangements rather than one physician employing one PA.
Medicare statute permits other health professionals (e.g. physicians, advanced practice nurses, physical therapists, psychologists, podiatrists, social workers, and others) that bill the program to receive payment directly under their own name. This legislation will level the playing field so PAs are allowed to compete with other health professionals on the basis of their clinical competence and skillsets without the concern of administrative burdens hindering employment opportunities.
Enactment of this legislation will largely not change how PAs currently practice and it will not change PA scope of practice.