PAs Advance the Profession at the Federal Level in 2019

Reflecting on the Accomplishments of the PA Profession

As we enter 2020, we have the opportunity to reflect on the PA profession’s federal accomplishments over the past year. As a result of the 2018 Congressional elections, 2019 marked the start of the 116^th Congress and a period of divided government, with Democrats gaining control of the House of Representatives and Republicans retaining control of the Senate.

Congress
The first year of a new Congress is a building year, which starts with a clean slate. New legislation can be introduced, and any legislation that did not make it across the finish line in a previous Congress must be reintroduced. In 2019, AAPA worked with Members of Congress to introduce the six pieces of legislation discussed in this article and to ensure they were introduced with bipartisan support. This puts the profession in the strongest position to advance these proposals through a divided Congress.

Authorizing PAs to receive direct payment from Medicare

Legislation that would authorize PAs to receive direct payment for providing Medicare services is a top priority for AAPA in the 116^th Congress. The PA Direct Payment Act (H.R. 1052), was reintroduced in the House of Representatives by Representatives Terri Sewell (D-Alabama) and Adrian Smith (R-Nebraska). A Senate companion bill, S. 596, was introduced for the first time by Senators John Barrasso (R-Wyoming) and Tom Carper (D-Delaware). Sen. Barrasso is a member of Senate Republican leadership and a former orthopaedic surgeon, and Sen. Carper is a senior member of the Senate Finance Committee.

The PA Direct Payment Act has garnered interest from the congressional committees with jurisdiction over Medicare issues in both the House and Senate, and is under consideration for inclusion in any healthcare package that Congress might consider over the coming months. It is viewed as a potential cost saver, which increases its ability to be put in a package because it can be used as an offset for other policies that would come with a cost.

Authorizing PAs to provide home health services

The Home Health Care Planning Improvement Act, S. 296 and H.R. 2150, has been successfully reintroduced in both the House and Senate. This legislation would authorize PAs to order home healthcare services for Medicare patients, ensuring continuity of care for patients that rely on PAs, and increasing the availability of care for patients in rural and underserved areas.

Authorizing PAs to certify the need for diabetic shoes for Medicare patients

The Promoting Access to Diabetic Shoes Act, S. 237 and H.R. 808, has also been reintroduced in both the House and the Senate. This legislation would modernize current Medicare policy and authorize PAs to certify a patient’s need for therapeutic shoes in order to help manage diabetes. Both bills garnered significantly more support in 2019 than in the last Congress, more than tripling the number of cosponsors for each bill.

Additional legislation aimed at removing barriers to PA practice

AAPA supported the introduction of other legislation aimed at improving access to care and removing barriers to PA practice. These include:

• The Increasing Access to Quality Cardiac Rehabilitation Care Act, S. 2842 and H.R. 3911. This legislation would authorize PAs to order cardiac and pulmonary rehabilitations services. It would also authorize PAs to begin supervising such services sooner than 2024, when it is authorized under current law.
• The Mainstreaming Addiction Treatment Act, S. 2074 and H.R. 2482, which would reduce burdens for PAs wishing to obtain a DEA waiver to prescribe buprenorphine to treat opioid use disorder.
• The ACO Assignment Improvement Act, H.R. 900, which would authorize assignment of patients treated by PAs to Medicare shared savings ACOs.

It is because of the advocacy of individual PAs – during Hill day at the 2019 AAPA Leadership and Advocacy Summit, through congressional letter-writing campaigns, and through meetings with PAs and their congressmen when they are home in their districts – that support for these bills increased. These lobbying efforts paid dividends as many members of Congress who had not been active before on PA issues signed on to cosponsor PA initiatives after being engaged by their PA constituents.

White House and Executive Agencies
A recent AAPA article highlighted many of the 2019 accomplishments at the Centers for Medicare and Medicaid Services with regard to the Medicare program, including Medicare supervision requirements for PAs now largely deferring to state law. The article also discusses the significant Indian Health Service change in 2019 that removed the requirement for a PA to have a supervisory physician.

On October 3, President Trump signed an executive order (EO) that called for several changes to be made in the Medicare Program, including asking that the Department of Health and Human Services (HHS) propose removing unnecessary supervision requirements and other barriers to PAs practicing at the top of their education, training, and experience. Following the issuance of the EO, AAPA has had substantive discussions with senior government officials concerning implementation of the EO, including a meeting with HHS Secretary Alex Azar.

AAPA continued to engage with the Department of Veterans Affairs to ensure that PAs are treated fairly, authorized to practice to the full extent of their training and education, and that the Department implements a law enacted in 2017 requiring PAs to be paid competitive wages. Part of this engagement included a meeting between VA Secretary Robert Wilkie and David E. Mittman, PA, DFAAPA, president and chair of the AAPA Board of Directors, as well as senior AAPA staff.

Other Federal Policy Developments
In June 2019, the Medicare Payment Advisory Commission (MedPAC), an independent government commission that advises Congress on issues impacting the Medicare program, recommended that Congress do away with “incident to” billing under Medicare for PAs and nurse practitioners. “Incident to” is a Medicare billing provision that allows a patient seen exclusively by a PA to be billed under the physician’s name if certain strict criteria are met, potentially obscuring the role that PAs play in providing care to Medicare patients.

AAPA engaged with the Administration, Congress, and outside advocacy groups in order to promote this policy change and called for it to be enacted along with AAPA’s other legislative proposals to remove barriers faced by PAs and improve access to care for patients. Given that this proposal is projected to increase transparency and produce substantial savings for the Medicare program, there has been interest from Congress in exploring this policy option.

These are just a few updates from the past year for PAs at the federal level, and AAPA is hopeful that 2020 will continue to be a productive year for the profession.

AAPA will be sure to keep you updated on the latest developments for the profession at the federal level. Please check out Advocacy Central for opportunities to add your voice to advance the profession. For any questions that you might have about a specific bill or issue, please contact AAPA’s Advocacy Department.