June 2, 2020
Federal COVID-19 Emergency Legislation Authorizes PAs to Order Home Health Services
Change Authorizes PAs to Move Patients Home, Free Up Hospital Beds
March 27, 2020
A bill AAPA has long advocated for, the Home Health Care Planning Improvement Act (S. 296/H.R. 2150), was included in the Coronavirus Aid, Relief, and Economic Security Act or the “CARES Act” (H.R. 748) that was signed today by the president.
The CARES Act permanently authorizes PAs (physician assistants) and nurse practitioners (NPs) to order home healthcare services for Medicare patients (in a manner consistent with state law). As healthcare facilities gird for an influx of COVID-19 patients, capacity will become a critical issue, and this authorization will ease some of that burden. AAPA worked closely with the relevant congressional committees and leadership to build support for this legislation and appreciates the efforts by our Congressional champions to include this proposal in the emergency legislation.
“Fast-tracking this bill by including it in the emergency COVID-19 legislation was critical. With the ability to order home health services, PAs can help to free up hospital beds for COVID-19 patients and decrease the spread of the virus by moving patients back into the home setting, away from exposures to the virus,” said David E. Mittman, PA, DFAAPA, president and chair of the AAPA Board of Directors. “We applaud Congress for enabling PAs to contribute more to the COVID-19 response.”
Under previous Medicare rules, only physicians could place orders for patients to receive home health services – medical care provided in a patient’s home that can include skilled medical care, respiratory therapy, occupational therapy, and speech therapy. This was despite the fact that many patients receive their medical care from PAs, NPs, or other advanced practice medical providers.
This federal restriction disrupted continuity of care for patients that rely on PAs for care. It also could deny or delay the availability of care for seniors and the disabled – two groups who need increased access to high-quality care during the COVID-19 response.
This legislation will improve access to home health services and promote continuity of care for Medicare beneficiaries, particularly patients living in rural and other medically underserved communities. Decades of data support the ability of PAs to provide high-quality care to people of all ages, including Medicare beneficiaries with multiple chronic conditions. PAs may be the only providers available in medically underserved rural and urban regions. The legislation requires the Department of Health and Human Services to implement these changes no later than six months following the date of enactment.
AAPA thanks the thousands of tireless PA advocates who for years have made the case to members of Congress about the necessity to eliminate the unwarranted restrictions, which prevented PAs from ordering home healthcare services for their Medicare patients.
The COVID-19 emergency legislation includes other critical provisions, including more than $1.6 billion for the Strategic National Stockpile to procure pharmaceuticals, personal protective equipment (PPE), and other medical supplies, which can be distributed to state and local health agencies in areas with shortages.
The CARES Act also contains provisions AAPA supported to expand access to telehealth. Telehealth visits for new patients during the coronavirus crisis can be covered by Medicare under the bill. Previously, the patient was required to have an established relationship with the provider. Also, certain patients with Health Savings Accounts and high-deductible plans will be able to receive telehealth benefits before reaching their deductible.
The legislation provides a five-year reauthorization for health professions’ workforce training and development, including PAs, under Title VII and for nursing workforce training and development under Title VIII. These sections largely reauthorize the workforce programs at currently appropriated levels. The Physician Assistant Education Association (PAEA) represents PA programs and performs advocacy related to PA education and student training. PAEA supports the Title VII reauthorization included in the legislation.
The legislation also authorizes physicians and NPs to use telehealth to conduct face-to-face encounters prior to recertification of eligibility for hospice care during the emergency period. In 2018, AAPA successfully pushed for Congress to authorize PAs to serve as attending providers for hospice patients. However, a face-to-face encounter prior to recertification for hospice care remains a service that can be provided by both physicians and NPs, but not PAs. NPs, while not permitted to recertify terminal illness, are permitted to conduct the face-to-face encounter to determine continued eligibility. PAs are not given the ability to conduct this face-to-face encounter.
AAPA requested that this emergency legislation authorize PAs to perform the face-to-face encounter needed for hospice recertification and asked that PAs also be able to perform the encounter via telehealth during the COVID-19 emergency. These requests were not included in the legislation.
Another section of the legislation titled “temporary waiver of requirement for face-to-face visits between home dialysis patients and physicians.” While the title of this section is physician-centric, AAPA staff interprets the language creating the waiver as applying to “physician services,” which PAs and NPs are able to provide under Medicare. AAPA and the American Association of Nurse Practitioners requested that this section be renamed to simply refer to waiving “face-to-face visits for home dialysis patients.” The broad coalition supporting the promotion of telehealth, the Alliance for Connected Care, supported our effort to rename this section. AAPA will strongly advocate for PAs to be included in any waiver that is created under this provision.
The Home Health Care Planning Improvement Act was introduced with strong bipartisan, bicameral support. AAPA would like to thank Senators Susan Collins (R-ME) and Ben Cardin (D-MD), who introduced the bill in the Senate, as well as Representatives Jan Schakowsky (D-IL), Buddy Carter (R-GA), Ron Kind (D-WI), and Mike Kelly (R-PA) who introduced the bill in the House, as well as the bill’s 47 cosponsors in the Senate and 140 cosponsors in the House.