PAs Secure Strengthened PA Practice and Expanded Patient CARE Under Medicare in 2020

Home Health and Direct Pay Achieved for the Profession in 2020

February 3, 2021

As we enter 2021, we have an opportunity to reflect on some of the PA profession’s many accomplishments at the Congressional level in 2020. Last year the federal government was consumed with addressing the COVID-19 pandemic and this resulted in a sometimes chaotic federal environment for policymaking. This meant AAPA had to pivot its strategy and outreach much like PAs across the country were forced to adjust to our new environment.

Legislative Victories in 2020
Given the significant impact of COVID-19, most of Congress’ attention in 2020 was paid to pandemic response and relief efforts. The largest and most significant legislative efforts to advance in Congress dealt with how to mobilize federal efforts to fight COVID-19 as well as remove barriers to accessing care. In this environment, AAPA recognized there was an opportunity to advance legislative proposals that removed barriers to PA practice as an important part of responding to the pandemic.

While the advocacy environment during COVID-19 was incredibly challenging, AAPA has put years of work into building relationships on Capitol Hill and selecting Congressional champions who are well-situated to advance legislation that removes barriers to PA practice. Efforts by dedicated PAs to advocate and demonstrate the importance of the profession for their Congressional representatives were also incredibly important in mobilizing Congressional support for PA initiatives in this environment.  Congress passed four major COVID-19 relief and response packages in 2020, and AAPA was successful in getting two major PA wins in these bills while also working to promote the interests of frontline medical workers generally in all four bills. The AAPA federal advocacy team also successfully worked to ensure these bills did not include provisions that could have disadvantaged the PA profession in relation to other health professions.

Authorizing PAs to provide home health services

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law at the end of March 2020, permanently authorized PAs to order home healthcare services for Medicare patients (in a manner consistent with state law) starting in 2020. This important provision came from the Home Health Care Planning Improvement Act, S. 296 and H.R. 2150, legislation that AAPA has advocated for over several Congresses.

Authorizing PAs to order home healthcare services for Medicare patients ensures continuity of care for patients that rely on PAs, as well as increasing the availability of care for patients in rural and underserved areas. During the current pandemic, ensuring that patients are able to access care at home when possible is a critical part of preserving capacity for healthcare facilities and potentially cutting down on the risk of patients becoming infected with COVID-19.

AAPA would like to thank Senators Susan Collins (R-ME) and Ben Cardin (D-MD) for introducing the Home Health Care Planning Improvement Act in the Senate, as well as Representatives Jan Schakowsky (D-IL), Buddy Carter (R-GA), Ron Kind (D-WI), and Mike Kelly (R-PA), for introducing the companion bill in the House.

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Authorizing PAs to receive direct payment from Medicare

The Coronavirus Relief & Omnibus Agreement, signed into law at the end of December 2020, authorized PAs to receive direct payment from the Medicare program beginning in 2022. This large, bipartisan agreement contained the PA Direct Payment Act, legislation that AAPA has been advocating for since 2017. The longstanding inability of PAs to be directly paid for the care they provide their Medicare patients existed for no other healthcare profession in the Medicare program. Advocating for passage of the PA Direct Payment Act was the top priority for AAPA and PA advocates during this past Congress.

Removing this barrier to care will ensure that PAs, where permitted by state law, can reassign their Medicare payments in a manner similar to physicians and APRNs, as well as ensure that PAs who own their own practice in accordance with state law will be able to receive direct pay from the Medicare program. The COVID-19 pandemic reinforced the urgent need for the PA Direct Payment Act to become law by bringing to light many of the obstacles faced by PAs as a result of this outdated policy. This is especially the case in rural areas, where Medicare allows PA-owned rural health clinics (RHCs) to receive Medicare payments in some instances. These PA-owned RHCs are only permitted to receive Medicare payment for bundled RHC primary care services. PA-owned RHCs are required to bear the costs of services not included in the bundled payment. For instance, COVID-19 and flu testing, as well as other laboratory services, are not included in the payment bundle for RHC primary care services. Direct payment for PAs is also one of the three pillars of Optimal Team Practice.

AAPA thanks the primary champions of this legislation, Senators John Barrasso (R-WY) and Tom Carper (D-DE) in the Senate and U.S. Reps. Terri Sewell (D-AL) and Adrian Smith (R-NE) in the House of Representatives, for successfully shepherding this bill through Congress and into law.

Additional Legislative Victories

In addition to these longstanding legislative priorities getting signed into law, AAPA was successful in many other advocacy efforts. AAPA was focused on ensuring PAs were properly included in COVID-19 legislation and also advocated for the things our members needed to do their job on the frontlines; such as personal protective equipment (PPE) and testing. AAPA joined with a coalition of other healthcare provider groups to successfully push for Congress and the Administration to allocate more resources to ensure access to PPE for front-line workers and to improve access to testing, particularly for front-line workers and underserved communities.

Additional Priorities in Congress
AAPA continued to support several other pieces of legislation aimed at improving access to care and removing barriers to PA practice. These bills, which did not pass Congress last year, include:

  • Promoting Access to Diabetic Shoes Act, S. 237 and H.R. 808. This legislation would authorize PAs and NPs to certify a patient’s need for therapeutic shoes in order to help manage diabetes. Both bills garnered significantly more cosponsors in the 116th Congress than in past Congresses.
  • Increasing Access to Quality Cardiac Rehabilitation Care Act, S. 2842 and H.R. 3911. This legislation would authorize PAs and NPs to order cardiac and pulmonary rehabilitations services. It would also authorize PAs and NPs to begin supervising such services sooner than 2024, when it is authorized under current law.
  • Mainstreaming Addiction Treatment Act, S. 2074 and H.R. 2482, which would reduce burdens for PAs and other healthcare providers wishing to obtain a DEA waiver to prescribe buprenorphine to treat opioid use disorder.
  • ACO Assignment Improvement Act, H.R. 900, which would authorize assignment of patients treated by PAs and NPs to Medicare shared savings ACOs.

While these bills were not signed into law in 2020, AAPA is already working on their reintroduction for 2021 and will continue to push them forward with our Congressional champions and other allies such as the American Association of Nurse Practitioners.

These are a few of the highlights from Federal Advocacy and Congress in what was a difficult year for the country and healthcare providers. AAPA is hopeful that COVID will come under control in 2021 and that we will see additional opportunities to advance the PA profession.

AAPA will continue to keep you updated on the latest developments for the profession and hope you will engage on issues with your members of Congress as needed. 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.