Courtesy of the National Association for Home Care & Hospice (NAHC)

In Medicare transmittal 11386 dated April 27, 2022, the Centers for Medicare & Medicaid Services (CMS) set out to clarify requirements for non-physician practitioners (NPPs) in the Medicare program by adding the following language from long-standing regulations that define NPPs.

“Physician assistant means an individual as defined at § 410.74(a) and (c). Clinical nurse specialist means an individual as defined at § 410.76(a) and (b), and who is working in collaboration with the physician as defined at § 410.76(c)(3). Nurse practitioner means an individual as defined at § 410.75(a) and (b), and who is working in collaboration with the physician as defined at § 410.75(c)(3)”

“In the absence of State law governing collaboration, collaboration is to be evidenced by [nurse practitioners (NPs)] documenting their scope of practice in the medical record, and indicating the relationships that they have with physicians to deal with issues outside their scope of practice.”

When the transmittal was issued, CMS clarified for the National Association for Home Care & Hospice (NAHC) that it interprets states that allow full practice authority for NPs and certified nurse specialists (CNSs) to be states that are absent state laws governing collaboration, and therefore, these practitioners would need to document in the medical record their scope of practice and the relationships that they have with physicians. NAHC and the American Association for Nurse Practitioners met with CMS to discuss our concerns with their interpretation of the regulation and the requirement for home health agencies to document such in the medical record.

CMS has rescinded Transmittal 11386 and replaced it with Transmittal 11447, dated June 6, 2022. Transmittal 11447 removes Chapter 7, Section 30.2.1, titled "Definition of an Allowed Practitioner" which was part of the April transmittal.

Although CMS’ rescinding of Transmittal 11386 pulls back that policy and places a hold on enforcement, CMS is still deliberating its policy position on the requirement for full practice authority NPPs to document their scope of practice and relationships with physicians.

NAHC will continue to advocate for reasonable policies for NPPs that order and certify home health services for Medicare beneficiaries.