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Analysis

CMS Wants More Input on Medicare Scope of Practice Regulations

By John Commins  
   December 26, 2019

Federal policy makers are examining regulations that require more-stringent supervision, or that limit providers from practicing at the top of their license.

The Centers for Medicare & Medicaid Services is asking stakeholders for more input and recommendations on policy changes that could eliminate some Medicare scope of practice restrictions.

Specifically, federal policy makers are considering revamping regulations that require more-stringent supervision than provided now by existing state scope of practice laws, or that limit providers from practicing at the top of their license.

CMS is acting on the executive order #13890, Protecting and Improving Medicare for Our Nation's Seniors.

"These burdensome requirements ultimately limit healthcare professionals, including Physician Assistants and Advanced Practice Registered Nurses, from practicing at the top of their professional license," CMS said in a media release.

The revamp comes as more states are pushing for legislation to expand scope of practice for advanced practice practitioners.

But expanded scope of practice for advanced practice practitioners has been contentious. Physician groups have insisted on medical-doctor supervision of advanced practice practitioners.

For example, in 20 states, a physician must co-sign a percentage or number of physician assistant charts, according to the American Medical Association. In 39 states, there are limits on the number of physician assistants a physician can supervise or with whom a physician can collaborate.

CMS said it has already made regulatory changes in payment rules, including the CY 2020 Physician Fee Schedule, Home Health, and Outpatient Prospective Payment System final rules.

These changes include a redefinition of physician supervision for PA services, allowing therapist assistants to perform maintenance therapy under the Medicare home health benefit, and reducing the minimum level of physician supervision required for hospital outpatient therapeutic services.

"We are proud of the work accomplished," CMS said. "Now we need your help in identifying additional Medicare regulations which contain more restrictive supervision requirements than existing state scope of practice laws, or which limit health professionals from practicing at the top of their license."

Additional recommendations and comments should be sent to PatientsOverPaperwork@cms.hhs.gov with the phrase "Scope of Practice" in the subject line by Jan. 17, 2020.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

The revamp comes as more states are pushing for legislation to expand scope of practice for advanced practice practitioners.

Expanded scope of practice has been contentious. Physician groups have insisted on medical-doctor supervision of advanced practice practitioners.

In 20 states, a physician must co-sign a percentage or number of physician assistant charts.

In 39 states, there are limits on the number of physician assistants a physician can supervise or with whom a physician can collaborate.


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