} Review recently enacted PA legislation. } Outline state PA legislative issues. } Describe federal PA issues

Size: px

Start display at page:

Download "} Review recently enacted PA legislation. } Outline state PA legislative issues. } Describe federal PA issues"

Ilene Malone
5 years ago
Views:

Marriott, Coralville, IA October 6, 2014 Ed Friedmann, PA } Review recently enacted PA

PA input is needed in health policy (To see bills or law go to www.legis.iowa.

patients with new problems c) Manage Medicaid lock in patients d) Receive direct Medicaid

rule making b) PAs are not included in Medicaid updates c) Medicaid service representatives

care provider choices for Medicaid patients e) All of the above a) A physician to visit a PA

every 2 weeks c) A physician to visit a PA staffed remote site for ½ day every 2 weeks d) The

1 Marriott, Coralville, IA October 6, 2014 Ed Friedmann, PA } Review recently enacted PA legislation } Outline state PA legislative issues } Describe federal PA issues } Describe why PA input is needed in health policy (To see bills or law go to and enter bill or law number) a) Apply for Medicaid provider number b) See Medicaid patients with new problems c) Manage Medicaid lock in patients d) Receive direct Medicaid reimbursement e) Be listed on the Medicaid provider list a) PAs are overlooked in Medicaid rule making b) PAs are not included in Medicaid updates c) Medicaid service representatives repeatedly provide misinformation about PA coverage d) PAs are not listed as Medicaid managed care provider choices for Medicaid patients e) All of the above a) A physician to visit a PA staffed remote site once every 2 weeks b) A physician to visit an NP staffed remote site once every 2 weeks c) A physician to visit a PA staffed remote site for ½ day every 2 weeks d) The same physician frequency as the neighboring states e) The practice to decide the details of visits and co-signatures Maple Tree buds

2 } Improving access to care } Allowing flexibility not one size fits all } Making state rules consistent with federal rules } Making state regulations consistent with national physician associations recommendations: leaving these supervision decisions to the practice } Decreasing rural practice costs } Decreasing physician travel time allowing more time for patients } 27 of 50 states have no remote site visit requirements including neighboring IL, WI and MN. } Supervision is available with modern technology such as telemedicine, Skype, internet accessibility, EHRs } 23 of 50 states have no co-signature requirement including IL, WI, MN and SD } NPs have no physician visit requirement in Iowa. } Define a PA remote site as a PA staffed location where a physician is present less than 50% of the time the clinic is open. } Require a physician to visit the site once every two weeks } Require a physician co-signing for new PA graduates } Contact PA Susan Koehler, Vice-chair, Iowa PA Reg. Board, SKoehlerPAC@gmail.com } PA Medicaid Enrollment now required: Includes enrollment for professional services and ordering and referring No change in reimbursement to physician or facility PAs not listed in Medicaid Directory PAs not included on Medicaid information letters mailings PAs need to enroll at: ProviderEnrollment.html } PA reimbursement is indirect (to physician or facility) } Bill under the physician s or facility s number } Assure that billing is correct } Payment is 100% of the physician s rate (except 65% for assisting in surgery-use modifier AS ) } Physician presence not required unless facility policy requires it } 2014 PA rural loan forgiveness program improvement bill (SF 2257) - passed } PA Involuntary hospital detention Bill (SF 2293) - not passed } Do-Not-Resuscitate (DNR) study bill (SSB 2243) not passed

Legislative Day Iowa Senate February 2012 IPAS members and students visit with Senate Leader Mike Gronstal to

awarded to PAs already in rural practices but with outstanding loans } Allows for 15 loan repayments per year to

Adds Grad Plus, Perkins loans } Eligibility begins in the final year of studies } Web address: www.iowacollegeaid.

a PA can provide information to the magistrate about a patient needing involuntary detention.

clinically indicated for each case A PA may provide information to a magistrate during court hours already A

respiratory arrest Unnecessary delays in hospitalization->tragic consequences } Jon Ahrendsen, M.D.

3 Legislative Day Iowa Senate February 2012 IPAS members and students visit with Senate Leader Mike Gronstal to discuss health care legislation } Annual repayment increased to $5,000, limit $20,000 total } Surplus funds may be awarded to PAs already in rural practices but with outstanding loans } Allows for 15 loan repayments per year to PAs or NPs in rural practice } Makes payments annual } Allows all approved Iowa PA Program students to qualify } Adds Grad Plus, Perkins loans } Eligibility begins in the final year of studies } Web address: } Passed the Iowa Senate 48-0, but not voted on in the House } Would remove required physician approval before a PA can provide information to the magistrate about a patient needing involuntary detention. } Reasons for passing PA detention bill include: Decision to contact a physician best made by the PA-physician as clinically indicated for each case A PA may provide information to a magistrate during court hours already A mental health emergency should be treated just like all other life-threatening emergencies such as cardiac or respiratory arrest Unnecessary delays in hospitalization->tragic consequences } Jon Ahrendsen, M.D. (Clarion) (reappointed) } One public member opening presently } Current PA members Jolene Kelly chair Susan Koehler Vice-chair Teresa Lee, Keith Guess, Melissa Gentry

} Medicare Hospice (HR 2969) [co-sponsored by all Iowa US Congressmen: Reps Braley, Loebsack, Latham and King] } Medicare Home Health (HR 2504 and S. 1332) } Federal Work Comp.

Congresswoman Karen Bass, PA) Senator Grassley meets with the Iowa Delegation in Washington 2012 } Allows PAs to join medical staff - passed } Allows PAs to order portable x-rays passed } Removal of

face to face requirement Policy requiring physician signature suspended } DOT medical Examiner certification required to do Federal truck driver physicals starting May 21, 2014 } Sustained Growth

4 } Medicare Hospice (HR 2969) [co-sponsored by all Iowa US Congressmen: Reps Braley, Loebsack, Latham and King] } Medicare Home Health (HR 2504 and S. 1332) } Federal Work Comp. } Electronic Health Records eligibility for all PAs [HR 1790] by Calif. Congresswoman Karen Bass, PA) Senator Grassley meets with the Iowa Delegation in Washington 2012 } Allows PAs to join medical staff - passed } Allows PAs to order portable x-rays passed } Removal of federal requirement for physician to visit RHC or CHC every 2 weeks - passed } Hospital admission: PAs may admit per Medicare (and Iowa PA rules) but physician must sign } Durable Medical Equipment: face to face requirement Policy requiring physician signature suspended } DOT medical Examiner certification required to do Federal truck driver physicals starting May 21, 2014 } Sustained Growth Rate (SGR) temporary patch passed for one year to prevent decrease in Medicare payments } ICD-10 delayed until October 2015 } Sunshine CME Act FAQ failed to exempt AAPA from reporting requirements like AMA, AAFP CME Legislative visits Washington DC, February 2014 } PAs included as primary care providers } Up to 100% of Federal Poverty Level (FPL) [Health and Wellness] } 100% to 133% of FPL state will pay insurance premium for plan in the insurance marketplace. } 134% to 400% of FPL federal government will subsidize insurance premium for plan in the insurance marketplace.

5 } Oregon requires insurance to pay the same rate for medical tasks done by PAs and NPs as for doctors performing the same service } Pays for service not providers State: Modernize remote site rules Full Medicaid recognition Fix commitment law Improve loan bill funding Sign DNR orders United Behavioral Health coverage Ensure PAs fully included in Health Care Reform Equal pay for equal work ins. payments Federal: Hospice, Fed. Work Comp., Home Health, Diabetic shoes EHR funding, Buphrenorphine } Physician Pain rules Check PMP (Pharm. Management Program) record of controlled drug presc. fills) Pill counts Drug testing Precautions Safety Security Overdose danger } NCCPA } PA Regulatory Board } Child and Dependent Adult Abuse 2hrs. Each every 5 yrs. } Medicare Hospital Admissions } Durable Medical Equipment } Sunshine Act and CME } AMA adopts policy to allow only physicians to perform chronic pain invasive procedures } 1. Keep a Professional File: License Malpractice Contract DEA Certificate State Controlled Drug Certificate CME Record Child/Dependent Adult Abuse CME Record ACLS/BCLS certification Supervising physician list (license number, date began and stopped supervising)

} 2. Fix Barriers to Care Identify the problem Document the problem Advise a potential fixer of the problem PA Society Legislator Congress member Agency Association PA Board Work with interested

org 703-836-2272 AAPA Reimbursement Staff: (Michael Powe, Andrew Iwanik, Trish Marriott, PA) michael@aapa.org Aiwanik@aapa.org tmarriott@aapa.org AAPA State Regulatory Staff: (Ann Davis, PA) ann@aapa.

org This makes all the studying worthwhile 1.

flexibility c) Differ with federal requirements, AMA recommendations and neighboring states d) Not required of NPs e) All of the above a) The amount of repayment was increased from $20,000 to $80,000

but none to the PA/NP program d) Repayments will now be made annually instead of at the end of the 4 year rural commitment e) In addition to PA students, graduates with outstanding loan repayments

6 } 2. Fix Barriers to Care Identify the problem Document the problem Advise a potential fixer of the problem PA Society Legislator Congress member Agency Association PA Board Work with interested groups Be patient and persistent } 3. Know resources Ed Friedmann, PA: edfriedman@aol.com (O); (H); (c) IPAS: AAPA: AAPA Reimbursement Staff: (Michael Powe, Andrew Iwanik, Trish Marriott, PA) michael@aapa.org Aiwanik@aapa.org tmarriott@aapa.org AAPA State Regulatory Staff: (Ann Davis, PA) ann@aapa.org PA Regulatory Board: Pierce Wilson (Board Administrator), pwilson@idph.state.ia.us, Board Secretary AAPA Federal Affairs Staff: (Sandy Harding) sharding@aapa.org This makes all the studying worthwhile 1. Problems with Iowa s PA remote site physician visit and co-signature requirements include: a) Decrease access to care especially in rural and underserved areas b) Increase costs and decrease practice flexibility c) Differ with federal requirements, AMA recommendations and neighboring states d) Not required of NPs e) All of the above a) The amount of repayment was increased from $20,000 to $80,000 for a 5-year commitment b) The average loan debt for an Iowa PA student on graduation is $80,000 c) The University of Iowa Foundation donated 1 million dollars to the physician loan repayment program but none to the PA/NP program d) Repayments will now be made annually instead of at the end of the 4 year rural commitment e) In addition to PA students, graduates with outstanding loan repayments are eligible for the program a) All four of Iowa s Federal legislators are cosponsors b) No other state has all of its congressional representatives as cosponsors c) NPs are not allowed to provide Medicare hospice care d) PAs may provide non-hospice care for their Medicare hospice patients e) PAs would be allowed to provide hospice care under NP supervision

a) Notify the medical board b) Notify the PA board c) Notify the nursing board d) Notify the PA board at the next license renewal a) Notify

notification is required a) See family planning patients b) Perform wellness exams c) Write prescriptions for their lock in patients d) See

the patient with a magistrate about detention b) NPs to staff the patient with a physician before talking with a magistrate about detention c)

adults without any psychiatric education may present information directly to a magistrate about someone needing involuntary hospitalization b)

hospitalization d) Patients with psychiatric emergencies deserve timely care e) PAs are not qualified to manage mental health emergencies a)

are made c) Financial support: membership and a PAC d) Members willing to ask nonmembers to join e) Capable legal, lobbyist and staff support

7 a) Notify the medical board b) Notify the PA board c) Notify the nursing board d) Notify the PA board at the next license renewal a) Notify the Medical board within 30 days b) Notify the PA board at the next license renewal c) Notify the Health Department d) Just like NPs, no notification is required a) See family planning patients b) Perform wellness exams c) Write prescriptions for their lock in patients d) See new patients or patients with new problems e) Receive direct reimbursement a) PAs to staff the patient with a physician prior to discussing the patient with a magistrate about detention b) NPs to staff the patient with a physician before talking with a magistrate about detention c) Psychiatric NPs to speak directly to a magistrate about detention d) The physician to speak with the magistrate e) Both a & c a) Already two adults without any psychiatric education may present information directly to a magistrate about someone needing involuntary hospitalization b) Unnecessary delay in hospitalization may result in avoidable death or injury c) PAs are educated in psychiatry about patients needing hospitalization d) Patients with psychiatric emergencies deserve timely care e) PAs are not qualified to manage mental health emergencies a) Membership willing to educate legislators b) Volunteers willing to learn the issues and be at the table for PAs when health policy decisions are made c) Financial support: membership and a PAC d) Members willing to ask nonmembers to join e) Capable legal, lobbyist and staff support f) Effective national association to support state chapters and pass federal legislation g) PAs who feel everything is fine and don t need to support their PA association.

a) All PA chart entries must be cosigned by a physician b) None of a PAs charts are required to be cosigned c) No specific number of PA charts are required to be cosigned d) Only those charts without

8 a) All PA chart entries must be cosigned by a physician b) None of a PAs charts are required to be cosigned c) No specific number of PA charts are required to be cosigned d) Only those charts without documented staffing with a physician need to be cosigned a) Seat belt exemptions b) Medicare Hospice or Home Health orders c) Schedule II Depressants (Seconal, Pentobarbital, Sodium Pentothal) d) Do Not Resuscitate orders e) Iowa disability exams f) None of the above a) Federal DOT, athletic and school bus driver physicals b) Death Certificate c) Skilled Nursing Care certification d) FMLA e) Handicapped Parking Permits f) Jury duty excuse requests (except Federal) g) Crossbow permits/handicapped fishing permits h) Durable medical equipment (except diabetic shoes) i) All of the above a) Failure to consult the supervising physician or specialist when needed b) Ignoring drug or alcohol dependency in a colleague c) Failure to keep records of supervising physician changes d) Not reporting name and address changes to the Board e) CME audit f) All of the above

Statement of the American Academy of Physician Assistants. for the Hearing Record of the Senate Finance Committee

Statement of the American Academy of Physician Assistants for the Hearing Record of the Senate Finance Committee on Chronic Illness: Addressing Patients Unmet Needs July 15, 2014 On behalf of the more