AMERICAN ACADEMY OF NURSE PRACTITIONERS Incorporated Long Term Care Fact Sheet

Transcription

1 AMERICAN ACADEMY OF NURSE PRACTITIONERS Incorporated 1985 'ministration: PO Box Austin, TX Fax Web Site: Office of Health Policy: PO Box Washington, DC Fax The Issue Long Term Care Fact Sheet For over twenty five years, nurse practitioners have been authorized to provide Medicare services to residents of long term care facilities. They are reimbursed at 85% of the Medicare physician rate for perfonning the same service. During that time, nurse practitioners have proved to be competent providers. Studies have demonstrated that their participation in the health care ofresidents/patients in long tenn care facilities has increased the quality of care provided to those patients. Unfortunately, the conditions of participation in the rules and regulations governing reimbursable Medicare services in skilled nursing facilities (SNF), have set limits on their ability to provide care in these facilities. At the time the initial regulations were written, there was limited understanding of the skills and abilities of nurse practitioners. As nurse practitioners have demonstrated their skill in working with the chronically and acutely ill in these settings, the requirements for physician "ontact with the patient have become obstructive rather than helpful. In particular, is the luirement for a physician to perform the admitting examination and the f'lrst and alternating monthly assessments on a patient in a skilled nursing facility (SNF). While these restrictions do not apply to other nursing facilities, they inappropriately remain in place for skilled nursing facilities (SNF). Needed To solve this problem, a change is needed in the Medicare Conditions of Participation for nurse practitioners to be able to perfonn the admitting examination and the required monthly visit ofa patient in a skilled nursing facility (SNF). Nurse practitioners are high quality primary care providers who have worked successfully with elderly patients in all settings, including skilled nursing facilities. They are specially trained to manage the problems of chronic illness in the aging population. The inability to conduct these examinations has serious ramifications for patient care in these facilities. It is not logical that nurse practitioners, who can conduct admitting physical examinations and follow up in a variety of other settings, are not allowed to conduct the same in skilled nursing facilities (SNF). The largestjull service Nurse Practitioner organ/ultion representing the 148,000 Nurse Practitioners in au Specialties '" Copyright American Academy of Nurse Practitioners 3/12

2 SAMPLE LETTER LONG TERM CARE Senator/Representative Dear Senator/Representative, I am writing to ask for your help with a serious problem that we are having with the limitations set on nurse practitioners regarding the Medicare Conditions of Participation for providing services in skilled nursing facilities. According to those rules, nurse practitioners are unable to conduct admitting physical examinations or alternating required medical visits for patients entering skilled nursing facilities. While we are able to admit patients to ambulatory practice, nursing homes that are not skilled nursing facilities and hospitals, and are authorized to certify and recertify patients for Medicare long term care, the Conditions of Participation prevent nurse practitioners from functioning at their full scope in a skilled nursing facility. Nurse practitioners are high quality primary care providers who have worked successfully with elderly patients in all settings including skilled nursing facilitates. They are specially trained to manage the problems of chronic illness in the aging population. The inability to conduct these examinations has serious ramifications for patient care in skilled nursing facilities. It is not logical that nurse practitioners, who can conduct provide there services in a variety of other settings, are not allowed to conduct an admitting physical examination in a skilled nursing facility. I would appreciate your assistance in taking steps to adjust this rule so that nurse practitioners may perform admitting examinations and follow up oversight visits on patients in skilled nursing facilities. If you would like to discuss these issues further, I can be reached at (personal address and phone number or you may refer them to Dr. Towers at the AANP Office of Health Policy). Thank you for your assistance in this matter. Sincerely, *Brackets and italics suggest where you may wish to personalize or add your own comments. : Representatives: The Honorable Senators: The Honorable United States House of Representatives United States Senate Washington, DC Washington, DC [We recommend that you fax and/or your Senator/Representative as well, since regular mail passes through lengthy security inspection] Please cc copies ofyour correspondence to Dr. Jan Towers, Office ofhealth Policy 1 American Academy ofnurse Practitioners 1 Box Washington, DC orjtowers@aanp.org American Academy of Nurse Practitioners March 2012

3 AMERICAN ACADEMY OF NURSE PRACTITIONERS Incorporated 1985 Office of Health Policy: P.O. Box Washington, DC Phone: Fax: Web Site: NEEDED Ordering Home Health Care S 227 and DR 2267 Legislation or reinterpretation of statute and/or regulation that will authorize nurse practitioners to certify patients to be eligible for Medicare home health services. (See S 227 or HR 2267) RATIONALE Legislation authorizing direct Medicare reimbursement to nurse practitioners providing reimbursable Medicare services became effective January I, Since that time nurse practitioners have been providing reimbursable care to patients as Part B providers. Under the provisions of this law, nurse practitioners were authorized to render, order and refer for services under their own PIN and UPIN numbers (now NPl numbers). They may order physical therapy, occupational therapy and speech therapy, bill as consultants and consul tees when providing services through telemedicine and order and bill for perfonning and interpreting diagnostic tests within their scope ofpractice. They may also bill for services as attendings in the program and for services "incident to" their own service. Despite their ability to provide and bill for services rendered in all of these areas, they are still unable to certify patient eligibility for home health care services. The apparent reason is that a language change or an expanded interpretation of the word "physician" is needed in Part A, Section 1814, of the Medicare law in order for home health agencies to accept their referrals. Nurse practitioners have been demonstrated to provide safe and responsible care to the patients they serve. They have expert knowledge that allows them to provide high level assessments of patients needs and recognize when additional care, such as home health care, is needed or not needed by their patients. Given their proven track record in the care of the elderly, it is not logical that nurse practitioners are authorized to be Part B Medicare provider are unable to certi eligibility for home health care for their patients. Instea ey must find a physician to sign orders at an a ttional -cost an ay in provision for tj:lese services when neooed. The largest full service Nurse Practitioner organization representing the 148,000 Nurse Practitioners in all Specialties Copyright American Academy ofnurse Practitioners 1112

4 HOUSE SAMPLE LETTER HOME HEALTH CARE FOR NURSE PRACTITIONER PROGRAMS HR2267 The Honorable Dear Representative I am writing to ask for your help with a major problem individuals needing home health care services are having in our state at this time. Currently, the conditions of participation in Medicare Part A, allow home health care agencies to accept authorization for services of patients to be eligible for home health services from physicians, but not other primary care providers such as nurse practitioners. As a result, Medicare patients who are being seen by a nurse practitioner must be certified eligible by a physician, at extra cost, and often at great inconvenience, in order to obtain home health care services. While nurse practitioners are authorized to perform physician services under Part B of Medicare law, we are told that language in Part A, that governs these programs, prevents these agencies from accepting our authorization for services. I would appreciate your help in correcting this problem by agreeing to be a cosponsor of HR The Home Health Care Planning Improvement Act of introduced by Representative Greg Walden (R/OR) and Allyson Schwartz (D/PA). Nurse practitioners have a long history of providing high quality, cost effective care to patients of all ages. We are particularly prepared to manage the problems of patients with chronic diseases and the elderly, and should be able to certify Medicare patients eligible for these services. We would appreciate your assistance in resolving this issue. If you need further information, please feel free to call me or contact the Office of Health Policy of the American Academy of Nurse Practitioners ( ). {"'You may wish to add your personol experiences to this letter.] : Representative: The Honorable United States House of Representatives Washington, DC We recommend that you fax and/or your Representative as well, since regular mail still passes through lengthy security inspection. Please cc copies of your correspondence to Dr. Jan Towers, Office of Health Policy, American Academy of Nurse Practitioners, Box 40130, Washington, DC American Academy of Nurse Practitioners September, 2011

5 SENATE SAMPLE LETTER HOME HEALTH CARE FOR NURSE PRACTITIONER PROGRAMS S227 rhe Honorable, Dear Senator I am writing to ask for your help with a major problem individuals needing home health care services are having in our state at this time. Currently, the conditions of participation in Medicare Part A, allow home health care agencies to accept authorization for services of patients to be eligible for home health services from physicians, but not other primary care providers such as nurse practitioners. As a result, Medicare patients who are being seen by a nurse practitioner must be certified eligible by a physician, at extra cost, and often at great inconvenience, in order to obtain home health care services. While nurse practitioners are authorized to perform physician services under Part B of Medicare law, we are told that language in Part A, that governs these programs, prevents these agencies from accepting our authorization for services. I would appreciate your help in correcting this problem by agreeing to be a cosponsor of S 227, The Home Health Care Planning Improvement Act of 2011, introduced by Senators Susan Collins (RIME) and Kent Conrad (D/ND). Nurse practitioners have a long history of providing high quality, cost effective care to patients of all ages. We are particularly prepared to manage the problems of patients with chronic diseases and the elderly, and should be able to certify Medicare patients eligible for these services. We would appreciate your assistance in resolving this issue. If you need further information, please feel free to call me or contact the Office of Health Policy of the American Academy of Nurse Practitioners ( ). ["'You may wish to add your personal experiences to this letter] : Senator: The Honorable United States Senate Washington, DC We recommend that you fax and/or your Senator as well, since regular mail passes through lengthy security inspections. Please cc copies of your correspondence to Dr. Jan Towers, Office of Health Policy, American Academy of Nurse Practitioners, Box 40130, Washington, DC American Academy of Nurse Practitioners September, 2011