In a new final rule, the U.S. Centers for Medicare & Medicaid Services (CMS) will permit physician assistants to send medication orders to hospices. Previously, only orders from physicians or nurse practitioners were acceptable. The rule becomes effective Jan. 1., 2020.
Hospices can accept the orders from physician assistants as long as the PA is acting within the scope of practice requirements for their state. The PA must also be the patient’s attending physician and not employed by or contracted with a hospice. These orders are not within the PA scope of practice for every state, so some will be excluded.
While hospice organizations were in favor of allowing hospices to accept PA medication orders, some voiced concern that the new rules didn’t go far enough.
“[The National Association for Home Care & Hospice (NAHC)] was supportive of CMS’ proposal allowing hospices to accept medication orders from PAs serving as hospice attending physicians, and we are appreciative that CMS has decided to move forward with finalizing it,” Theresa Forster, vice president for hospice policy at NAHC told Hospice News. “At the same time, additional action is needed to ensure that hospices may take full advantage of the contribution that PAs can make to end-of-life care, including allowing PA to perform up to their full scope of practice as employees of hospice programs.”
One particular point of concern is the rule does not allow physician assistants to complete the face-to-face encounter the CMS requires for hospice recertification. According to CMS rules, a hospice physician or nurse practitioner must meet with the patient face-to-face before the third or subsequent certification for a patient who has lived beyond their six-month terminal prognosis.
“The statute did not get changed to allow PAs to help with the face-to-face requirement, which was a hope for lots of hospice,” said Judi Lund Person, vice president, regulatory and compliance for the National Hospice and Palliative Care Organization. “That will require a statutory change, and because it also touches the Affordable Care Act, then that’s another part of the puzzle.”
The NHPCO also took issue with the stipulation that the PA not be an employee of or contracted with a hospice. No such rule exists for physicians or nurse practitioners.
“When [CMS] proposed the rule we pushed back on that in our comments on the physician reschedule, and it’s frustrating because we thought this was fixed,” Lund Person told Hospice News. “So now I think it’s another round of conversations with CMS to say this should be the same as nurse practitioners.”