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CMS Proposes Expanded Role for Physicians Assistants in Hospice CoP

Posted on Thursday, August 8, 2019 2:17 PM

As of January 1, 2019, physician’s assistant (PA) can serve as hospice attending physicians but hospices are not allowed to accept drug orders from them.  CMS is now proposing to amend that rule to permit a hospice to accept drug orders from a physician PA.  Under the provision the PA must be an individual acting within his or her state scope of practice requirements and a hospice’s policies.  CMS is also proposing that the PA must be the patient’s attending physician, and that he or she may not have an employment or contractual arrangement with the hospice. 

“CMS has, as part of the proposed rule, request public comment on the following questions:

  • What is the role of a NPP [non-physician practitioner] in delivering safe and effective hospice care to patients? What duties should they perform? What is their role within the hospice interdisciplinary group and how is it distinct from the role of the physician, nurse, social work, and counseling members of the group?
  • Nursing services are a required core service within the Hospice benefit, as provided in section 1861(dd)(B)(i) of the Act, which resulted in the defined role for NPs in the Hospice COPs. Should other NPPs also be considered core services on par with NP services? If not, how should other NPP services be classified?
  • In light of diverse existing state supervision requirements, how should NPP services be supervised? Should this responsibility be part of the role of the hospice medical director or other physicians employed by or under contract with the hospice? What constitutes adequate supervision, particularly when the NPP and supervising physician are located in different offices, such as hospice multiple locations?
  • What requirements and time frames currently exist at the state level for physician cosignatures of NPP orders? Are these existing requirements appropriate for the hospice clinical record? If not, what requirements are appropriate for the hospice clinical record?
  • What are the essential personnel requirements for PAs and other NPPs?”

Source: NAHC

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