CMS Cares
News about COVID-19 is changing rapidly, and we want to thank all of you who are on the front lines treating patients. We’d like to share some information from AANP about recent changes affecting home health care and Medicare/CMS.

Section 3708 of the Coronavirus, Aid, Relief and Economic Security Act (CARES ACT), which was passed by Congress and signed into law last month removed federal barriers that prevented NPs from documenting Medicare home health care face-to-face assessments and certifying and recertifying patient eligibility. The new law also requires Medicaid to adhere to this change. Per the CARES Act, CMS must finalize rulemaking within six months. AANP is currently working with CMS on ways to expedite this process and will share information as it’s available.

Additionally, while this section removes the federal barriers for Medicare and Medicaid patients, consistent with longstanding language in the Social Security Act, an NP still must be practicing in accordance with state law to provide these services. The majority of state nurse practice acts authorize NPs to broadly provide services and refer patients; however, AANP anticipates that some states may require updates, including to Medicaid regulations and state plan amendments, to address any state language that may inhibit NPs in certain states from performing these services once they are implemented at the federal level. AANP will also provide additional resources including billing and documentation requirements as they are available.

Last week, CMS released regulatory changes to remove barriers to patient care effective only for the duration of the COVID-19 Public Health Emergency (PHE). While these changes are temporary, they lay the groundwork for the permanent implementation of the home health provisions of the CARES Act, which is outlined below.

  • For Medicare home health, NPs, CNSs, and PAs are authorized to care for patients and perform the necessary orders and certifications. This means CMS will not audit home health claims or home health care agencies on the requirements that physicians provide these services during the PHE.
  • For Medicaid, CMS issued an interim final rule, which amended the Medicaid regulations to authorize NPs to order home health and all services under the home health benefit (including DME and medical supplies) for the duration of the PHE. This addresses both the home health issue and the DME issue that has arisen in a number of states. These issues were also permanently addressed by the CARES Act, but under that legislation CMS has six months to finalize rulemaking. These actions should provide immediate relief as CMS goes through the rulemaking process to permanently fix these issues. 
  • CMS is waiving 482.12(c), which requires that Medicare patients in hospitals be under the care of a physician. This allows hospitals to use other practitioners, such as NPs, to the fullest extent possible. This waiver should be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. 
  • CMS is waiving the minimum personnel qualifications for CNSs, NPs and PAs, described at 42 CFR 485.604 (a)(2), 42 CFR 485.604 (b)(1-3), and 42 C.F.R 485.604 (c)(1-3). NPs, CNSs and PAs will still have to meet state requirements for licensure and scope of practice but not additional federal requirements that may exceed state requirements. This will give states and facilities more flexibility in using clinicians in these roles to meet increased demand. These flexibilities should be implemented so long as they are not inconsistent with a state or pandemic/emergency plan. 
  • To the extent National coverage determinations (NCDs) and Local Coverage Determinations (LCDs) require a specific practitioner type or physician specialty to furnish or supervise a service, during this PHE, the chief medical officer or equivalent of a hospital or facility will have the authority to make those staffing decisions. 

There are a number of other flexibilities contained in these regulatory changes, including to telehealth. AANP will provide further information once the CMS document is reviewed. All of this information is available on AANP’s COVID-19 Practice and Policy Resources page under the Coronavirus Waivers link. Click the link before for more information.
We will continue to provide updates as more policy and regulatory changes unfold.
We want to thank our colleagues at AANP for their tireless work on behalf of NPs. If you have additional questions, please contact AANP’s federal government affairs team at [email protected] and the state government affairs team at [email protected] .

Becky Compton, DNP, RN, FNP-BC
VCNP president

Kim Bednar, DNP, FNP
VCNP government relations chair

Deborah Gray, DNP, ANP-BC, FNP-C, FAANP
AANP state representative