CMS rescinds new NP documentation requirement

Editor's Note: This situation is still developing, and additional clarification from CMS and the MACs is expected soon. SimiTree will update as new information becomes available. 


Following an industry outcry and a flurry of questions, the Centers for Medicare and Medicaid Services (CMS) is walking back a new requirement for additional documentation in the medical record when a nurse practitioner certifies eligibility or orders services for Medicare patients.

CMS has rescinded Change Request 12516, which would have updated Chapter 7 of the Medicare Benefit Policy Manual and required nurse practitioners to document their scope of practice and the collaborative relationships they have with physicians.

“With this decision by CMS to rescind the change, the section of the policy manual reflecting the collaborative documentation requirement will remain unchanged,” said SimiTree Director of Compliance and Regulatory Kim Skehan.

“This is a great outcome for an issue that sparked numerous questions and a great deal of confusion among providers,” Skehan added. “It has taken a lot of work on the part of the National Association for Home Care and Hospice (NAHC).”

When the now-rescinded documentation requirement became effective on May 26. Skehan was inundated with questions from providers about how and where to add to the additional documentation in the medical record. Skehan worked closely with NAHC to communicate these concerns and support the removal of the requirement from Chapter 7, Section 30.2.1 titled, Definition of an Allowed Practitioner.

Ongoing confusion

The issue of nurse practitioners and clinical nurse specialists certifying and ordering services for Medicare patients has been a source of ongoing confusion for home health providers, Skehan said.

Many providers have struggled to make sense of confusing overlap between state scope of practice laws and Medicare requirements.

Allowing practitioners other than the physician to certify Medicare patients and order services was approved two years ago under the Coronavirus Aid, Relieve and Economic Security Act (CARES Act), which amended the Social Security Act in response to COVID-19.

The CARES act permits nurse practitioners, clinical nurse specialists and physician assistants who are working in collaboration with a physician to certify and order services for Medicare patients, as long as state laws do not prohibit it.

But states vary widely in what they do and do not allow, and many home health providers have struggled to make sense of confusing overlap between state scope of practice laws and Medicare requirements.

“State law prevails,” Skehan said. “Some states allow a practitioner to work independently without a written collaborative agreement or supervision from a physician, and in other states general or direct supervision and collaboration is required.”

Nurse practitioners, clinical nurse specialists and physician assistants are required to practice in accordance with state law in the state in which services are performed.

Read the CMS notice here

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