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Regs & Eggs - January 23, 2020

Potential Changes to Non-Physician Supervision and Reimbursement Policies Coming to Medicare

You may have heard that the Centers for Medicare & Medicaid Services (CMS) is considering changing existing Medicare regs around non-physician supervision requirements and reimbursement—in other words, what services non-physicians like nurse practitioners and physician practitioners can perform unsupervised, and how much they can get paid.

As background, CMS recently released a request for information asking for feedback on a certain section of President Trump’s Executive Order (EO), “Protecting and Improving Medicare for Our Nation’s Seniors.” The EO directs the Secretary of the Department of Health and Human Services (HHS) to propose specific reforms to the Medicare program, including ones that eliminate supervision and licensure requirements that are more stringent than other federal or state laws. CMS therefore requested help from the public on identifying Medicare regs that contain more restrictive supervision requirements than existing state scope of practice laws or that limit health professionals from practicing at the top of their license.

In response to this request for information, physician groups united in expressing concern about potential reg changes—with dozens of organizations including ACEP signing on to a letter from the American Medical Association (AMA). The letter specifically requests that CMS not make any regulatory changes until it carefully reviews and considers fact-based resources that highlight the vast differences in education and training of physicians compared to non-physician practitioners. We argue that while non-physician practitioners have an important responsibility providing care to patients, their skillsets are not interchangeable with that of fully-trained physicians.

So, what exactly is going on, and what does this potentially mean for you? Well, it is important to note that CMS has not actually proposed or implemented any changes yet. In order for CMS to make any changes, the agency is required by law to propose and finalize new regs. If CMS does proceed with issuing a new reg that addresses non-physician supervision requirements and reimbursement, ACEP will submit detailed comments and push back against any administrative action that could jeopardize patient care or devalue the critical role that physicians play in serving their patients.
So stay tuned for updates as we wait for CMS’ next move.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!

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jeff headshot.PNGIf you have any questions or want to weigh in on other regulatory items, feel free to email me: jdavis@acep.org.
Jeffrey Davis is the Director of Regulatory Affairs at the American College of Emergency Physicians (ACEP). He manages ACEP’s formal response to federal policies and works with federal agencies and other stakeholders to help advance ACEP’s federal affairs agenda. Prior to that, Jeffrey worked in the Budget Office at the U.S. Department of Health and Human Services for nearly eight years. Jeffrey came to the Government as a Presidential Management Fellow, and in his position in the Budget Office, he advised top level officials on major budgetary and policy considerations within Medicare and prepared detailed analyses of Medicare regulations and legislation. Jeffrey has a Masters of Science in Health Policy and Management from the Harvard T.H. Chan School of Public Health and a Bachelors of Arts degree from Duke University.

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