News

ALLOWING PHYSICIAN ASSISTANTS TO SERVE MEDICARE HOSPICE PATIENTS

Allowing Physician Assistants to Serve Medicare Hospice Patients

Recommendation
The American Academy of Physician Assistants recommends that sections 1861(dd)(3)(B) and
1814(a)(7)(A)(i)(I) of the Social Security Act be amended to permit physician assistants (PAs) to provide hospice care to their patients who elect Medicare’s hospice benefit. (The recommended provisions were included in S. 318, S. 1157, and H.R. 3590 in the 111th Congress.)

Background
Medicare coverage was originally extended to PAs through the 1977 Rural Health Clinic Services Act. Congress acknowledged that PAs had the educational preparation and skills to provide a wide range of primary care services to Medicare beneficiaries living in areas experiencing a shortage of physicians. Congress’ aim was to extend medical services to rural Medicare beneficiaries. Subsequent Congresses steadily expanded Medicare coverage for services provided by PAs. In 1997, the 105th Congress passed the Balanced Budget Act (BBA). The BBA made it clear that medical services provided by PAs, as allowed by state law, are covered by Medicare in all settings at one uniform rate. Unfortunately, the former Health Care Services Administration (now the Centers for Medicare and Medicaid Services) decided that the BBA’s Medicare provisions regarding coverage of services provided by PAs did not apply to hospice care. As a result, PAs are not allowed to provide hospice care to their patients, forcing families to seek alternative health care professionals to manage hospice
care services.

Rationale
The 1997 BBA broadly authorizes PAs to deliver physician medical services if allowed by state law and delegated by the supervising physician. The law makes it clear that state law, not federal coverage policies, determines the conditions of PA practice. However, since HCFA, and later CMS, determined that the BBA provisions regarding PAs do not apply to certain sections of the Social Security Act, it is necessary to enact a technical correction to clarify Congress’ original intent through the 1997 BBA. In the absence of this change, beneficiaries face delays, disruption in care, and denial of medically necessary care covered by Medicare.

For further information, please contact:
Sandy Harding, Senior Director of Federal Advocacy
American Academy of Physician Assistants
Telephone: 703-836-2272, ext. 3205
E-mail: sharding@aapa.org

UPCOMING LEGISLATIVE AGENDA 1-2011

Upcoming Legislative Agenda
As we begin 2011, the PSPA is preparing to embark on another 2-year legislative session. Republicans have taken control of the house and senate and we have a new republican Governor. Our legislative agenda includes making the necessary changes to our regulations that put us in line with the AAPA’s six key elements that should be found in state regulations. Pennsylvania already has three of the key elements in place and we are looking add the other three.

Issues we are planning to address are:
1. Changing our work agreements from “approved” to “filed” with the Boards of Medicine and Osteopathic Medicine. This would allow PAs to begin working immediately once their paperwork has been submitted to the boards.
2. Removal of counter-signature requirements in all practice settings
3. We will also be working on allowing PAs to sign state and municipal police physicals, day care and foster care physical forms, as well as amending the Public Utility Commission regulations to allow PAs to sign emergency shut off forms.

The legislative and regulatory session is 2 years in length. Completion of our goals will hopefully take less than the full two years. We will notify you when we need you and your supervising physicians to write letters of support to your legislators. Now is a good time to introduce yourself to your representative and senator for your district. Let them know what a good job you do providing care to their constituents. You don’t have to mention our agenda or discuss politics, just let them know who you are and that you are available to answer questions if needed.

Finally, and as always, your input and suggestions are appreciated to help us identify other barriers to practice. Please contact the PSPA office if you have further suggestions.

ALLOWING PHYSICIAN ASSISTANTS TO PRESCRIBE BUPRENORPHINE

Allowing Physician Assistants to Prescribe Buprenorphine

Recommendation
The American Academy of Physician Assistants recommends that Congress amend the Drug Addiction and Treatment Act of 2000 to allow physician assistants who complete certification training to obtain a DEA waiver to prescribe and dispense buprenorphine for opioid addiction (in states where PAs are permitted to prescribe Schedule III, IV, and V medications).

Background
The Drug Addiction Treatment Act of 2000 changed addiction treatment in the United States by
allowing physicians to treat opioid addiction in settings other than traditional opioid treatment program settings like methadone clinics. The legislation permits physicians who complete certification training to obtain special designation (a “waiver”) from the Drug Enforcement Administration (DEA) to prescribe and dispense Schedule III, IV, and V narcotic medications in settings that do not require specific Federal/State licensure (i.e., physician offices). In 2002, buprenorphine became the first medication to be approved by the Food and Drug Administration (FDA) for use in office-based opioid treatment (OBOT). However, DATA 2000 specifically requires that prescribers of buprenorphine for treatment of opioid addiction be a physician (MD or DO), and bars physicians from delegating such prescriptive duties to physician assistants, even when state law permits PAs to prescribe controlled substances.

Rationale
All 50 states and the District of Columbia have enacted laws giving physician assistants broad prescriptive authority. PAs are permitted to prescribe Schedule III, IV, and V controlled medications in 48 states and the District of Columbia; 36 of these permit PAs to prescribe Schedule IIs as well. Buprenorphine has been determined to be an effective alternative to traditional Schedule II methadone treatment for opioid addiction. Because it is safer and less susceptible to diversion and abuse, buprenorphine – a Schedule III medication – was approved by the FDA in 2002 for office-based dispensing, which greatly improves access to critically needed treatment to many much earlier point. states where they are already permitted to prescribe Schedule III-V medications would greatly increase access to this potentially life-saving treatment. It does not make sense for PAs to be restricted from prescribing Schedule III buprenorphine when they Schedule II controlled medications, such as methadone, in 36 states. more patients at aAllowing physician assistants to prescribe buprenorphine for opioid addiction inare permitted to prescribe.

For further information, please contact:
Sandy Harding, Senior Director of Federal Advocacy
American Academy of Physician Assistants
Telephone: 703-836-2272, ext. 3205
E-mail: sharding@aapa.org

EXTENDING MEDICAID EHR INCENTIVE PAYMENTS TO PHYSICIAN ASSISTANTS

Extending Medicaid EHR Incentive Payments to Physician Assistants

Recommendation
The American Academy of Physician Assistants recommends that section 4201(a)(3)(B) of the Health Information Technology for Economic and Clinical Health (HITECH) Act be amended to extend the EHR Medicaid incentive payment to all physician assistants whose patient volume includes at least 30% Medicaid recipients.

Background
As introduced, HITECH offered electronic health record (EHR) incentives to physicians, dentists, and advanced practice nurses with a patient volume of at least 30% Medicaid recipients. Physician assistants (PAs) were not included in the list of eligible health professionals. (An incorrect assumption was made that an incentive payment to physician assistants would be covered under the payment to physicians.) The provision was partially fixed by extending the EHR incentive payment to PAs practicing in a rural health clinic (RHC) or federally qualified health center (FQHC) led by a PA. The partial fix is not sufficient to meet the needs of medical practices and clinics in which PAs provide a
high volume of care to Medicaid beneficiaries.

Rationale
More than 75,000 physician assistants provide high quality, cost-effective medical care in virtually all health care settings and in every medical and surgical specialty. An estimated 6,000 PAs are employed in RHCs and FQHCs. Enhanced, quality patient care is the ultimate beneficiary of the use of electronic health records. The current ARRA limitation on Medicaid EHR limits the development of EHR systems for Medicaid beneficiaries who are served by PAs. PAs are often the sole health care professional in medically underserved communities, and they may not be employed by an RHC or FQHC. Some of the most vulnerable practices, who serve at-risk populations, such as border communities, are excluded from the EHR incentive, because it is not made available to PAs with patient volumes of 30% and above Medicaid patients.
Medical practices and clinics that employ a large number of PAs are penalized through the Medicaid EHR incentive limitation. Additionally, an incentive program that fully recognizes physicians and advance practice nurses, but not PAs, creates a financial disincentive for medical practices to hire PAs.

For further information, please contact:
Sandy Harding, Senior Director of Federal Advocacy
American Academy of Physician Assistants
Telephone: 703-836-2272, ext. 3205
Email: sharding@aapa.org