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