A Status Report on NP/PA Ordering Authority for Home Care

Situation Report | April 5, 2021

HCA continued last week with our relentless petition of the state Department of Health (DOH) to greenlight nurse practitioner (NP) and physician assistant (PA) orders for home care.

It’s now been a full year since the U.S. Centers for Medicare and Medicaid Services (CMS) and Congress approved NP/PA orders at the federal level but, still, no state guidance has been issued.

In response to our appeals, however, some encouraging news may be finally on the horizon. 

HCA confirmed this week that DOH’s proposed regulatory amendments to Social Services Regulations Title 18 Part 505.14 — which would authorize NP/PAs to order personal care services — may be on track for late April or early May adoption, pending assessment of the public comments received on the proposal (which was part of a broad DOH regulatory package).  

DOH also confirmed that it has already filed the necessary State Medicaid Plan Amendment with CMS that would incorporate NP/PA ordering authority for home care within the state’s overall approved Medicaid plan. 

The Social Services regulatory changes would conform with the existing State Health Regulations (Title 10 Parts 763 and 766) that have long-already provided for NP/PA ordering authority for home care, but the ability to utilize these provisions had been limited by federal requirements permitting home care upon M.D. orders only. HCA has simply asked the state to align its regulations and directives with the new and broader permissions authorized at the federal level several months ago.

HCA continues to urge DOH to issue its NP/PA guidance without any further regulatory or state plan amendment delay. We will keep the membership closely posted of the developments.