DOH Proposed Rule Addresses HCA-Sought NPP Ordering Permissions for Home Care  

Situation Report | February 1, 2021 

A newly posted state Department of Health (DOH) revised proposed rule is poised to address a long-sought HCA priority: allowing non-physician practitioners (NPP) to broadly order home care services in New York State. 

The rule, as noted elsewhere in this week’s Situation Report, also includes several proposed changes to personal care and the Consumer Directed Personal Assistance Program (CDPAP).

Page 237 of the proposed rule summary here explains the following change for personal care and CDPAP services, noting the applicability of Nurse Practitioner (NP) and Physician Assistant (PA) orders to “all manner of home care service”:  

Regulations have been amended to clarify that a physician signature on the order form is no longer required when an NP or PA conducts the clinical examination. Based on these comments, the Department believes not requiring a physician signature on the order form in these cases is consistent with recent changes in federal law that allows for NPs and PAs, rather than physicians, to order all manner of home care service.   

While HCA has some follow-up questions for the Department, the language suggests broad applicability of NPP-ordering permissions. In December, HCA was advised of DOH’s decision to pursue this rule change and was informed at the time that DOH’s overall intention was to apply these changes to personal care, Managed Long Term Care (MLTC), CHHAs and Licensed Home Care Services Agencies (LHCSAs). HCA is reaching out to DOH for further confirmation now that this proposal is posted.  

We also stress that this is a proposed rule, and not in effect. It is subject to a 45-day comment period. Providers and MLTCs should write in strong support of this proposal as instructed in the New York State Register notice (page 35). 

NPP orders a longtime priority

Allowing NPP orders for home care has been a longtime priority. HCA and our national association partners were very supportive in March when the federal CARES Act allowed NPP orders for home health. However, while this flexibility was permitted at the federal level, New York State’s Department of Health maintained that a discrepancy existed in state law and regulations, limiting applicability of NPP-ordering permissions across New York home care providers and services, causing confusion for referral sources and continued access-to-care burdens.   

HCA repeatedly contended that existing regulations do provide a path for NPP-ordering permissions across home care programs. We pursued every avenue to reconcile the state’s interpretation with the broader federal allowances.     

Over the past few weeks, DOH officials told HCA that a proposed solution was imminent, and we thank the Department for working to resolve this critical issue. DOH has repeatedly cited HCA’s specific advocacy as a pivotal catalyst for this change. 

HCA will report back to the membership as we learn more about the Department’s proposals and the precise impact for home care.