Months Later, Federal Home Care Authorization Change Remains Muddied at State Level

In July, we reported on a state-level discrepancy that has denied New York home care providers from freely acting on a critical home care regulatory change passed by Congress in March to help eligible patients access services more efficiently.

Months later, we still see no clear resolution on the matter.

As part of the CARES Act, Congress authorized certain non-physician practitioners (or NPPs) to order home health services, beyond only doctors — a change that was promptly implemented by the U.S. Centers for Medicare and Medicaid Services (CMS).

Under the change, the authority to produce home care orders now extends federally to nurse practitioners, physician assistants and clinical nurse specialists — but only in states that don’t otherwise limit those permissions or have conflicting ones in place.

New York State has the option to implement these broad NPP ordering permissions; but state Health Department officials have yet to do so, creating a state of limbo for New York providers that has now persisted even seven months later.

That inconsistency has major implications.

Hospitals and physicians, prompted by the federal change, have begun initiating referral requests under the premise that their own NPPs or partner NPPs can now expedite access to home care services at a time when the system is overwhelmed by COVID-19 emergency priorities, and related administrative and clinical duties. The change does not mean new patients are eligible for services. It simply allows for greater flexibility in the qualified medical professionals that may sign off on services.

As we note elsewhere in this month’s Capitol Report, home care referrals from hospitals, physicians and other settings are on the rise overall. Agencies have enough challenge meeting this referral demand because of workforce shortages and other reasons; a discrepancy in the regulations shouldn’t be yet another reason. But it is.

HCA has reached out to all levels of the Department for resolution on the matter, and still awaits a definitive response. Meanwhile, access to services hangs in the balance.

To learn more about this issue, and what you can do to help, please contact HCA’s Director for Public Policy and Advocacy Alyssa Lovelace at