NY Providers in Limbo on Practitioner Orders for Home Care

Clarity needed to expedite service access for patients with COVID-19 and other severe illnesses

Home care providers cheered when federal officials announced earlier this year that certain non-physician practitioners (or NPPs) would now be allowed to order home health services, beyond only doctors. As a result, under federal law today, nurse practitioners, physician assistants and clinical nurse specialists are all permitted to order home health services.

State regulators, however, have left this issue unclear.

New York State long ago moved in the direction of allowing NPPs to order home health services; and with the federal change, the state can implement broad NPP ordering permissions to the full extent now allowed by the federal government.

But officials have failed to do so, creating an inconsistency that demands a resolution so that home care providers in New York State can act on these vital reforms.

Thus, New York home care providers and patients remain in limbo awaiting the state Department of Health (DOH) to announce that services can now be delivered under the new, more flexible rules.

We urge DOH to correct this discrepancy.

What the feds have changed

The change — made by Congress and the U.S. Centers for Medicare and Medicaid Services (CMS) in April — has been a long time coming, prodded by the COVID-19 pandemic and the urgent need to expedite access to home care services at a time when the entire health care system was overwhelmed.

The CMS change helps ease the process for home care providers to begin serving patients who often need services as immediately as possible — for example, when being discharged home from the hospital with serious ongoing needs after a critical illness like COVID-19.

In short, the CMS change broadens the types of advanced practice professionals that home care agencies can now turn to as they seek sign off for home health service authorization. These authorizations hinge on obtaining orders from medical professionals overseeing a patient’s care.

Why NPPs

Not every patient sees a physician for routine primary or geriatric care. Often it is a non‐physician advanced‐practice clinician who sees the patient and best knows his or her clinical needs. Or, in other cases, a nurse practitioner or physician assistant working with the physician is the clinician most accessible to coordinate with the home care agency and the patient, and to sign the approved orders.

Particularly in COVID-19, physicians have been consumed with urgent care or otherwise diminished in their practice accessibility to sign paperwork timely for initiation of necessary care at home.

COVID-19 brought these system gaps to a head, making it a clear decision for Congress and CMS to change and modernize the requirements. The New York State Legislature took this step nearly 30 years ago, and it’s why now DOH should move promptly to take a next step in response to the new federal permissions by incorporating them fully into state regulations, as DOH is authorized to do.

For a fuller briefing on this matter and how you can help, please contact HCA’s Director for Public Policy and Advocacy Alyssa Lovelace at alovelace@hcanys.org.