CMS Calls for Feedback on Scope of Practice - due by 01/17/2020

The NYSCA has been in contact with the American Chiropractic Association (ACA) regarding possible changes to Medicare as outlined in the following letter from National Government Services.

The lack of coverage for services and procedures that fall under the scope of practice of Doctors of Chiropractic results in an increased burden to seniors who have to pay for these services out of pocket, be referred to a specialist to have them performed or forgo necessary care altogether.

In addition, patients who see Doctors of Chiropractic are less likely to use opioids, undergo surgical procedures, and have a high level of satisfaction. The current Medicare rules and statutes present barriers to cost effective and safe care rendered under the license of a Doctor of Chiropractic and should be modified to reflect the full range of serviced permitted under state laws.

Comments from stakeholders is important and we encourage members to take the time to write a letter emphasizing the issues we face in trying to provide the highest quality health care for seniors under the restrictions imposed by Medicare. Comments must be received by next Friday, January 17, 2020. Please send these to [email protected] with the subject line “Scope of Practice”.

Feedback on Scope of Practice

The Centers for Medicare & Medicaid Services (CMS) is seeking additional input and recommendations regarding elimination of specific Medicare regulations that require more stringent supervision than existing state scope of practice laws, or that limit health professionals from practicing at the top of their license.

We are seeking additional feedback in response to part of the President’s Executive Order (EO) #13890 on Protecting and Improving Medicare for Our Nation’s Seniors. The EO specifically directs HHS to propose a number of reforms to the Medicare program, including ones that eliminate supervision and licensure requirements of the Medicare program that are more stringent than other applicable federal or state laws. These burdensome requirements ultimately limit healthcare professionals, including Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), from practicing at the top of their professional license.

In response to suggestions we have already received regarding supervision, scope of practice, and licensure requirements, CMS has made a number of regulatory changes in several payment rules, including the CY 2020 Physician Fee Schedule, Home Health, and Outpatient Prospective Payment System final rules. These changes include, but are not limited to: redefining physician supervision for services furnished by PAs, allowing therapist assistants to perform maintenance therapy under the Medicare home health benefit and reducing the minimum level of physician supervision required for all hospital outpatient therapeutic services.

We are proud of the work accomplished, and now we need your help in identifying additional Medicare regulations which contain more restrictive supervision requirements than existing state scope of practice laws, or which limit health professionals from practicing at the top of their license. If you submitted comments on these topics to our 2019 Request for Information on Reducing Administrative Burden to Put Patients over Paperwork, thank you! We are reviewing those submissions.

We welcome any additional recommendations. Please send your recommendations to [email protected] with the phrase “Scope of Practice” in the subject line by January 17, 2020.

We also continue to welcome your input on ways in which we can reduce unnecessary burden, increase efficiencies and improve the beneficiary experience, and request that input on such topics only be sent to this email address with the phrase “Scope of Practice” in the subject line if they relate to the specific areas in regulation which restrict non-physician providers from practicing to the full extent of their education and training.

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