CMS Requests Feedback on Scope of Practice for Nonphysician Providers: Comments Due January 17, 2020

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.

CMS is 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 the Department of Health & Human Services (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 health care professionals, including physician assistants (PAs) and advanced practice registered nurses (APRNs), from practicing at the top of their professional license.

In response to suggestions CMS has 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.

CMS is requesting help in identifying additional Medicare regulations that contain more restrictive supervision requirements than existing state scope of practice laws, or that limit health professionals from practicing at the top of their license. CMS is reviewing comments  already submitted in response to the 2019 Request for Information on Reducing Administrative Burden to Put Patients over Paperwork. CMS also welcomes any additional recommendations. Send additional recommendations to PatientsOverPaperwork@cms.hhs.gov with the phrase “Scope of Practice” in the subject line by January 17, 2020.

Note: CMS continues to welcome your input on ways in which it can reduce unnecessary burden, increase efficiencies, and improve the beneficiary experience, and requests 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.

Submit Comments to CMS