2 comments
We respectfully request the 10% FMAP for Medicaid HCBS be used for a rate increase for Medicaid Agency Directed Personal Care Providers as this waiver is not adequately funded to care for the Commonwealth's most vulnerable population. Agency Directed Personal Care Providers have already incurred the increased costs associated w/Covid-19 and the cost of revenue and continue to be impacted by the minimum wage increase which took effect May 1, 2021. Agency Directed Providers are facing tan additionally unfunded minimum wage increase January, 2022 which will further jeopardize our ability to continue to provide crucial community home based personal care at a tremendous cost savings to the Commonwealth over these recipients receiving care in a skilled nursing or rehab facility.
In order to continue providing this invaluable home based community service to the Commonwealth's most vulnerable population, we recommend Virginia State policy makers:
Sincerely,
Janelle Caldwell, AmeriCare Plus-Staffing Coordinator
June 24, 2021
Emily McClellan
Virginia Department of Medical Assistance Services
Regulatory Manager
Division of Policy and Research
600 E. Broad St., Suite 1300
Richmond, VA 23219
Submitted via: Virginia regulatory town hall
RE: General Notice: Draft Home Health Provider Manual
Dear Ms. McClellan,
The American Association of Nurse Practitioners (AANP), with a membership of over 118,000 nurse practitioners (NPs), represents the interests of the more than 325,000 NPs in the United States. This includes the over 7,809 NPs practicing in Virginia, 1,999 of whom are AANP members. AANP welcomes the opportunity to provide comment on the proposed draft of the home health provider manual.
AANP appreciates that the Virginia Department of Medical Assistance Services (DMAS) made it a priority to update the home health provider manual and the department’s continued work towards ensuring that home health agencies are authorized to accept orders for home health services from NPs and other qualified clinicians. However, we do have recommended changes to the “Face-to-Face Encounter Requirements for Fee-for-Service” section of the draft provider manual to ensure that it aligns with Section 3708 of the CARES Act, federal home health regulations, and the Virginia Nurse Practice Act.
On page 5 of the DMAS home health provider manual, the agency addresses “Face-to-Face Encounter Requirements for Fee-for-Service.” The manual states that “the face-to-face encounter must be conducted by one of the following five (5) practitioners” which include “a licensed nurse practitioner or licensed clinical nurse specialist working in collaboration and with a practice agreement with the physician who orders the individual's services.” This language does not reflect the changes pursuant to Section 3708 of the CARES Act, 42 CFR § 440.70 and 12 VAC 30-50-160 which authorize NPs to order home health services (which is reflected throughout the rest of the manual) or the Code of Virginia Chapter 29 § 54.1-2957 which authorizes nurse practitioners licensed in Virginia to practice without a collaborative practice agreement if certain criteria are met.
The draft language which states “the physician who orders the individual’s services” infers that a physician is still required to order home health services. We believe that this language was an oversight, as DMAS clearly authorized nurse practitioners and other clinicians to order home health services throughout the rest of the manual in accordance with Section 3708 of the CARES Act, 42 CFR § 440.70, 12 VAC 30-50-160 and Virginia’s Medicaid State Plan Amendment. We recommend that this language be deleted from the draft manual.
The collaborative practice agreement requirements for NPs licensed in Virginia are governed by Code of Virginia Chapter 29 § 54.1-2957. Chapter 29, § 54.1-2957, sub-section (I) reads “A nurse practitioner, other than a nurse practitioner licensed by the Boards of Medicine and Nursing in the category of certified nurse midwife or certified registered nurse anesthetist, who has completed the equivalent of at least five years of full-time clinical experience as a licensed nurse practitioner, as determined by the Boards, may practice in the practice category in which he is certified and licensed without a written or electronic practice agreement upon receipt by the nurse practitioner of an attestation from the patient care team physician.” When a nurse practitioner meets the requirements of the licensing chapter, they may practice without a collaborative agreement. Therefore, the face-to-face requirements as currently drafted in the home health provider manual are not consistent with Code of Virginia Chapter 29 § 54.1-2957.
In order to better reflect the intent of the CARES Act and the other changes made by DMAS in the home health provider manual, we respectfully request the agency remove the following language: “working in collaboration and with a practice agreement with the physician who orders the individual's services.” This change will ensure consistency within the home health regulations and reduce confusion for patients and health care providers.
We thank you for the opportunity to comment on these proposed changes to the Virginia Department of Medical Assistance home health provider manual and again express our appreciation for making increased access to home health services a priority. These proposed regulations will increase the ability of NPs and other clinicians to deliver high-quality, cost-effective health care and will improve access to these services for residents of Virginia. Should you have comments or questions, please direct them to Frank Harrington, Director of Reimbursement and Regulatory Affairs, fharrington@aanp.org, (571) 777-8454.
Sincerely,
Tay Kopanos, DNP, NP
VP of State Government Affairs