By Greg Freeman
EXECUTIVE SUMMARY
Policies enacted for non-physician practitioners during the pandemic may need revision. Federal and state authorities are tightening some rules back to pre-pandemic status.
- Non-physician practitioners were given more autonomy during the pandemic.
- States are reverting to tighter controls on prescribing and telehealth services.
- Healthcare organizations should monitor changes in their own states.
Workforce shortages prompted many hospitals and health systems to make more use of non-physician practitioners in recent years, particularly during the pandemic. Many continued this practice after seeing how nurse practitioners, physician assistants, and other non-physicians can offer cost savings.
Pandemic-era rules allowing relaxed licensing and supervision requirements for non-physicians are undergoing revisions, which means healthcare employers may need to review their policies. For example, in 2022, CMS ended its blanket waivers and reinstated federal physician supervision requirements and other restrictions for some facilities. In addition, many states relaxed scope of practice requirements during the pandemic and are revising those positions now, says Amanda J. Newlon, JD, an attorney with Trenam Law in Tampa, FL.
“The trend that I have been seeing is that the states are kind of falling in line with the federal government, and a lot of states have started to make adjustments to scope of practice for mid-level practitioners. I don’t think it’s any secret that over the past few years, we’ve seen the opening up of independent practice for APRNs [advanced practice registered nurses] in particular,” Newlon says. “Physician assistants are stuck a little bit behind APRNs, in my opinion, with respect to gaining autonomous practice. But you can certainly see that with the COVID waivers, you have more APRNs who are able to operate without supervisory relationships.”
Telehealth services expanded dramatically during the pandemic, due in part to relaxed requirements from CMS and states. Newlon says that also is changing. “Every state has its own scope of practice requirements, its own telehealth supervision requirements,” she says. “There are a lot of states that are making it mandatory to pay for telehealth services through Medicaid and saying insurers have to pay for it at the same rate as they would for in-person [services].”
Another important issue for facilities using telehealth is mid-level practitioners’ prescriptive authority for controlled substances. Some states were more lenient with that prescribing during the pandemic and are now contracting back to earlier restrictions.
For example, Florida suspended some restrictions on APRNs prescribing controlled substances because of the pandemic, allowing a virtual evaluation of a patient for a controlled substance prescription. The earlier restrictions are back in effect now, so an APRN can prescribe controlled substances only after seeing the patient in person.
It is changes like that — many of them at the state level — that healthcare organization should track as the country transitions out of the pandemic, Newlon says. With rules changing so much, it can be difficult — and it can be expensive to consult an attorney about every change.
“There is a lot of confusion out there right now about what exactly you can do,” Newlon says. “They’re confused, but everybody’s heart is in the right place. They’re trying, but it just changes so quickly, and it’s very hard to keep track of the little details.”
SOURCE
- Amanda J. Newlon, JD, Trenam Law, Tampa, FL. Phone: (813) 202-7811. Email: [email protected].
Pandemic-era rules allowing relaxed licensing and supervision requirements for non-physicians are undergoing revisions, which means healthcare employers may need to review their policies. For example, in 2022, CMS ended its blanket waivers and reinstated federal physician supervision requirements and other restrictions for some facilities.
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