Maryland Waiver Eases Homebound Patients’ Access to Nurses
A major recommendation of the Institute of Medicine’s 2010 Future of Nursing: Leading Change, Advancing Health report, written to improve health and health care for all Americans, is to allow advanced practice registered nurses (APRNs) to order and certify home health services. Starting in January, Maryland’s nurse practitioners (NPs) will be able to do so.
What are home health services, and why Maryland?
Home health services are Medicare benefits provided to beneficiaries in their homes, including wound care, physical and occupational therapy, patient and caregiver education, and monitoring serious illness. A year ago — in January 2019 — Maryland and the Centers for Medicare and Medicaid Services launched the state’s Total Cost of Care Model, which set an annual savings for each Medicare beneficiary. But that came up against the federal law requiring that homebound patients be under the care of a physician to receive home health care services—a rule that increases costs and delays services when an NP is the primary care provider. Thus was born change request (CR) number 11330, the Maryland waiver to this federal restriction that went into effect January 1.
Cost savings are not the only reason this waiver makes sense. NPs make most of the nation’s house calls. As I wrote in 2012, allowing Maryland’s NPs to certify home health services will benefit consumers by increasing continuity of care and benefit physicians by removing this paperwork requirement.
Maryland’s NPs, their patients, hospitals and other referral sources, and home health agencies need to learn about the waiver to ensure a smooth transition. Among organizations helping spread the news:
- The Nurse Practitioner Association of Maryland created a webpage about the waiver and provides updates in weekly email blasts.
- The American Association of Nurse Practitioners (AANP) posted an advocacy webpage about the Maryland waiver with an email to its Maryland members.
- Maryland-National Capital Homecare Association is charged with getting the word out to its members, troubleshooting billing issues, and encouraging home health agencies to collect data about the number of referrals from NPs, type and length of services, and number of unplanned emergency department visits or rehospitalizations.
This last point is especially important, as data collection is essential for the successful implementation of the waiver and for future efforts in other states and nationally.
What about the rest of the nation? Current legislation to allow NPs and other APRNs to certify home health services, the Home Health Care Planning Improvement Act (S. 296/H.R. 2150), is supported by AARP, AANP, and the American Academy of Home Care Medicine. These bills have bipartisan support, including 38 co-sponsors in the United States Senate and 122 co-sponsors in the House of Representatives. Advocates are hopeful that this legislation will be passed or that the bill language will be inserted in other successful legislation.
Andrea Brassard is a senior strategic policy adviser for the Center to Champion Nursing in America, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation.