Wanting to Learn More about Hospice?

In early 2018, Congress passed the Medicare Patient Access to Hospice Act which allowed the Centers for Medicare & Medicaid Services (CMS) to change the regulations to recognize physician assistants as designated hospice attendings effective January 1, 2019.  

What does this mean?  

PAHPM, along with AAPA have been in direct contact with CMS to help clarify what this change will mean for PAs.  CMS has clarified that while the statute was changed to allow PAs to be hospice attending, there are still separate discretionary Conditions of Participation (COP) rules and regulations that guide hospice actions and these were not changed.  One particular COP, 418.106(b) Standard: Ordering of drugs, states:

Only a physician as defined by Section 1861(r)(1) of the Act, or a nurse practitioner in accordance with the plan of care and State law, may order drugs for the patient.  

If the drug order is verbal or given by or through electronic transmission— 

  1. It must be given only to a licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and  
  2. The individual receiving the order must record and sign it immediately and have the prescribing person sign it in accordance with State and Federal regulations

CMS has stated that this COP can be changed at the discretion of CMS and the Administrator--ie. we do not need another bill to change this.  They will start that process this year, and PAHPM and AAPA will be working closely with them to follow through on this.

One other change that was not made was the wording for who can certify terminal illnesses.  This still will fall to our physician colleagues with hospice.  The law as written, also did not allow PAs to be included as those that can do face-to-face visits during the recertification periods on hospice as our advance practice nurse colleagues currently can with approval from a physician.  This will require a new statute or bill to change the law, and again, PAHPM will continue to advocate for PAs. 

Bottom Line:

PAs will be able to follow care, place orders for care and equipment, and bill for patients for whom we are designated as the patient's elected hospice attending.  CMS did note that PAs are part of the interdisciplinary group (IDG) stating, the attending physician, which could include an NP or PA, does, in fact, play an essential role int he function of the IGD.  We will not be able to prescribe hospice medicines at this time. 

Note, each state has it's own statute and limitations for hospice.  Some mirror CMS regulations, others do not and may be more limiting.  We are working with AAPA to help understand what barriers exist for PAs to practice under the new CMS guidelines in their own states.  

For question regarding restrictive hospice language in your state, you can contact Erika Miller at emiller@aapa.org as noted in the link below.  You may also try reaching out to your state's hospice association--many states have one.  


See the AAPA page with Hospice FAQs.

Keep an eye out on this space for updates and further guidance!

More work to do!

Needing resources on how to care for patients on Hospice?

Visit some of these resources here.   Members, more to come on this website to help you prepare for 2019!

End-of-Life Resources --Collection of content from AFP on End-of-Life Care and Resources

The Hospice Referral

The Role of the Family Physician in the Hospice Referral and Management of Hospice