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Missouri senators discuss expanding at-home health care licensing

CAITLIN R. KING
Missouri News Network

The Committee for Seniors, Families, Veterans & Military Affairs held a hearing for a bill that would expand provisions to home health licensing Wednesday morning.

Sponsored by Sen. Justin Brown, R-Rolla, Senate Bill 177 would eliminate the requirement for “a physician to sign off on home health certification or for Medicare to approve the care” and would instead “allow a nurse practitioner physician assistant to certify home health at the time it is needed … and allow patients a right to choose their home as a place to recover.”

Only allowing a physician to sign off on home health care “results in delays,” Brown said. “These delays in getting signatures and therefore delays in care can worsen a chronic condition [and cause] unnecessary emergency room visits.”

The first witness to speak in support of the bill, Carol Hudspeth with the Missouri Alliance for Home Care, said these provisions have already been federally implemented because of the COVID-19 pandemic.

“At the federal level, Medicare requirements allow it. The Missouri home health statute prohibits it because it uses the word ‘physician.’ A physician’s written, signed plan of care. So we need to change that to include nurse practitioners, clinical nurse specialists and physician assistants to mirror the federal regulation,” Hudspeth said.

She clarified, “(the bill) in no way changes any collaborative practice arrangements that are in Missouri. It just simply follows the federal change.”

The last witness to speak, Shantel Dooling, disagreed with Hudspeth’s statement that it would be still be collaborative.

“I don’t believe that that would be the case,” she said. “If there is a collaborative practice already, ... if, regardless, you’re having to wait for the physician, then what is the point of this legislation?”

Dooling is the director of legislative affairs for the Missouri State Medical Association. Her major issue with the bill is that “there’s a big difference between management of a treatment plan and establishing a treatment plan.”

The MSMA, Dooling said, “rarely get[s] a lot of our member physicians reaching out to us when a bill comes up. It’s generally us bringing it to their attention and getting what their concerns are. However, on this bill, we had a lot of members that were reaching out to us. They feel like this could potentially be a huge scope issue.”

Gov. Mike Parson signed executive orders in March of 2020 that temporarily waived certain licensure requirements for physicians, anesthesiologist assistants, perfusionists, physical therapists, physical therapy assistants and physician assistants.

“Since then, … home health agencies have been able to utilize nurse practitioners and physician assistants to get home health services ordered,” Hudspeth said.

MSMA agencies in areas like Kansas City, Rolla, Springfield and southeast Missouri have benefited from these orders, particularly in time-sensitive situations, Hudspeth said.

“(The waiver) allows us to talk directly with the patient’s primary provider when obtaining orders rather than having to go through the physician, who has never seen the patient,” Hudspeth said. “This results in improved coordination of care.”