On April 16, 2015, H.R.2-Medicare Access and CHIP Reauthorization Act of 2015 was signed into law and became Public Law (PL) 114-10. The law made a permanent change to the Medicare physician fee schedule and includes provisions of particular interest to nurse practitioners (NPs). Notably, the law authorizes NPs, clinical nurse specialists (CNSs), and physician assistants (PAs) to sign requests for durable medical equipment (DME). Section 504 of the legislation reads: "Modifies the requirement that a physician order for Medicare durable medical equipment (DME) document that the physician, physician assistant, practitioner, or specialist concerned has had face-to-face encounter with the patient."1
Physician documentation requirement
Passage of the Patient Protection and Affordable Care Act in 2010 included a requirement for a physician to document a face-to-face encounter between a patient and physician, NP, CNS, or PA, which sparked an effort by advanced practice registered nurses to repeal the provision. Representative Jim McDermott (D-WA), a physician and Ranking Member of the House Ways and Means Committee Health Subcommittee, sponsored legislation for 5 years to repeal the physician documentation requirement. Although implementation of the requirement had been postponed, PL 114-10 now officially allows NPs to order-without a physician signature-oxygen, home blood glucose monitors, and other DME. The Medicare Learning Network guidance on documenting the face-to-face encounter and the DME specifically covered is available at: http://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmatte.
Medicare Part B revision
Revision of the Medicare Part B reimbursement formula will benefit NPs as well, despite Medicare reimbursement for NPs remaining at 85% of the physician fee schedule. PL 114-10 repealed the sustainable growth rate formula (SGR), averting a 21% across-the-board decrease in Medicare's physician fees that had been scheduled to take effect on April 1, 2015. The SGR is designed to control spending by automatically reducing Medicare fees if provider spending exceeds a target based on overall economic growth. The SGR is replaced by an approach to reward high-performing providers while supporting alternative payment models, such as accountable care organizations and patient-centered healthcare homes. Fees will increase 0.5% in June 2015 and each subsequent year through 2019 with no further increase through 2025. Alternative payment models will offer providers additional payments.2
The Merit-based Incentive Payment system will consolidate three existing performance incentive programs. Eligible physicians, NPs, CNSs, PAs, and certified registered nurse anesthetists will receive payment increases or decreases based on performance measures to be established by the Department of Health and Human Services.1
Access to NP care
Another section of the law that benefits NPs directs the Secretary of Health and Human Services to make payments for chronic care management services furnished by a physician, PA, NP, CNS, or certified nurse midwife. Funding for community health centers and the National Health Service Corps was extended through fiscal year 2017, and the State Children's Health Insurance Program was also extended through 2017.1 Each of these programs assures patient access to NP care.
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