Hard News: Physician cosignature required for DME ordered for Medicaid patients

As many of you have heard, the Washington State Health Care Authority (HCA), as of January 1, is requiring NP's and PA's to have physician cosignature for almost all DME for medicaid patients. This will include things like braces and supports, crutches, diabetic testing and injection supplies, in addition to diabetic shoes and home health (which has been the case for years). 

Effective January 1, 2019, only physicians will be authorized to order home health services and medical equipment.

The Health Care Authority (HCA) is amending its rules for home health services (Chapter 182-551 WAC, Subchapter II) and medical equipment (Chapter 182-543 WAC) to align with federal regulations published by the Centers for Medicare and Medicaid Services. Advanced registered nurse practitioners (ARNPs) or physician assistants (PAs) ordering home health services or medical equipment must have a physician’s signature on their requested order.

Please see the November 14, 2018 letter from Medicaid Director MaryAnne Lindeblad for more information, as well as the proposed home health services rules and medical equipment rules for a full description of all the changes.

Read how YOU can help:  Representatives of ARNPs United met with national leaders from the American Association of Nurse Practioners discussing strategies to mitigate newly implemented rules by the Washington State Health Care Authority (HCA) requiring a physician  order for medical supplies and home care for our Medicaid patients. A coalition of national organizations, including AARP, the American College of Nurse Midwives, the Association of Physician Assistants, Community Health Centers Association and suppliers formed to support federal legislation amending this rule. We need your stories, how the rules impact you, your patients and your employer? What is it costing you and your employer to get the extra coding and documentation into patient charts? Many of you have submitted concerns, your story can carry farther. Attached to this announcement is a sample letter to give your patients to assist them describe how these rules have delayed access to covered services.

ARNPs United and representatives from the Nursing Care Quality Assurance Commission met with HCA staff and asked them to review our Global Signature Legislation passed in Washington State in 2015 to ameliorate the immediate issue. We will meet with them again for their response.

Send your impact stories and documentation of increased costs through the website for ARNPs United or comment below. We will forward them to the national coalition as well as the state and regional stakeholders. 

Serena Williams, ARNP, CRNPA secretary