Health and Human Services Commission Council. SUBJECT: Item 5.a. Payment to Advanced Practice Registered Nurses and Physician Assistants

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Health and Human Services Commission Council. SUBJECT: Item 5.a. Payment to Advanced Practice Registered Nurses and Physician Assistants"

Transcription

1 TO: Health and Human Services Commission Council DATE: August 15, 2014 FROM: Laurie Vanhoose, Medicaid/CHIP, Director of Policy Development SUBJECT: Item 5.a. Payment to Advanced Practice Registered Nurses and Physician Assistants BACKGROUND: Federal Requirement Legislative Requirement Other The proposed amendments clarify that services performed by an advanced practice registered nurse (APRN) or a physician assistant (PA) but billed by a supervising physician are to be reimbursed according to the requirements in chapter 355 of the Texas Administrative Code. Currently, APRNs, under title 1, of the Texas Administrative Code (TAC), and PAs, under TAC title 1, , are to be reimbursed at 92 percent of the physician rate for professional services billed under their own provider numbers and 100 percent of the physician rate for laboratory services, x-ray services, and injections. Due to a lack of clarity in current rule and certain technical limitations, a physician may bill for services performed by an APRN or PA under the physician's supervision at the full physician rate. Cost containment measures carried out in response to the General Appropriations Act, which directs HHSC to enforce appropriate payment practices for non-physician services, include ensuring application of the 92 percent reimbursement rate for APRNs and PAs performing under the supervision of a physician. See General Appropriations Act, 83d Leg., R.S., ch. 1411, art. II, at II-101, 2013 Tex. Gen. Laws 3743, 3952 (Health and Human Services Section, Health and Human Services Commission, rider 51(b)(24)). The term APRN, previously known as nurse practitioner, includes the following categories of nurses with advanced training: nurse practitioner (NP), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), and certified nurse-midwife (CNM). HHSC is proposing to amend to require a physician billing for supervised services to indicate that the supervised services were performed by an APRN or PA, as appropriate, on the physician's claim form. HHSC is also proposing to amend to clarify that the payment rate for the supervised services is set in accordance with the appropriate reimbursement rule. Finally, these rule changes are coordinated with proposed clarifications to the corresponding reimbursement rules in chapter 355 for PAs, NPs, CNSs, CRNAs, and CNMs. Those proposed changes clarify that services performed by one of the above provider types while under the supervision of a physician are to be reimbursed at the 92 percent level appropriate to the supervised practitioner. ISSUES AND ALTERNATIVES: 1

2 The proposed rule changes are in response to legislative direction and intended to ensure appropriate payment for services performed under a physician's supervision and, as such, there is no alternative. STAKEHOLDER INVOLVEMENT: The proposed rule amendments were sent to external stakeholders for review. Comments received from stakeholders were reviewed by HHSC staff and taken into consideration. External stakeholders included: Consortium of Texas Certified Nurse-Midwives Texas Nurse Practitioners Texas Clinical Nurse Specialists TxCNS Texas Association of Nurse Anesthetists Texas Academy of Physician Assistants Texas Academy of Family Physicians Texas Association of Health Plans Texas Association of Home Care Hospice Texas Hospital Association Texas Medical Association Texas Osteopathic Medical Association Texas Pediatric Society Texas Society of Psychiatric Physicians FISCAL IMPACT: None (if no, delete the table below) Yes (if yes, complete the table below) SFY15 SFY16 SFY17 SFY18 SFY19 State ($2,859,391) ($4,738,542) ($5,110,796) ($5,503,272) ($5,925,887) Federal ($3,964,932) ($6,358,747) ($6,838,692) ($7,363,858) ($7,929,355) Total ($6,824,323) ($11,097,289) ($11,949,488) ($12,867,130) ($13,855,242) SERVICES IMPACT STATEMENT: Describe the proposed rule s impact on the HHSC client population. Not applicable. The proposed amendments only clarify that services performed by an advanced practice registered nurse (APRN) or a physician assistant (PA) but billed by a supervising physician are to be reimbursed according to the requirements in chapter 355 of the Texas Administrative Code. The proposed amendments clarify that services performed by an advanced practice registered nurse (APRN) or a physician assistant (PA) but billed by a supervising 2

3 physician are to be reimbursed according to the requirements in chapter 355 of the Texas Administrative Code. Clients will not be impacted. RULE DEVELOPMENT SCHEDULE: August 14, 2014 August 15, 2014 October 10, 2014 December 26, 2014 January 1, 2015 Present to the Medical Care Advisory Committee Present to HHSC Council Publish proposed rules in Texas Register Publish adopted rules in Texas Register Effective date REQUESTED ACTION: The Council recommends to the Executive Commissioner that the proposed rule be published in the Texas Register and later adopted should there be no substantive comment. 3

4 TITLE 1 PART 15 CHAPTER 354 SUBCHAPTER A DIVISION 1 RULE DIVISION 5 RULE ADMINISTRATION TEXAS HEALTH AND HUMAN SERVICES COMMISSION MEDICAID HEALTH SERVICES PURCHASED HEALTH SERVICES MEDICAID PROCEDURES FOR PROVIDERS Claim Information Requirements PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES Authorized Physician Services PROPOSED PREAMBLE The Texas Health and Human Services Commission (HHSC) proposes to amend , concerning Claim Information Requirements, and , concerning Authorized Physician Services. Background and Justification The proposed amendments clarify that services performed by an advanced practice registered nurse (APRN) or a physician assistant (PA) but billed by a supervising physician are to be reimbursed according to the requirements in chapter 355 of the Texas Administrative Code. Currently, APRNs, under title 1, of the Texas Administrative Code (TAC), and PAs, under TAC title 1, , are to be reimbursed at 92 percent of the physician rate for professional services billed under their own provider numbers and 100 percent of the physician rate for laboratory services, x-ray services, and injections. Due to a lack of clarity in current rule and certain technical limitations, a physician may bill for services performed by an APRN or PA under the physician's supervision at the full physician rate. Cost containment measures carried out in response to the General Appropriations Act, which directs HHSC to enforce appropriate payment practices for non-physician services, include ensuring application of the 92 percent reimbursement rate for APRNs and PAs performing under the supervision of a physician. See General Appropriations Act, 83d Leg., R.S., ch. 1411, art. II, at II-101, 2013 Tex. Gen. Laws 3743, 3952 (Health and Human Services Section, Health and Human Services Commission, rider 51(b)(24)). The term APRN, previously known as nurse practitioner, includes the following categories of nurses with advanced training: nurse practitioner (NP), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), and certified nurse-midwife (CNM). HHSC is proposing to amend to require a physician billing for supervised services to indicate that the supervised services were performed by an APRN or PA, as appropriate, on the physician's claim form. HHSC is also proposing to amend to clarify that the payment rate for the supervised services is set in accordance with the appropriate reimbursement rule. Finally, these rule changes are coordinated with proposed clarifications to the corresponding reimbursement rules in chapter 355 for PAs, NPs, CNSs, CRNAs, and CNMs. Those proposed changes clarify that services performed by one of the above provider types while under the 4

5 supervision of a physician are to be reimbursed at the 92 percent level appropriate to the supervised practitioner. Section-by-Section Summary Claim Information Requirements The rule is amended to add subsection (b), which states that if the billing provider is a physician supervising the performance of eligible services by a PA, an NP, a CNS, a CRNA, or a CNM, the physician must note on the claim, in accordance with standards set by HHSC, that the services were performed by the supervisee Authorized Physician Services Subsection (a) of the rule is amended to state that services performed under a physician s supervision by a PA, an NP, a CNS, a CRNA, or a CNM will be reimbursed according to the reimbursement rule applicable to the supervised practitioner. Fiscal Note Greta Rymal, Deputy Executive Commissioner for Financial Services, has determined that during the first five-year period the amended rules are in effect, there will be a fiscal impact to state government. The fiscal impact is anticipated to be savings of $2,859,391 in General Revenue (GR) ($6,824,323 All Funds (AF)) for State (SFY) 2015, $4,738,542 GR ($11,097,289 AF) for SFY 2016, $5,110,796 GR ($11,949,488 AF) for SFY 2017, $5,503,272 GR ($12,867,130 AF) for SFY 2018, and $5,925,887 GR ($13,855,242 AF) for SFY The amended rule is not anticipated to result in any fiscal implications to local governments. There are no anticipated economic costs to persons who are required to comply with the proposed rule. There is no anticipated negative impact on local employment. Small and Micro-business Impact Analysis HHSC has determined that there will be no effect on small businesses or micro businesses to comply with the amended rules as the amendment merely clarifies and brings billing practices into compliance with current state policy. Public Benefit Chris Traylor, Chief Deputy Commissioner, has determined that, for each year of the first five years the sections are in effect, the public will benefit from the adoption of the rules. The anticipated public benefit of enforcing the proposed amended rules will be clarifying the APRN and PA provider payment process. 5

6 Regulatory Analysis HHSC has determined that this proposal is not a major environmental rule as defined by of the Texas Government Code. A major environmental rule is defined to mean a rule the specific intent of which is to protect the environment or reduce risk to human health from environmental exposure and that may adversely affect, in a material way, the economy, a sector of the economy, productivity, competition, jobs, the environment, or the public health and safety of a state or a sector of the state. This proposal is not specifically intended to protect the environment or reduce risks to human health from environmental exposure. Takings Impact Assessment HHSC has determined that this proposal does not restrict or limit an owner s right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under of the Government Code. Public Comment Written comments on the proposal may be submitted within 30 days of publication of this proposal in the Texas Register to Alexander Melis, Project Manager, 4900 N. Lamar Blvd., Mail Code H310, Austin, Texas; by fax to (512) ; or by to Statutory Authority--Medicaid These amendments are proposed under Texas Government Code , which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code and Texas Government Code (a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas. The proposed amendments affect Texas Human Resources Code Chapter 32 and Texas Government Code Chapter 531. No other statutes, articles, or codes are affected by this proposal. Statutory Authority--CHIP These amendments are proposed under the authority granted to HHSC by Government Code , which authorizes the Executive Commissioner of HHSC to adopt rules necessary to implement HHSC s duties and Texas Health and Safety Code (d), which directs HHSC to adopt rules necessary to implement the Children s Health Insurance Program. The proposed amendments affect Texas Health and Safety Code Chapter 62, and Texas Government Code Chapter 531. No other statutes, articles, or codes are affected by these proposed amendments. This agency hereby certifies that this proposal has been reviewed and approved by legal counsel and found to be within the agency s legal authority to adopt. 6

7 TITLE 1 PART 15 CHAPTER 354 SUBCHAPTER A DIVISION 1 RULE ADMINISTRATION TEXAS HEALTH AND HUMAN SERVICES COMMISSION MEDICAID HEALTH SERVICES PURCHASED HEALTH SERVICES MEDICAID PROCEDURES FOR PROVIDERS Claim Information Requirements Eligible providers are required to provide separate claim information for each eligible recipient. Claims must be complete, accurate, and as specified by the Health and Human Services Commission or its designee. (a) Required information includes the following: (1) name, address, and appropriate Texas provider identification number of the provider of services or supplies or both; (2) the date of the claim; (3) the name, address, identification number, and date of birth of the individual who received services or supplies or both; (4) the type of such services or supplies or both provided; (5) the date(s) each service or supplies or both were provided; (6) the amounts of each charge for the various types of services or supplies or both; (7) the total charge for services or supplies or both; (8) credits for any payments made at the time of submission of the claim, including payments made by private health insurance and under Medicare; (9) indication that the eligible recipient has health, accident, or other insurance policies, or is covered by private or governmental benefit systems, or other third party liability, when reported, known, or suspected; (10) the date of the eligible recipient's death, if applicable; and (11) the name and associated national provider identifier of: (A) the eligible billing provider; (B) the ordering or referring provider or other professional, if services or supplies, or both, are ordered or referred; and (C) the supervising and supervised provider, except for pharmacy claims, if: 7

8 (i) the services or supplies, or both, were provided due to a referral or ordered by a provider; (ii) the referring or ordering provider is acting at the direction or under the supervision of another provider; and (iii) the referral or order is based on the supervised provider's evaluation of the recipient or enrollee. (b) If the billing provider is a physician supervising the performance of eligible services by a Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, or Certified Nurse-Midwife, the physician must note on the claim, in accordance with standards set by HHSC, that the services were performed by the supervisee. 8

9 TITLE 1 PART 15 CHAPTER 354 SUBCHAPTER A DIVISION 5 RULE ADMINISTRATION TEXAS HEALTH AND HUMAN SERVICES COMMISSION MEDICAID HEALTH SERVICES PURCHASED HEALTH SERVICES PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES Authorized Physician Services (a)this rule specifies the conditions under which a physician may bill Texas Medicaid for covered services. Such conditions include compliance with this rule as well as compliance with all applicable federal and state laws, rules, regulations and policies relating to covered services. (b)physician services. A physician may bill for reasonable and medically necessary services that are within the scope of practice of medicine or osteopathy as defined by state law. Eligible physician services include those performed by the physician and those medical acts delegated by the physician to qualified and properly trained persons acting under the physician's supervision. Services performed under a physician s supervision by a Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM), and Physician Assistant (PAs) are reimbursed according to the reimbursement rule applicable to the supervised practitioner. Delegation and supervision of medical services must be consistent with this chapter and the rules and laws of the Texas Medical Board, and supervision of the delegated medical act must be appropriately documented in the patient's chart. A physician shall not bill the Texas Medicaid program for services if that billing would result in duplicate payment for the same services. (c)physician supervising other physicians. A physician supervising other physicians may bill when the supervision and services are performed in the context of an accredited graduate medical education program. Facilities and professional practices do not qualify for reimbursement for services provided by resident physicians in an outpatient setting unless the facility or professional practice is owned by, or affiliated with, an accredited graduate medical education program. (1)For all services billed to the Medicaid program, the supervision must be medically appropriate, as described in this rule, and provided to a resident physician performing a Medicaid-covered service. The supervision must be either personal or direct. To qualify for reimbursement, the medical record must clearly establish: (A)The nature of the supervisory role of the billing physician in the delivery of the services provided by the resident physician; and (B)That the supervision complies with the definition of supervision applicable to the covered service, as defined in of this title (relating to Definitions). (2)Personal supervision is required during the key portions of all major surgeries and the key 9

10 portions of all other physician services billed to the Medicaid program if the immediate supervision, participation, or intervention of the supervising physician is medically prudent in order to assure the health and safety of the patient. Physician services that require personal supervision may include invasive procedures and evaluation and management services that require complex medical decision making. Situations that require personal supervision include those in which: (A)The clinical condition of the patient is unstable or will likely become unstable during, or as a result of, the planned medical intervention; or (B)The planned medical intervention, even under optimal conditions, will result in medically reasonable risk for significant morbidity or death following the service or procedure; or (C)Deviation from expected technique at the time the procedure or service is performed presents a medically reasonable, causally-related, foreseeable risk to the patient's life or health. (3)For surgical services, the supervising surgeon is responsible for pre-operative, operative, and post-operative care provided to the patient and billed to the Medicaid program. The supervising surgeon, however, may delegate the pre- and post-operative care to a resident if appropriate direct supervision, as defined in of this title, is provided. (4)For all services that do not require personal supervision and are billed to the Medicaid program, the supervising physician must provide direct supervision. The supervising physician may not provide direct supervision for an activity at the same time as providing personal supervision for another activity, with the following exceptions. (A)The supervising physician in the outpatient setting may provide personal and direct supervision concurrently for residents providing evaluation and management services; and (B)A supervising surgeon or supervising anesthesiologist may be involved in two concurrent anesthesia cases with residents. The supervising surgeon or supervising anesthesiologist must be present during all key portions of the procedure if the immediate supervision, participation, or intervention of the supervising physician is medically prudent in order to assure the health and safety of the patient. (5)Supervision in the outpatient setting. A face-to-face encounter between the physician providing direct supervision and the patient is not required in the outpatient setting in the context of a graduate medical education program. All other requirements for personal or direct supervision in this division must be met for the services to qualify for reimbursement. The supervising physician must document that he/she: (A)Reviewed the patient's history and physical examination; (B)Confirmed or revised the patient's diagnosis; 10

11 (C)Determined the course of treatment to be followed; (D)Assured that any needed supervision of interns or residents was provided; and (E)Confirmed that the documentation in the medical record comports with the level of service billed. (6)Supervision in the inpatient setting. A physician who supervises other physicians in an inpatient setting must comply with documentation requirements of paragraph (5)(A) - (E) of this subsection and must document that he or she has completed a: (A)Personal examination of the patient not later than 36 hours after the patient's admission and before the patient's discharge and, as necessary, based on the patient's condition; and (B)Face-to-face encounter with the patient on the same day as any billed services provided by the resident physician. (d)services provided by a physician assistant or advanced practice nurse. If the services are provided by a physician assistant or advanced practice nurse, practicing within the scope of their license and consistent with this chapter and with the rules and laws of the Texas Medical Board and Texas Nursing Board, as applicable, the physician services are covered. Services provided by a certified registered nurse anesthetist must be billed as described in of this title (relating to Certified Registered Nurse Anesthetists' Services). (e)substitute physician. A physician may bill for the services of a substitute physician who sees patients in the billing physician's practice under either a reciprocal or locum tenens arrangement. To qualify for reimbursement, the billing physician and substitute physician must comply with the following requirements: (1)The substitute physician's name and address must be documented on the claim. (2)The substitute physician must be licensed to practice in the state of Texas. (3)Consistent with the requirements of and of this title (relating to Provider Responsibility and Mandatory Exclusion respectively), the substitute physician must be enrolled in Medicaid and not be on the Medicaid or Title XX provider exclusion list. (4)The time period for which a physician may bill for the services of a substitute physician is limited to the following situations: (A)Reciprocal Arrangements. When the substitute physician sees patients in the billing physician's practice under a reciprocal arrangement, the billing physician may bill for services furnished by the substitute physician during a period that does not exceed 14 continuous days. (B)Locum Tenens Arrangements. When the substitute physician sees patients in the billing physician's practice under a locum tenens arrangement, the billing physician may bill for services 11

12 furnished by the substitute physician during a period that does not exceed 90 continuous days. Except as provided in clause (iii) of this subparagraph, services furnished by the substitute physician after the 90th day must be billed under the substitute physician's own Medicaid provider number. (i)when the billing physician is absent for more than 90 days, the billing physician may bill for services furnished by a different substitute physician for each consecutive continuous 90 day period. (ii)the billing physician may only bill for services furnished by a substitute physician on a temporary basis. Except as provided in clause (iii) of this subparagraph, the billing physician may not bill for services furnished by a substitute physician to address long-term vacancies in a physician practice. (iii) When the billing physician is absent or unavailable due to active duty as a member of a reserve component of the U.S. Armed Forces, the billing physician may bill for the services of a substitute physician for a longer continuous period during all of which the billing physician has been called or ordered to active duty as a member of a reserve component of the Armed Forces. Medicaid may reimburse the billing physician for services provided by the substitute physician until the billing physician is no longer on active duty as a member of a reserve component of the Armed Forces. 12

Health and Human Services Commission Council. Kami Geoffray, Medicaid & CHIP Program

Health and Human Services Commission Council. Kami Geoffray, Medicaid & CHIP Program TO: Health and Human Services Commission Council DATE: May 23, 2014 FROM: Kami Geoffray, Medicaid & CHIP Program SUBJECT: Agenda Item 5.b. - Payment to Anesthesiologist Assistants BACKGROUND: Federal Requirement

More information

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION TITLE 1. ADMINISTRATION PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION CHAPTER 354. MEDICAID HEALTH SERVICES SUBCHAPTER A. PURCHASED HEALTH SERVICES The Texas Health and Human Services Commission

More information

Medical Care Advisory Committee. Andy Vasquez, Deputy Director, Medicaid/CHIP Vendor Drug Program Health and Human Services Commission

Medical Care Advisory Committee. Andy Vasquez, Deputy Director, Medicaid/CHIP Vendor Drug Program Health and Human Services Commission TO: Medical Care Advisory Committee DATE: November 8, 2013 FROM: Andy Vasquez, Deputy Director, Medicaid/CHIP Vendor Drug Program Health and Human Services Commission Agenda Item No.: 7 SUBJECT: Fee-for-Service

More information

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION TITLE 1. ADMINISTRATION PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION CHAPTER 354. MEDICAID HEALTH SERVICES SUBCHAPTER A. PURCHASED HEALTH SERVICES DIVISION 5. PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES

More information

Health and Human Services Commission Council. SUBJECT: 5.a. Potentially Preventable Readmissions and Potentially Preventable Complications

Health and Human Services Commission Council. SUBJECT: 5.a. Potentially Preventable Readmissions and Potentially Preventable Complications TO: Health and Human Services Commission Council DATE: June 12, 2015 FROM: Matthew Ferrara, Director, Health Policy & Clinical Services SUBJECT: 5.a. Potentially Preventable Readmissions and Potentially

More information

Medical Care Advisory Committee. Brian Dees, Program Policy, HHSC

Medical Care Advisory Committee. Brian Dees, Program Policy, HHSC TO: Medical Care Advisory Committee DATE: February 20, 2015 FROM: Brian Dees, Program Policy, HHSC Agenda Item No.: 7 Subject: Private Duty Nursing Services New/Repeal: The Texas Health and Human Services

More information

Medicare Information for Advanced Practice Nurses and Physician Assistants. September 2010 / ICN: 901623

Medicare Information for Advanced Practice Nurses and Physician Assistants. September 2010 / ICN: 901623 R Medicare Information for Advanced Practice Nurses and Physician Assistants September 2010 / ICN: 901623 This publication provides information about required qualifications, coverage criteria, billing,

More information

ARIZONA STATE SENATE Fifty-Second Legislature, Second Regular Session

ARIZONA STATE SENATE Fifty-Second Legislature, Second Regular Session Assigned to HHS FOR COMMITTEE ARIZONA STATE SENATE Fifty-Second Legislature, Second Regular Session FACT SHEET FOR registered nurses; advanced practice Purpose Modifies statutes related to the licensing

More information

Provider restrictions apply please see Behavioral Health Policy.

Provider restrictions apply please see Behavioral Health Policy. Payment Policy Mid-Level Practitioner EFFECTIVE DATE: 02 02 2006 POLICY LAST UPDATED: 10 01 2013 OVERVIEW This policy documents the services covered when rendered by a BCBSRI credentialed Mid-level practitioners

More information

ADVANCED PRACTICE REGISTERED NURSE (APRN) FAQS

ADVANCED PRACTICE REGISTERED NURSE (APRN) FAQS 1 ADVANCED PRACTICE REGISTERED NURSE (APRN) FAQS Licensure Q. May I begin orientation as an APRN prior to licensure? A. You may participate in an orientation including anything but delivery of services

More information

In the Hospital Setting

In the Hospital Setting In the Hospital Setting 2013 PENNSYLVANIA HOSPITAL QUALITY: Achieving More Together Use of Physician Assistants, Certified Registered Nurse Practitioners, Certified Nurse Midwives, Certified Registered

More information

SUBCHAPTER JJ. AUTISM SPECTRUM DISORDER COVERAGE DIVISION 1. GENERAL PROVISIONS 28 TAC 21.4401-21.4404

SUBCHAPTER JJ. AUTISM SPECTRUM DISORDER COVERAGE DIVISION 1. GENERAL PROVISIONS 28 TAC 21.4401-21.4404 Part I. Texas Department of Insurance Page 1 of 8 SUBCHAPTER JJ. AUTISM SPECTRUM DISORDER COVERAGE DIVISION 1. GENERAL PROVISIONS 28 TAC 21.4401-21.4404 INTRODUCTION. The Texas Department of Insurance

More information

Advanced Practice Registered Nurses in Texas

Advanced Practice Registered Nurses in Texas Advanced Practice Registered Nurses in Texas Lynda Woolbert, MSN, RN, PNP Executive Director Coalition for Nurses in Advanced Practice www.cnaptexas.org 1 What is an APRN? RN with advanced education, national

More information

Advanced Practice Registered Nurse Legislation

Advanced Practice Registered Nurse Legislation Minnesota Nurses Association Advanced Practice Registered Nurse Legislation Minnesota Nurses Association Revised September, 2005 1625 Energy Park Drive, Suite 200 St. Paul, MN 55108 Phone: (651) 646-4807

More information

Randy Fink Frontier Nursing University December 5 th, 2012

Randy Fink Frontier Nursing University December 5 th, 2012 Randy Fink Frontier Nursing University December 5 th, 2012 A Registered Nurse trained in one of four advanced practice roles at the graduate level (National Council of State Boards of Nursing, 2008) Certified

More information

TABLE 1: General Differences in Prescriptive Authority Law before and after Implementing SB 406

TABLE 1: General Differences in Prescriptive Authority Law before and after Implementing SB 406 Comparison of Texas Prescriptive Authority Law for APRNs Before and After November 1, 2013 Lynda Woolbert, MSN, RN, CPNP-PC, FAANP SB 406 is the new prescriptive authority law governing delegation of prescriptive

More information

SUBCHAPTER EE. High Deductible Health Plans 28 TAC 21.3901-21.3905. 1. INTRODUCTION. The Texas Department of Insurance proposes new 21.

SUBCHAPTER EE. High Deductible Health Plans 28 TAC 21.3901-21.3905. 1. INTRODUCTION. The Texas Department of Insurance proposes new 21. Page 1 of 8 pages SUBCHAPTER EE. High Deductible Health Plans 28 TAC 21.3901-21.3905 1. INTRODUCTION. The Texas Department of Insurance proposes new 21.3901-21.3905 concerning high deductible health plans

More information

Department of State Health Services Council Agenda Memo for State Health Services Council June 14, 2012

Department of State Health Services Council Agenda Memo for State Health Services Council June 14, 2012 Department of State Health Services Council Agenda Memo for State Health Services Council June 14, 2012 Agenda Item Title: New rule concerning Autologous Adult Stem Cell Banks Agenda Number: 4.a Recommended

More information

HANDBOOK FOR ADVANCED PRACTICE NURSES

HANDBOOK FOR ADVANCED PRACTICE NURSES HANDBOOK FOR ADVANCED PRACTICE NURSES CHAPTER N 200 Policy and Procedures for Advanced Practice Nurse Services Illinois Department of Public Aid FOREWORD PURPOSE CHAPTER N-200 ADVANCED PRACTICE NURSE SERVICES

More information

Texas State Government Effectiveness and Efficiency APRN Prescriptive Authority & Recommendations

Texas State Government Effectiveness and Efficiency APRN Prescriptive Authority & Recommendations Texas State Government Effectiveness and Efficiency APRN Prescriptive Authority & Recommendations SUBMITTED TO THE 82ND TEXAS LEGISLATURE JANUARY 2011 LEGISLATIVE BUDGET BOARD STAFF INCREASE ACCESS TO

More information

Department of State Health Services Council Agenda Memo for State Health Services Council September 5-6, 2012

Department of State Health Services Council Agenda Memo for State Health Services Council September 5-6, 2012 Department of State Health Services Council Agenda Memo for State Health Services Council September 5-6, 2012 Agenda Item Title: Amendments to rules concerning breast and cervical cancer services Agenda

More information

2/20/2014. Joette Derricks, CPC, CHC, CMPE, CSSGB, CLHC Vice-President, Regulatory Affairs & Research Anesthesia Business Consultants

2/20/2014. Joette Derricks, CPC, CHC, CMPE, CSSGB, CLHC Vice-President, Regulatory Affairs & Research Anesthesia Business Consultants Joette Derricks, CPC, CHC, CMPE, CSSGB, CLHC Vice-President, Regulatory Affairs & Research Anesthesia Business Consultants Neda M. Ryan, Attorney, Clark Hill PLC Anesthesia Business Consultants, Clark

More information

INS AND OUTS OF MID-LEVEL PROVIDER BILLING

INS AND OUTS OF MID-LEVEL PROVIDER BILLING INS AND OUTS OF MID-LEVEL PROVIDER BILLING Presented by: Amy E. Bishard, BA, CPC, CPMA, CEMC, RCC OBJECTIVES Describe scopes of practice for Nurse Practitioners and Physician Assistants Discuss documentation

More information

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center SECTION 5 HOSPITAL SERVICES Table of Contents 1 GENERAL POLICY... 2 1-1 Clients Enrolled in a Managed Care Plan... 3 1-2 Clients NOT Enrolled in a Managed Care Plan (Fee-for-Service Clients)..................

More information

Title 30: Professions and Occupations. Part 2630 Collaboration. Part 2630 Chapter 1: Collaboration with Nurse Practitioners

Title 30: Professions and Occupations. Part 2630 Collaboration. Part 2630 Chapter 1: Collaboration with Nurse Practitioners Title 30: Professions and Occupations Part 2630 Collaboration Part 2630 Chapter 1: Collaboration with Nurse Practitioners Rule 1.1 Scope. These rules apply to all individuals licensed to practice medicine

More information

The Evolving Role of the Midlevel Providers

The Evolving Role of the Midlevel Providers The Evolving Role of the Midlevel Providers Sarah Sinclair Executive Chief Nursing Officer Stanley Shalom Zielony Institute for Nursing Excellence May 12, 2011 Overview Healthcare and the economy Workforce

More information

Oregon CO-OP Modifier Table - December 2013

Oregon CO-OP Modifier Table - December 2013 Oregon CO-OP Modifier Table - December 2013 Modifier Modifier Description Pricing Functionality 22 Increased Procedural Services Modifier 22 should only be reported with procedure codes that have a global

More information

Prescriptive Authority Frequently Asked Questions Mandated by Senate Bill 406

Prescriptive Authority Frequently Asked Questions Mandated by Senate Bill 406 Agenda Item: 7.7 Prepared by J Zych Meeting Date: January 23-24, 2014 Prescriptive Authority Frequently Asked Questions Mandated by Senate Bill 406 Summary of Request: This agenda item is for information

More information

Prepared By: The Professional Staff of the Committee on Health Policy REVISED:

Prepared By: The Professional Staff of the Committee on Health Policy REVISED: BILL: SB 152 The Florida Senate BILL ANALYSIS AND FISCAL IMPACT STATEMENT (This document is based on the provisions contained in the legislation as of the latest date listed below.) Prepared By: The Professional

More information

Health Law Alert. Supervision Requirements for CRNAs in Indiana

Health Law Alert. Supervision Requirements for CRNAs in Indiana Health Law Alert March 31, 2006 About Hall Render Hall, Render, Killian, Heath & Lyman is a full service health law firm with offices in Indiana, Kentucky, Michigan and Wisconsin. Since the firm was founded

More information

DEPARTMENT OF SOCIAL SERVICES AUDIT PROTOCOL PHYSICIAN SERVICES UPDATED FEBRUARY 1, 2015

DEPARTMENT OF SOCIAL SERVICES AUDIT PROTOCOL PHYSICIAN SERVICES UPDATED FEBRUARY 1, 2015 DEPARTMENT OF SOCIAL SERVICES AUDIT PROTOCOL PHYSICIAN SERVICES UPDATED FEBRUARY 1, 2015 Listed are the most common audit findings noted for physician services provided under the State Medicaid program,

More information

July 17, 2015. Submitted electronically to: www.regulations.gov

July 17, 2015. Submitted electronically to: www.regulations.gov Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS 2390 P P.O. Box 8016 Baltimore, MD 21244 8016 Submitted electronically

More information

SHORT TITLE: Professions and occupations; Oklahoma Nursing Practice Act; certified registered nurse anesthetists; modifying certain definition;

SHORT TITLE: Professions and occupations; Oklahoma Nursing Practice Act; certified registered nurse anesthetists; modifying certain definition; SHORT TITLE: Professions and occupations; Oklahoma Nursing Practice Act; certified registered nurse anesthetists; modifying certain definition; effective date. STATE OF OKLAHOMA 1st Session of the 45th

More information

SHORT TITLE: Professions and occupations; certified registered nurse anesthetist scope of practice; effective date.

SHORT TITLE: Professions and occupations; certified registered nurse anesthetist scope of practice; effective date. SHORT TITLE: Professions and occupations; certified registered nurse anesthetist scope of practice; effective date. STATE OF OKLAHOMA 2nd Session of the 45th Legislature (1996) SENATE BILL NO. 943 By:

More information

ADVANCING HIGHER EDUCATION IN NURSING

ADVANCING HIGHER EDUCATION IN NURSING September 4, 2012 Submitted via www.regulations.gov Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attn: CMS 1590 P P.O. Box 8010

More information

Medicare Information for Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants

Medicare Information for Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Serices R Official CMS Information for Medicare Fee-For-Serice Proiders Medicare Information for Adanced Practice Registered Nurses,

More information

STATE OF WISCONSIN BOARD OF NURSING

STATE OF WISCONSIN BOARD OF NURSING STATE OF WISCONSIN BOARD OF NURSING --------------------------------------------------------------------------------------------------------------------- IN THE MATTER OF RULE-MAKING : PROPOSED ORDER OF

More information

Section. CPT only copyright 2007 American Medical Association. All rights reserved. 2Texas Medicaid Reimbursement

Section. CPT only copyright 2007 American Medical Association. All rights reserved. 2Texas Medicaid Reimbursement Section 2Texas Medicaid Reimbursement 2 2.1 Reimbursement.................................................... 2-2 2.1.1 Electronic Funds Transfer........................................ 2-2 2.1.1.1 Using

More information

How Do I Ask Questions During this Training? Questions that arise during the training may be emailed to: elibrarytraining@ahca.myflorida.com.

How Do I Ask Questions During this Training? Questions that arise during the training may be emailed to: elibrarytraining@ahca.myflorida.com. How Do I Ask Questions During this Training? Questions that arise during the training may be emailed to: elibrarytraining@ahca.myflorida.com. 2 Training Objectives Describe new information contained in

More information

Compliance Risks with Non-Physician Practitioners

Compliance Risks with Non-Physician Practitioners Compliance Risks with Non-Physician Practitioners Kim Huey, MJ, CPC, CCS-P, PCS Health Care Compliance Association Clinical Practice Compliance Conference October 2013 NPP Coding and Billing Definitions

More information

Physician Extenders: Know the Compliance Risks Surrounding Midlevel Practitioners. January 24, 2014

Physician Extenders: Know the Compliance Risks Surrounding Midlevel Practitioners. January 24, 2014 Physician Extenders: Know the Compliance Risks Surrounding Midlevel Practitioners January 24, 2014 Tizgel K. S. High, Esq. LifePoint Hospitals, Inc. Catherine (Kate) S. Stern, Esq. King & Spalding LLP

More information

Reimbursement Rules That Could Trip Up Hospital Attorneys THEMES

Reimbursement Rules That Could Trip Up Hospital Attorneys THEMES Reimbursement Rules That Could Trip Up Hospital Attorneys Cynthia F. Wisner Associate Counsel, Trinity Health 1 THEMES Medicare is eliminating grandfathering and bundling payments Lab technical fees 3

More information

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97 6 The Collaborative Models of Mental Health Care for Older Iowans Model Administration Collaborative Models of Mental Health Care for Older Iowans 97 Collaborative Models of Mental Health Care for Older

More information

Nurse Practitioners and Physician Assistants as Billing Providers

Nurse Practitioners and Physician Assistants as Billing Providers Office of Origin: UCSF Clinical Enterprise Compliance Program I. PURPOSE To establish guidelines for UCSF Nurse Practitioners (NP) and Physician Assistants (PA) to bill Medicare, Medi-Cal and other payors

More information

02- DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION. Chapter 8 REGULATIONS RELATING TO ADVANCED PRACTICE REGISTERED NURSING

02- DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION. Chapter 8 REGULATIONS RELATING TO ADVANCED PRACTICE REGISTERED NURSING 02- DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 380 BOARD OF NURSING Chapter 8 REGULATIONS RELATING TO ADVANCED PRACTICE REGISTERED NURSING SUMMARY: This chapter identifies the role of a registered

More information

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee New Patient Visit Policy Number NPV04242013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 12/16/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to

More information

TELEMEDICINE, TELEHEALTH, AND HOME TELEMONITORING TEXAS MEDICAID SERVICES. Biennial Report to the Texas Legislature

TELEMEDICINE, TELEHEALTH, AND HOME TELEMONITORING TEXAS MEDICAID SERVICES. Biennial Report to the Texas Legislature TELEMEDICINE, TELEHEALTH, AND HOME TELEMONITORING TEXAS MEDICAID SERVICES Biennial Report to the Texas Legislature As Required by Texas Government Code 531.0216 Texas Health and Human Services Commission

More information

The following instructions are taken directly from the Consultations section of CPT:

The following instructions are taken directly from the Consultations section of CPT: Heading: Clarification Title: Consultations Noridian Administrative Services (NAS) published this article on Consultations in Medicare B News, Issue 222, which was dated September 7, 2005. This article

More information

Provider Handbooks. Telecommunication Services Handbook

Provider Handbooks. Telecommunication Services Handbook Provider Handbooks January 2016 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health

More information

MEDICAL SERVICE RESEARCH AND DEVELOPMENT PLAN AND UT PHYSICIANS

MEDICAL SERVICE RESEARCH AND DEVELOPMENT PLAN AND UT PHYSICIANS MEDICAL SERVICE RESEARCH AND DEVELOPMENT PLAN AND UT PHYSICIANS BILLING AND DOCUMENTATION GUIDELINES MEDICAL SERVICE RESEARCH AND DEVELOPMENT PLAN AND UT PHYSICIANS BILLING AND DOCUMENTATION GUIDELINES

More information

Ohio Legislative Service Commission

Ohio Legislative Service Commission Ohio Legislative Service Commission Bill Analysis Lisa Musielewicz S.B. 228 129th General Assembly (As Introduced) Sens. Burke, Lehner, Schiavoni, Tavares, Schaffer BILL SUMMARY Authorizes a certified

More information

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services MEDICARE CLAIMS PROCESSING MANUAL Accessed September 25, 2005 100.1 - Payment for Physician Services in Teaching Settings Under the MPFS Payment is made for physician services furnished in teaching settings

More information

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services:

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services: PROVIDER BILLING GUIDELINES Anesthesia Background Qualified medical professionals administer anesthesia to relieve pain while at the same time monitoring and controlling the patients health and vital bodily

More information

SUBCHAPTER T. MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES 28 TAC 3.3312

SUBCHAPTER T. MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES 28 TAC 3.3312 Part I. Texas Department of Insurance Page 1 of 17 SUBCHAPTER T. MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES 28 TAC 3.3312 1. INTRODUCTION. The Texas Department of Insurance proposes amendments

More information

Chapter 815. UNEMPLOYMENT INSURANCE Subchapter C. TAX PROVISIONS The Texas Workforce Commission (Commission) proposes the repeal of and new 815.

Chapter 815. UNEMPLOYMENT INSURANCE Subchapter C. TAX PROVISIONS The Texas Workforce Commission (Commission) proposes the repeal of and new 815. Chapter 815. UNEMPLOYMENT INSURANCE Subchapter C. TAX PROVISIONS The Texas Workforce Commission (Commission) proposes the repeal of and new 815.107 Reports Required and Their Due Dates and amendments to

More information

Third-Party Liability (TPL); Reimbursement for Third-Party Claims; Medicare/Medicaid

Third-Party Liability (TPL); Reimbursement for Third-Party Claims; Medicare/Medicaid HUMAN SERVICES 45 NJR 1(2) January 22, 2013 Filed January 3, 2013 DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES Administration Manual and Hospital Services Manual Third-Party Liability (TPL); Reimbursement

More information

Medical Care Advisory Committee. David Auzenne Department of State Health Services

Medical Care Advisory Committee. David Auzenne Department of State Health Services TO: Medical Care Advisory Committee DATE: November 8, 2013 FROM: David Auzenne Department of State Health Services Agenda Item No.: 9 SUBJECT: Amendments to Title 25. Health Services, Part 1. Department

More information

Center for Clinical Standards and Quality/Survey & Certification Group

Center for Clinical Standards and Quality/Survey & Certification Group Department of Health & Human Services Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop C2-21-16 Baltimore, Maryland 21244-1850 Center for Clinical Standards and Quality/Survey

More information

Teaching Physician Billing Compliance. Effective Date: March 27, 2012. Office of Origin: UCSF Clinical Enterprise Compliance Program. I.

Teaching Physician Billing Compliance. Effective Date: March 27, 2012. Office of Origin: UCSF Clinical Enterprise Compliance Program. I. Teaching Physician Billing Compliance Effective Date: March 27, 2012 Office of Origin: UCSF Clinical Enterprise Compliance Program I. Purpose These Policies and Procedures are intended to clarify the Medicare

More information

HOUSE OF REPRESENTATIVES STAFF ANALYSIS

HOUSE OF REPRESENTATIVES STAFF ANALYSIS BILL #: HB 375 Physician Assistants SPONSOR(S): Steube TIED BILLS: IDEN./SIM. BILLS: SB 748 HOUSE OF REPRESENTATIVES STAFF ANALYSIS REFERENCE ACTION ANALYST STAFF DIRECTOR or BUDGET/POLICY CHIEF 1) Health

More information

Steve LeFar. 9th Annual Survey. Earn CEU credit. Equal access for people with disabilities. Medicare hospital Outpatient Prospective Payment System

Steve LeFar. 9th Annual Survey. Earn CEU credit. Equal access for people with disabilities. Medicare hospital Outpatient Prospective Payment System Volume Nine Number Four Published Monthly Earn CEU credit see insert Meet Steve LeFar President of MediRegs page 16 Special Focus: 9th Annual Survey Equal access for people with disabilities page 4 Also:

More information

Please see Section IX. for Additional Information:

Please see Section IX. for Additional Information: The Florida Senate BILL ANALYSIS AND FISCAL IMPACT STATEMENT (This document is based on the provisions contained in the legislation as of the latest date listed below.) BILL: CS/SB 614 Prepared By: The

More information

HOSPICE UTILIZATION OF NURSE PRACTITIONERS. July, 2006

HOSPICE UTILIZATION OF NURSE PRACTITIONERS. July, 2006 H O S P I C E A N D P A L L I A T I V E C A R E P R A C T I C E G R O U P HOSPICE AND PALLIATIVE CARE PRACTICE GROUP: Mary H. Michal, Chair Linda Dawson Meg S. L. Pekarske Matthew K. McManus 22 East Mifflin

More information

Prepared By: The Professional Staff of the Appropriations Subcommittee on Health and Human Services REVISED:

Prepared By: The Professional Staff of the Appropriations Subcommittee on Health and Human Services REVISED: The Florida Senate BILL ANALYSIS AND FISCAL IMPACT STATEMENT (This document is based on the provisions contained in the legislation as of the latest date listed below.) Prepared By: The Professional Staff

More information

Table of Contents Forward... 1 Introduction... 2 Evaluation and Management Services... 3 Psychiatric Services... 6 Diagnostic Surgery and Surgery...

Table of Contents Forward... 1 Introduction... 2 Evaluation and Management Services... 3 Psychiatric Services... 6 Diagnostic Surgery and Surgery... Table of Contents Forward... 1 Introduction... 2 Evaluation and Management Services... 3 Psychiatric Services... 6 Diagnostic Surgery and Surgery... 6 Other Complex or High Risk Procedures... 7 Radiology,

More information

LEGISLATIVE QUESTIONNAIRE FOR NEW OR EXPANDED REGULATION OF HEALTH OCCUPATIONS

LEGISLATIVE QUESTIONNAIRE FOR NEW OR EXPANDED REGULATION OF HEALTH OCCUPATIONS LEGISLATIVE QUESTIONNAIRE FOR NEW OR EXPANDED REGULATION OF HEALTH OCCUPATIONS Submitted to the Minnesota Legislature by the Minnesota Advanced Practice Registered Nurse (APRN) in collaboration with the

More information

Advanced Practice Nurses Authority to Diagnose and Prescribe

Advanced Practice Nurses Authority to Diagnose and Prescribe Advanced Practice Nurses Authority to Diagnose and Prescribe ted ec ot. r p e ht ion th rig mat of ty y r y p s o cie Co inf rte So u l o a dc dic ide Me e t a St ois v ro P n Illi www.isms.org ADVANCED

More information

Regulatory Compliance Policy No. COMP-RCC 4.07 Title:

Regulatory Compliance Policy No. COMP-RCC 4.07 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.07 Page: 1 of 7 This policy applies to (1) any Hospital in which Tenet Healthcare Corporation or an affiliate owns a direct or indirect equity interest

More information

SUBCHAPTER RR. STANDARD PROOF OF HEALTH INSURANCE FOR MEDICAL BENEFITS FOR INJURIES INCURRED AS A RESULT OF A MOTORCYCLE ACCIDENT 28 TAC 21.

SUBCHAPTER RR. STANDARD PROOF OF HEALTH INSURANCE FOR MEDICAL BENEFITS FOR INJURIES INCURRED AS A RESULT OF A MOTORCYCLE ACCIDENT 28 TAC 21. Part I. Texas Department of Insurance Page 1 of 14 SUBCHAPTER RR. STANDARD PROOF OF HEALTH INSURANCE FOR MEDICAL BENEFITS FOR INJURIES INCURRED AS A RESULT OF A MOTORCYCLE ACCIDENT 28 TAC 21.5201 1. INTRODUCTION.

More information

1) ELIGIBLE DISCIPLINES

1) ELIGIBLE DISCIPLINES PRACTITIONER S APPLICABLE TO ALL INDIVIDUAL NETWORK PARTICIPANTS AND APPLICANTS FOR THE PREFERRED PAYMENT PLAN NETWORK, MEDI-PAK ADVANTAGE PFFS NETWORK AND MEDI-PAK ADVANTAGE LPPO NETWORK. 1) ELIGIBLE

More information

DATE NAME TITLE ORGANIZATION ADDRESS CITY, ST ZIPXX. Dear SALUTATION:

DATE NAME TITLE ORGANIZATION ADDRESS CITY, ST ZIPXX. Dear SALUTATION: DATE NAME TITLE ORGANIZATION ADDRESS CITY, ST ZIPXX Dear SALUTATION: Considering your leadership role in the Veterans Health Administration (VHA) helping to carry out Secretary McDonald s directive to

More information

WEST VIRGINIA ~ STATUTE

WEST VIRGINIA ~ STATUTE WEST VIRGINIA ~ STATUTE STATUTE West Virginia Code 30-3-16, 30-3-13, 30-3-5 DATE Enacted 1976 REGULATORY BODY PA DEFINED SCOPE OF PRACTICE PRESCRIBING/DISPENSING SUPERVISION DEFINED PAs PER PHYSICIAN APPLICATION

More information

Arizona Administrative Code Title 9, Ch. 11 Department of Health Services Health Care Institution Facility Data

Arizona Administrative Code Title 9, Ch. 11 Department of Health Services Health Care Institution Facility Data TITLE 9. HEALTH SERVICES CHAPTER 11. DEPARTMENT OF HEALTH SERVICES HEALTH CARE INSTITUTION FACILITY DATA Editor s Note: The headings for Articles 3, 4, and 5 were amended or created as part of a Notice

More information

1) What is the purpose of the Graduate Nurse Education (GNE) Demonstration?

1) What is the purpose of the Graduate Nurse Education (GNE) Demonstration? GRADUATE NURSE EDUCATION DEMONSTRATION FREQUENTLY ASKED QUESTIONS General 1) What is the purpose of the Graduate Nurse Education (GNE) Demonstration? The primary purpose of the Demonstration is to provide

More information

Title: Use of Substitute Physicians for Medicare Services

Title: Use of Substitute Physicians for Medicare Services Effective Date: 10/02; Rev. 10/04, 11/07, 7/10 POLICY: Whenever a Physician Practice (as defined below) uses a Substitute Physician (as defined below) for coverage for an absent physician, the practice

More information

Incident To, Non Physician Practitioners, Locum Tenens and Reciprocal Billing

Incident To, Non Physician Practitioners, Locum Tenens and Reciprocal Billing Incident To, Non Physician Practitioners, Locum Tenens and Reciprocal Billing Presented by: Medicare Part B Provider Outreach and Education (POE) December 2015 Disclaimer This information release is the

More information

HOUSE OF REPRESENTATIVES STAFF ANALYSIS

HOUSE OF REPRESENTATIVES STAFF ANALYSIS HOUSE OF REPRESENTATIVES STAFF ANALYSIS BILL #: HB 187 Health Insurance--Certified Surgical First Assistants SPONSOR(S): Homan TIED BILLS: IDEN./SIM. BILLS: SB 594 REFERENCE ACTION ANALYST STAFF DIRECTOR

More information

SUBCHAPTER R. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY 28 TAC 19.1701 19.

SUBCHAPTER R. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY 28 TAC 19.1701 19. Part I. Texas Department of Insurance Page 1 of 244 SUBCHAPTER R. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY 28 TAC 19.1701 19.1719 SUBCHAPTER U.

More information

Graduate Nurse Education Demonstration Solicitation

Graduate Nurse Education Demonstration Solicitation Graduate Nurse Education Demonstration Solicitation I. Introduction A. Authority The Graduate Nurse Education (GNE) Demonstration is mandated under Section 5509 of the Affordable Care Act (Pub. L. 111-148)

More information

Texas Board of Nursing 333 Guadalupe Suite 3-460 Austin, TX 78701 APRN Office: 512-305-6843

Texas Board of Nursing 333 Guadalupe Suite 3-460 Austin, TX 78701 APRN Office: 512-305-6843 Texas Board of Nursing 333 Guadalupe Suite 3-460 Austin, TX 78701 APRN Office: 512-305-6843 Requirements for Refresher Course/Extensive Orientation for Advanced Practice Registered Nurses Returning to

More information

Ratified: June 6, 2013 PROFESSIONAL STAFF BY-LAW

Ratified: June 6, 2013 PROFESSIONAL STAFF BY-LAW Ratified: June 6, 2013 PROFESSIONAL STAFF BY-LAW ARTICLE 1 DEFINITIONS AND INTERPRETATION...4 Section 1.1 Definitions...4 Section 1.2 Interpretation...6 Section 1.3 Delegation of Duties...6 Section 1.4

More information

Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF TELEMEDICINE MEDICAL SERVICE PROVIDERS UNDER MEDICAID. (a) The commission by rule shall develop and

Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF TELEMEDICINE MEDICAL SERVICE PROVIDERS UNDER MEDICAID. (a) The commission by rule shall develop and Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF TELEMEDICINE MEDICAL SERVICE PROVIDERS UNDER MEDICAID. (a) The commission by rule shall develop and implement a system to reimburse providers of services

More information

THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER HOUSTON

THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER HOUSTON THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER HOUSTON MEDICAL SERVICE RESEARCH AND DEVELOPMENT PLAN UT NON-PHYSICIAN PRACTITIONERS BILLING AND DOCUMENTATION GUIDELINES 2010 1 Table of Contents NPP BILLING

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Mental Health Services ICN 903195 September 2013 This booklet was current at the time it was published or uploaded onto

More information

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION TITLE 1. ADMINISTRATION PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION CHAPTER 354. MEDICAID HEALTH SERVICES SUBCHAPTER A. PURCHASED HEALTH SERVICES DIVISION 5. PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES

More information

National Health Policy Forum To the Top of the License: Pursuing an Expanded Scope of Practice Nursing Education and Practice

National Health Policy Forum To the Top of the License: Pursuing an Expanded Scope of Practice Nursing Education and Practice National Health Policy Forum To the Top of the License: Pursuing an Expanded Scope of Practice Nursing Education and Practice Linda Cronenwett, PhD, RN, FAAN Professor and Dean Emerita School of Nursing

More information

FREQUENTLY ASKED QUESTIONS REGARDING NURSE PRACTITIONER PRACTICE. Practice Questions

FREQUENTLY ASKED QUESTIONS REGARDING NURSE PRACTITIONER PRACTICE. Practice Questions BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY GOVERNOR EDMUND G. BROWN JR. BOARD OF REGISTERED NURSING PO Box 944210, Sacramento, CA 94244-2100 P (916) 322-3350 F (916) 574-8637 www.rn.ca.gov Louise

More information

MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) ADVANCING CARE INFORMATION PERFORMANCE CATEGORY

MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) ADVANCING CARE INFORMATION PERFORMANCE CATEGORY MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) ADVANCING CARE INFORMATION PERFORMANCE CATEGORY SUMMARY OF PROVISIONS Brief Synopsis MACRA sunsets the Electronic

More information

Medicaid Electronic Health Records (EHR) Incentive Program FAQ

Medicaid Electronic Health Records (EHR) Incentive Program FAQ Program Basics 1. What is the Texas Medicaid EHR Incentive Program? As part of the American Recovery and Reinvestment Act of 2009, federal incentive payments will be available to doctors and hospitals

More information

MEDICARE TEACHING PHYSICIAN QUESTIONS & ANSWERS December 2003

MEDICARE TEACHING PHYSICIAN QUESTIONS & ANSWERS December 2003 MEDICARE TEACHING PHYSICIAN QUESTIONS & ANSWERS December 2003 In November 2002 CMS issued revisions to the Carrier Manual Instructions, section 15016, Supervising Physicians in Teaching Settings. To help

More information

CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES Subchapter QQ, Provider Network Contract Registration 28 TAC 3.9801 3.

CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES Subchapter QQ, Provider Network Contract Registration 28 TAC 3.9801 3. Part I. Texas Department of Insurance Page 1 of 23 CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES Subchapter QQ, Provider Network Contract Registration 28 TAC 3.9801 3.9805 1. INTRODUCTION.

More information

Session of 2015. HOUSE BILL No. 2280. By Committee on Health and Human Services 2-10

Session of 2015. HOUSE BILL No. 2280. By Committee on Health and Human Services 2-10 Session of HOUSE BILL No. 0 By Committee on Health and Human Services -0 0 0 AN ACT concerning the board of nursing; relating to the certified nursemidwives; amending K.S.A. Supp. -0 and repealing the

More information

8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1 NMAC - N, 11-1-14]

8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1 NMAC - N, 11-1-14] TITLE 8 SOCIAL SERVICES CHAPTER 310 HEALTH CARE PROFESSIONAL SERVICES PART 12 INDIAN HEALTH SERVICE AND TRIBAL 638 FACILITIES 8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1

More information

SUBCHAPTER B. Health Care Provider Billing Procedures 28 TAC 133.20 Medical Bill Submission By Health Care Provider

SUBCHAPTER B. Health Care Provider Billing Procedures 28 TAC 133.20 Medical Bill Submission By Health Care Provider Page 1 of 12 Pages SUBCHAPTER B. Health Care Provider Billing Procedures 28 TAC 133.20 Medical Bill Submission By Health Care Provider 1. INTRODUCTION. The Commissioner of Workers Compensation (Commissioner),

More information

TEXAS ~ STATUTE Continued

TEXAS ~ STATUTE Continued TEXAS ~ STATUTE STATUTE DATE Enacted 1981 REGULATORY BODY Texas Rev. Civ. Stat., Occupations Code, Chapter 204: Physician Assistant Licensing Act; Occupations Code Chapter 157; Authority of Physician to

More information

1970 1) Vanderbilt University established the first master s program to prepare nurse practitioners (NPs) in Tennessee.

1970 1) Vanderbilt University established the first master s program to prepare nurse practitioners (NPs) in Tennessee. Tennessee Nurses Association History of Advanced Practice Registered Nursing in Tennessee 1969 The 1969 Tennessee Medical Association (TMA)-Tennessee Nurses Association (TNA)-Tennessee Hospital Association

More information

Office of Health Care Ombudsman, statutory duties

Office of Health Care Ombudsman, statutory duties Office of Health Care Ombudsman, statutory duties Enabling statute, 8 V.S.A. 4089w (a) The department shall establish the office of the health care ombudsman by contract with any nonprofit organization.

More information

Nurse Practitioners in Long-Term Care. Mobile Medical and Nursing Inc.

Nurse Practitioners in Long-Term Care. Mobile Medical and Nursing Inc. Nurse Practitioners in Long-Term Care W H Y H A V E N T W E T H O U G H T O F T H I S B E F O R E? The NP's Role in Nursing Facilities Medicare requires that the initial visit (history and physical), for

More information

ON APRIL 5, 2016, THE TEXAS WORKFORCE COMMISSION PROPOSED THE BELOW RULES WITH PREAMBLE TO BE SUBMITTED TO THE TEXAS REGISTER.

ON APRIL 5, 2016, THE TEXAS WORKFORCE COMMISSION PROPOSED THE BELOW RULES WITH PREAMBLE TO BE SUBMITTED TO THE TEXAS REGISTER. CHAPTER 805. ADULT EDUCATION AND LITERACY PROPOSED RULES WITH PREAMBLE TO BE SUBMITTED TO THE TEXAS REGISTER. THIS DOCUMENT WILL NOT HAVE ANY SUBSTANTIVE CHANGES BUT IS SUBJECT TO FORMATTING CHANGES AS

More information