Physician Delegation of Tasks in Nursing Homes

CMS has updated guidance first issued in 2003 regarding physician delegation of tasks in a nursing home.  The latest CMS letter outlines the tasks that can be performed by the physician, NP and PA in a nursing home. While in many respects the letter is similar to the previous issuance regarding the requirement that the physician makes the initial visit, there is now language that addresses nursing homes that are dually certified (as is the case in NYS).  It states the following: "In dually-certified facilities, the facility must determine the payment source. For a Part A Medicare stay, the NPP (non-physician practioners) must follow the guidelines for services in a SNF. For residents in a Medicaid stay, the NPP must follow the provisions outlined for care in NFs. At the option of the state, any required physician task in a NF (including tasks which the regulations specify must be performed personally by the physician) may also be satisfied when performed by a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee of the facility, but who is working in collaboration with a physician.”  In contrast to the initial SNF visit, NPPs may provide initial NF visits and other required visits if the state permits. LeadingAge NY has contacted DOH and is awaiting clarification on the NYS position in regard to physician delegation.  Click here to view the CMS letter and here to view an article from the Medicare Learning Network (MLN).

Contact:  Elliott Frost, efrost@leadingageny.org, 518-867-8832