Amanda Newlon was quoted extensively in an article in the March 2023 issue of Healthcare Risk Management, discussing the need for healthcare providers to review their non-physician policies from the height of the COVID-19 pandemic.
After non-physician practitioners, such as nurse practitioners or physician assistants, were given more autonomy during the pandemic to meet the demand for medical services, federal and state authorities have begun tightening some of those loosened rules back to pre-pandemic status, meaning providers should review their policies to make sure they are compliant with the more strict guidelines. For example, the CMS ended its blanket waivers and reinstated federal physician supervision requirements for some facilities in 2022, and many states relaxed scope-of-practice requirements during the pandemic and are now revising those positions, according to Newlon.
“The trend that I have been seeing is that the states are kind of falling in line with the federal government, and a lot of states have started to make adjustments to the scope of practice for mid-level practitioners. I don’t think it’s any secret that over the past few years, we’ve seen the opening up of independent practice for APRNs [advanced practice registered nurses] in particular,” Newlon said. “Physician assistants are stuck a little bit behind APRNs, in my opinion, with respect to gaining autonomous practice. But you can certainly see that with the COVID waivers, you have more APRNs who are able to operate without supervisory relationships.”
Newlon added that relaxed requirements for telehealth services are also changing. “Every state has its own scope of practice requirements, its own telehealth supervision requirements,” she said. “There are a lot of states that are making it mandatory to pay for telehealth services through Medicaid and saying insurers have to pay for it at the same rate as they would for in-person [services].”
Florida, for example, had suspended some restrictions on APRNs prescribing controlled substances, allowing for a virtual evaluation of a patient for a controlled substance, but the earlier restrictions are now back in place and require an APRN to see a patient in person before prescribing a controlled substance. Newlon advises healthcare organizations to track changes like this at the state level, as well as at the federal level, although so many rules changing can be difficult to track without consulting an attorney.
“There is a lot of confusion out there right now about what exactly you can do,” Newlon said. “They’re confused, but everybody’s heart is in the right place. They’re trying, but it just changes so quickly, and it’s very hard to keep track of the little details.”
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