close-up of stethoscope on prescription pad

The upcoming release of the final Medicare home health rule is a major concern for home care providers. But there are other regulations to worry about, according to a home care regulatory expert. Among these, No Surprise billing requirements should be top of mind, along with rules surrounding advanced practice registered nurses (APRNs).

The No Surprises Act was part of the Consolidated Appropriations Act of 2021 and contained provisions to help consumers resolve out-of-network payment disputes. While one part of the law, balance billing, does not apply to home care providers, good faith estimate (GFE) requirements do, explained Mary Carr, vice president for regulatory affairs for the National Association for Home Care & Hospice. She presided Monday over a regulatory roundup session at the annual conference in St. Louis.

 “They need to be aware that if they have a patient who is self-pay or underinsured, they have to provide specific notice requirements and very specific time frames,” she told McKnight’s Home Care Daily Pulse following the session, adding. “They have to provide what the cost is going to be for the patient.”

In September, the Centers for Medicare & Medicaid Services issued an interim rule that addressed these requirements. After probing, NAHC learned that the GFE requirements apply to home care agencies. While the interim rule currently is under enforcement discretion, providers should be wary.

“It will [concern me] in time because enforcement will start to pick up,” she said.

Another issue that should be on home care providers’ radars concerns APRNs. Two long-standing regulations govern APRN requirements in the Medicare program. They articulate that in absence of states’ governing collaboration between APRNs and physicians, APRNs must document their scope of practice, as well as their relationships with physicians to deal with issues outside their scope of practice.

CMS has updated its coverage policy to explicitly state that APRNs have to work in collaboration and in accordance with regulations, Carr noted.

As a result, she is advising home care companies in those states that do not have laws governing the collaboration to ask APRNs for the following statements: “I am practicing within my scope. Out of my scope, I refer to physicians I work with.”

Correction: The last paragraph has been revised to reflect that APRNs who work in states that do not have laws governing collaboration should provide statements reflecting their practice scope. It previously incorrectly had the word “now,” instead of “not.”