The Centers for Medicare & Medicaid Services published guidelines this week to clarify what tasks a physician may delegate to nurses in skilled nursing facilities (SNFs) and other nursing facilities. The document specifies what roles can be played by nurse practitioners, physician assistants or clinical nurse specialists under the regulatory structure of nursing facilities where Medicare or Medicaid payments are involved.
Many of the guidelines involve ordering and performing diagnostic tests, the ordering of durable medical equipment and the instances where a physician countersignature is still required. Other sections of the document clarify what roles nurses may play if they are in collaboration with the physician but are not employed by the SNF.
Source: MLN Matters #SE1308, March 2013
State law further complicates the situation, since states can define their own laws about which nursing ranks can perform which roles in the long-term care arena.
Long-term care nurses, especially nurse practitioners, have been pushing for expansion of their roles in anticipation of the influx of new beneficiaries under the Affordable Care Act and the upcoming baby boomers.
“We have a ready-made, no-added-cost workforce in place that could be providing care at a much higher level if we modernize our state laws,” Taynin Kopanos, DNP, NP, American Association of Nurse Practitioners Vice President of State Government Affairs, told The Washington Post. "So the question for states is, are you going to fully deploy this resource or not?"