From left to right, nurse practitioners Linda Krause, Lisa Moreland and Jenny Barlow, WMHS President and CEO Barry P. Ronan, WMHS Senior Vice President and Chief Operating Officer Nancy Adams, WMHS Senior Vice President and Chief Medical Officer Gerald Goldstein, M.D., nurse practitioners Lynn Metcalf, Tiffany Bennett, Allison Rexrode and Ashley Preston.

Maryland becomes first state to allow nurse practitioners to order home health care

Now that the calendar has changed to 2020, historic change has taken place across the state of Maryland in relation to the authorization for home health care.

In October of 2019, The Centers for Medicare and Medicaid Services announced an adjustment in policy that enables all Medicare-enrolled nurse practitioners in Maryland to certify home health care services for Medicare beneficiaries as part of the Maryland Total Cost of Care Model.

Under the previous Medicare regulations, a nurse practitioner could provide primary care services, but only a physician could order the patient to receive home health care services.

The push to change the existing policy was championed by Western Maryland Health System President and CEO Barry Ronan. “When I learned that the 5,300 nurse practitioners who had full practice authority in Maryland were not permitted by CMS to write orders for home care services, I realized that something had to be done,” Ronan said. “I am extremely grateful that the leadership at both the Centers for Medicare and Medicaid Innovations, the Maryland Hospital Association and Bobby Neal, Maryland’s Secretary of Health, were receptive to the recommendation that a demonstration project be created for NPs in Maryland being permitted to write orders for home care. This action no longer interrupts the continuum of care for NPs in the treatment of their patients.”

Maryland will become the only state to allow NPs to write these orders. “The previous policy excluded nurse practitioners and was completely antithetical to the mission of this state, which is value-based care and care in the most appropriate location,” said Gerald Goldstein, M.D., WMHS Senior Vice President and Chief Medical Officer.

“We have been carefully decreasing unnecessary length of stay and utilization. We place patients in the correct location, but because a patient’s primary care provider happens to be a nurse practitioner, the patient is unable to receive home care while under their care.”

Sharon Mason, WMHS Director of Home Health & Hospice Services, called the change a “historic victory” for home health care, nurse practitioners and patients in the community alike. “Our goal is to keep patients out of the hospital,” she said.

“This opens the patients’ doors to us. We are now able to get to them as soon as possible. Previously, their care was being delayed, and sometimes, after surgery or a hospital stay, they ended up back in the emergency department. Home health care is so important. It is one of the leading ways to reduce readmissions.”

Jennifer Barlow, a Nurse Practitioner at WMHS LaVale Primary Care Center, said she treated many patients who were turning down home health care services because they did not want to go through the process that was in place.

“Patients would often refuse to seek home health services because it was difficult to get authorized,” she said. “At their sickest and most vulnerable points, they were forced to go see a new provider they did not know in order to get the services started. It was very hard to overcome.”
Mason said that WMHS Home Health Care will now be able to touch 15-20 percent more patients than they have in the past. “We were hoping for this,” she said, “and now we are making a plan to reach our local nurse practitioners to educate them about some of the regulatory pieces and orders so that we can provide seamless care. That’s the whole goal.

“The community is going to benefit greatly from this welcomed change in the regulation. So many patients struggle to get the care they need after they leave the hospital. They can take comfort in knowing there are now no barriers to home health care, regardless of who their provider may be. There are no limitations and that’s just huge.”