CMS clarifies physician delegation of tasks in skilled nursing facilities

Nursing home operators can now download a brief clarifying which tasks physicians may delegate to other practitioners caring for Medicare beneficiaries in skilled nursing facilities, the Centers for Medicare & Medicaid Services announced in a document released Wednesday.

The focal point is certain tasks that a doctor can delegate to a non-physician practitioner (NPP), such as a nurse practitioner, physician assistant or clinical nurse specialist.

A physician must conduct the initial comprehensive visit within 30 days of a resident being admitted to a SNF, according to the CMS brief. However, a NPP may conduct medically necessary visits prior to the physician’s initial visit, and may perform subsequent visits, including required monthly visits.

A facility employee is not allowed to sign a certification or recertification of a resident’s need for skilled care, according to the CMS clarification. However, if allowed by the state, non-physician practitioners who are not employed by the facility may sign these documents.

In facilities where beds are certified under both Medicare and Medicaid, regulations are determined according to which program is paying for the resident’s care, according to the CMS guidance. For example, in the case of a dually-certified nursing home resident whose stay is paid through Medicaid, any required physician task can be performed by a NPP who is not employed by the facility, subject to state regulations.

“Improper application of these regulations may affect a facility’s compliance and payment to providers,” according to the CMS document, which addresses a section of the Affordable Care Act. The full document is available here.