Ordering Respiratory Services Our thanks to NAPNAP’s Professional Issues Chair, Andrea Kline Tilford, MS, RN, CPNP-AC/PC, FCCM, for providing answers to the following questions below. (Posted 3/22/10) UPDATED INFORMATION NOW AVAILABLE – SEE BELOW
Question: What is the new regulation from CMS and The Joint Commission stipulating that respiratory orders may only come from MDs and DOs?
Answer: As of January 1, 2010, a new regulation was put into effect by the Centers for Medicare and Medicaid Services (CMS). The Joint Commission (TJC) has followed with support of this new regulation. This regulation pertains to both ambulatory and inpatient orders for respiratory therapy prescriptions/orders. "Two Joint Commission elements of performance address respiratory care for hospitals that use Joint Commission accreditation for deemed status purposes. The Centers for Medicare & Medicaid Services (CMS) requires a doctor of medicine or osteopathy to direct respiratory care services but does not limit the authority of a doctor of medicine or osteopathy to delegate tasks to other qualified health care personnel to the extent recognized under state law or a state’s regulatory mechanism. Therefore, non-physician practitioners may write respiratory care orders, provided it is within the scope of their license. However, if a doctor of medicine or osteopathy delegates responsibility for writing orders to an eligible non-physician practitioner (such as a physician assistant or nurse practitioner), the responsible doctor of medicine or osteopathy must co-sign the order." Go to http://www.jcrinc.com/common/PDFs/fpdfs/pubs/pdfs/JCReqs/JCP-01-10-S4.pdf for the full Joint Commission’s clarification on respiratory care orders in hospitals. Question: Are you aware of any NP organizations that are working to change this regulation?
Answer: NAPNAP posted a Quick Poll question related to this on our website to gauge if nurse practitioners were aware of this and if it is affecting their practice. The results are provided below.
In response, NAPNAP provided a swift and concise response regarding the regulation to both CMS and The Joint Commission urging these organizations to allow NPs to practice to their full scope in order to minimize delays in patient care and ultimately improve patient outcomes. Click here to read NAPNAP’s letters and click here to read the response letter from CMS sent on April 9th. Go to http://edocket.access.gpo.gov/2010/pdf/2010-9163.pdf to read the proposed change in the May 4, 2010 Federal Register. See page 24050, item IX. ________________________________________________________________________ NAPNAP's QUICK POLL: NPs Ordering Respiratory Services Are you aware of the CMS Standard 482.57(b)(3) and The Joint Commission's similar standard PC 02.01.03 EP 14 : Respiratory Services must be provided only on, and accordance with, orders of MD or DO? Yes, I am aware and this has been a barrier to my practice as an APRN. - 85 (17.3%) Yes, I am aware but this has not been a barrier to my practice as an APRN. - 42 (8.6%) Yes, I am aware but this does not apply to my practice as an APRN. - 15 (3.1%) No, I am not aware of this. - 349 (71.1%) Total number of votes: 491 _________________________________________________________________________ UPDATED 10/07/10
NPs Ordering Respiratory Services and MD/DO Co-Signature - Standard Changed
The Centers for Medicaid and Medicare Services (CMS) changed the standards to clarify the types of practitioners who are allowed to order rehabilitation and respiratory care services, respectively in accordance with both hospital policies and procedures and State laws. Read the full report in the Federal Register at http://edocket.access.gpo.gov/2010/pdf/2010-19092.pdf (located on page 365).
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