New Washington State Medicaid rules on Medical Equipment and Home Health

January 15, 2019

Dear Members:

            We are all impacted by the recent implementation by the Washington State Health Care Authority (HCA) restricting ARNPs from ordering medical equipment and home health services for our Medicaid patients. New regulations require a physician’s order, documented in the medical record, for equipment and services previously permitted for our Medicaid patients.

            The HCA made these changes to bring Washington state rules into compliance under the Medicaid expansion authorized by the Patient Protection and Affordable Care Act (ACA), which required orders for Medicaid patients to align with Medicare guidelines.

            ARNPs United met with the HCA in 2017 and forestalled implementation for one year. During that time, representatives from the HCA met with leadership from the Centers for Medicaid and Medicare Services requesting an exemption to implementation on behalf of Washington State and were denied. We considered asking the Federal Trade Commission to intervene as an unfair barrier to practice and learned one arm of the federal government cannot sue another arm of government.

            We have two approaches to amend these rules. On the state level we are meeting with representatives of the Health Care Authority to clarify their intent and interpretation. Some equipment and suppliers may accept our orders under pharmacy benefits. Suppliers may be able to authorize equipment due to a broader interpretation of the regulations. Please refer to page 5535 of the Federal Register.

            The second option is to pass legislation through the US Congress amending Medicare guidelines and authorizing ARNPs to order home health services and medical equipment without restrictions. In the 2017-2018 Congress, H.R. 1825 and S.445, the Home Health Care Planning Improvement Act had bipartisan support and near majority sponsorship. The bill has not yet been reintroduced for the 2019 session. The American Association of Nurse Practitioners (AANP) will alert us when this legislation is reintroduced. Every US Congressional Representative in Washington State signed in support in 2018. Representative Kim Schrier is new to Congress and we will request her support once the bill is introduced. Last session the bill sat in the Senate Finance Committee. Senator Maria Cantwell sits on that committee and is in a position to move it forward. Let her know how this impacts you, your patients and practices.

            I am grateful to all of you who have reached out to work on amending these rules. Please continue to send your stories.

            Nancy Lawton, MN, ARNP, FNP-BC