Washington state: Medicaid restricts prescriptions

OLYMPIA, Wash. - Only physicians can now order medical equipment for Medicaid recipients, says the Health Care Authority in Washington state.

Advanced nurse practitioners (ARNPs) or physician assistants (PAs) ordering medical equipment must have a physician's signature on their requested orders, the Medicaid director says.

“I wouldn't say the majority of the prescriptions we receive are from ARNPs or NPs, but there are certain clinics where they are the primary practitioners,” said Ryan French, home health director at Jim's Pharmacy & Home Health in Port Angeles, in December, ahead of the new rule going into effect Jan. 1. “I just sent 12 faxes about the change to clinics where they are the prescribers. We don't want our patients to have a lapse in getting their equipment and supplies.”

In a Nov. 14 letter to stakeholders, the Medicaid director says the state's making the change “to align with federal regulations published by CMS on Feb. 2, 2016.”

The change, however, came as a surprise to providers, who noted how, back in 2015, Congress required CMS to expand who can conduct the face-to-face exams required for DME prescriptions to include PAs, NPs or clinical nurse specialists.

“We saw the change coming, but we thought the uproar that happened when Medicare made a similar announcement on the face-to-face would also happen in this case, but no one seems to be discussing it or complaining,” said Dawn Rolph, office manager for In Home Medical in Pasco. “It's strange, because it's going to be a huge problem.”

The biggest problem: reduced, or at least delayed, access to equipment and supplies, providers say.

“It's not frantic right now,” Rolph said in December, “but it's going to be when we can't provide people's equipment and they ask, 'Why not,' and we say, 'Because the state changed the rules.'”