Recognizing Services Provided by Physician Assistants through the Medicaid Program
Relevant Legislation and Congressional Committees
The Medicaid Advanced Practice Nurses and Physician Assistants Access Act of 2007 (S. 59/H.R. 2066), was introduced in the 110th Congress. The bill improves access to medical services provided by physician assistants by requiring states to recognize physician assistants (PAs) as Medicaid and SCHIP covered providers. This legislation was reintroduced by Senator Daniel Inouye (D-HI) on January 6, 2009; it’s expected to be reintroduced in the House early in the 111th Congress. The House Energy and Commerce Committee and Senate Finance Committee exercise jurisdiction over Medicaid.
Background
Physician assistants are not federally-required Medicaid covered providers under fee for service plans, although certain nurse practitioners and midwives have been since the 1980s. Currently all states have chosen to cover PAs to some extent, even though there is no federal requirement that they do so. However, lack of federal standardization across the states has led to significant differences in the extent to which states recognize PAs as primary care providers, and to which they provide reimbursement under Medicaid plans, needlessly reducing access to health care for one of the nation’s most vulnerable patient populations. This legislation would require that states’ Medicaid managed care plans recognize PAs as primary care case managers, require state Medicaid managed care provider panels to include PAs, and expand Medicaid fee-for-service coverage for PAs.
The House Commerce and Senate Finance committees adopted a provision to include PAs as Medicaid covered providers in their respective Medicaid bills during the 104th Congress, but the bill was never sent to the President. In the 105th Congress, the House again included PAs, but the provision was not included in the final 1997 Balanced Budget Act. Failure to include the PA provision in the Balanced Budget Act is attributable to a miscommunication and to time constraints during the congressional conference, rather than to any objections by the House or the Senate to including PAs.
Recommendation
We urge Members of Congress to support the Medicaid Advanced Practice Nurses and Physician Assistants Access Act and move this important legislation forward in the 111th Congress to include PAs as federally-recognized Medicaid providers.
Justification
Many PAs practice in areas with large Medicaid populations. In states where PAs have been included as Medicaid covered providers, PAs have been credited with improving access to quality, cost-effective health care for thousands of Medicaid patients. The absence of quality and consistent primary and preventive care can lead to increased urgent care and emergency room visits, which results in higher medical costs. It is in the best interest of the state to promote and sustain the cost-effective delivery of services to Medicaid beneficiaries by those practices that have demonstrated a commitment to caring for this patient population. Moreover, it is important to promote continuity of care, and to increase access to care – especially for populations with special health care needs. In this era of tightened state and federal budgets, patients should be allowed – even encouraged – to utilize the current providers with whom they have established a medical home.
For further information, please contact :Kristin Butterfield
Assistant Director, Federal Affairs
American Academy of Physician Assistants
Telephone: 703/836-2272, ext. 3223
E-mail:
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Sandy Harding, Director of Federal Affairs
American Academy of Physician Assistants
Telephone: 703/836-2272, ext. 3205
E-mail:
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