Improve Patient Access to Medicare Hospice Services

ACTION NEEDED: Authorize Nurse Practitioners to Certify Medicare Patients for Hospice Care

Congress should enact legislation that will authorize hospice care programs to accept initial certification of eligibility orders from nurse practitioners (NPs) for Medicare beneficiaries.


Legislation authorizing direct reimbursement to NPs for Medicare services became effective January 1, 1998. Since that time, NPs have been providing and receiving payment for care to Medicare patients as Part B providers. NPs are authorized to furnish, order and refer for services under their provider numbers. NPs order physical therapy, order occupational therapy, bill as consultants and consultees when providing services through telemedicine, order and bill for performing and interpreting diagnostic tests within their scope of practice and certify patients eligible for skilled nursing care. They may also bill for services as attending providers and for services “incident to” their own service.

Despite their ability to provide and bill for services rendered in all of these areas, as well as serve as attending providers and recertify Medicare patients’ eligibility for hospice care, NPs are still unable to provide the initial certification of patients for hospice care. Instead, they must find a physician to certify eligibility at an additional cost. A language change or an expanded interpretation of the word “physician” is needed in Part A, Section 1814, of the Medicare law in order for hospice programs to accept initial certifications from NPs.

NPs have demonstrated the ability to deliver safe, cost-effective and responsible care to the patients they serve. They have expert knowledge that allows them to provide high-level assessments of patient needs and recognize when additional care such as home health care is needed. In its landmark 2010 report, “The Future of Nursing: Leading Change, Advancing Health,” the Institute of Medicine specifically recommends that NPs be recognized to certify Medicare payments for hospice care.


The American Association of Nurse Practitioners (AANP) urges members of Congress to remedy this problem and improve Medicare beneficiaries’ access to hospice care by enacting legislation that will clearly authorize NPs to provide the initial certification of patients for hospice care, in addition to their current ability to recertify patients and serve as attending providers.

Given their proven track record in caring for the elderly, it is illogical and impractical that NPs are recognized as Part B Medicare providers, are able to serve as attending providers and are able to recertify patients for hospice care but are still unable to provide the initial certification of hospice care for their patients.

For additional information, please contact the AANP Government Affairs Office at 703-740-2529 or

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