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Improve Patient Access to Medicare Hospice Services

ACTION NEEDED: Amend Part A, Section 1814 of the Social Security Act to authorize Nurse Practitioners (NPs) to Certify Medicare Patients for Hospice Care


Legislation authorizing direct reimbursement to nurse practitioners for Medicare services became effective January 1, 1998. Since that time, nurse practitioners have been providing and receiving payment for care to Medicare patients as Part B providers. Nurse practitioners are authorized to furnish, order and refer for services under their provider numbers. Daily practice includes: assessment; ordering, performing, supervising and interpreting diagnostic and laboratory tests; making diagnoses; initiating and managing treatment including prescribing medication and non-pharmacologic treatments; coordinating care; counseling; and educating patients and their families and communities. Additionally, in the 116th Congress, nurse practitioners were authorized to order, certify, and recertify home health care plans of care.

Despite NPs’ ability to provide and bill for services rendered in all of these areas, as well as being defined as a hospice attending physician in the Social Security Act and authorized to perform required hospice face-to-face assessments, they are still not authorized to certify patients eligibility for hospice care. Instead, they must find a physician to certify eligibility which incurs an additional cost and delays timely access to patient care in the hospice setting. A statutory change is needed in Part A, Section 1814, of the Social Security Act in order for hospice programs to accept certifications from nurse practitioners.

Nurse practitioners currently provide a substantial portion of the high-quality, cost-effective care that our communities require, and will continue to do so to meet the needs of their communities. As of 2018, there were more than 145,000 NPs billing for Medicare services, making NPs the largest and fastest growing Medicare designated provider specialty. Over 82% of NPs are accepting Medicare patients and over 80% are accepting Medicaid patients. NPs have a particularly large impact on primary care as approximately 73% of all NP graduates deliver primary care. NPs comprise approximately one quarter of the primary care workforce, with that percentage growing annually. In its landmark 2010 report, “The Future of Nursing: Leading Change, Advancing Health,” the Institute of Medicine specifically recommended that nurse practitioners be recognized to certify Medicare patients for hospice care.


The American Association of Nurse Practitioners (AANP) urges Members of Congress to improve Medicare beneficiaries’ access to hospice care by enacting legislation that will authorize nurse practitioners to provide certification of patients for hospice care.

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

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