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Improve Patient Access to Medicare Skilled Nursing Care

ACTION NEEDED: Authorize Nurse Practitioners (NPs) to Perform Admitting Examinations and Monthly Patient Assessments

Congress should pass legislation to amend Medicare conditions of participation for skilled nursing facilities (SNFs) to authorize NPs to provide admitting examinations and required monthly visits for Medicare beneficiaries in skilled nursing facilities.


For more than 25 years, NPs have been authorized to provide Medicare services to residents of long-term care facilities. During that time, they have proven to be exceptionally competent providers. Studies have demonstrated that NPs’ participation in the health care of residents in long-term care facilities has increased the cost-effective quality of care provided to those patients.

Unfortunately, current Medicare conditions of participation governing reimbursable services furnished in SNFs limit the ability of facilities to make full use of the abilities of NPs to care for patients. When the initial regulations were written, the understanding and appreciation of the skills and abilities of NPs was limited. As NPs have consistently demonstrated their skill in working with the chronically and acutely ill in these settings, the outdated requirements for physician contact with patients have become increasingly obstructive rather than beneficial. In particular, the requirements that a physician must perform the admitting examination and the first and alternating monthly assessments of patients in SNFs are serious obstacles to efficient patient care. In its landmark 2010 report, “The Future of Nursing: Leading Change, Advancing Health,” the Institute of Medicine specifically recommends that NPs be authorized to conduct initial admitting physical examinations and required monthly assessments. These inappropriate restrictions do not apply to other long-term care nursing facilities, but they remain in place for Medicare beneficiaries in SNFs.


The American Association of Nurse Practitioners (AANP) calls on members of Congress to enact legislation amending the Medicare conditions of participation for SNFs to authorize NPs to perform admitting examinations and to provide monthly patient assessments.

Recognizing the proven track record of NPs in providing high-quality care to elderly patients in all settings, it is impractical and illogical to restrict their ability to admit and assess patients in SNFs when they are recognized to conduct these examinations in other practice settings. NPs are specially trained to manage the problems of chronic illness in the aging population. The inability to conduct these examinations has serious ramifications for patient care in these facilities.

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

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