Achieving provider status is about giving patients access to the valuable care that you provide. Becoming a “provider” in the Social Security Act means that patients can pharmacists can participate in Part B of the Medicare program and bill Medicare for services that are within their state scope of practice to perform.
The Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/S. 314)
H.R. 592 will enable Medicare beneficiaries’ access to pharmacist-provided ambulatory-based patient care services under Medicare Part B by amending section 1861(s)(2) of the Social Security Act. These services would be reimbursable under Medicare Part B if they are provided in medically underserved communities and consistent with state scope of practice laws.
- Who– State-licensed pharmacists who may have additional training or certificates depending on state laws.
- What – Pharmacist services according to state scope of practice.
- Where– Medically underserved communities (i.e., Medically Underserved Areas (MUAs), Medically Underserved Populations (MUPs), or Health Professional Shortage Areas (HPSAs) as designated by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA)).
- Reimbursement– Consistent with Medicare reimbursement for other non-physician practitioners, pharmacist services would typically be reimbursed at 85% of the physician fee schedule.
Key aspects of legislation
The bill seeks to increase access and improve quality by enabling pharmacists to provide patient care services as consistent with their education, training and license. Importantly, the federal legislation would not expand the types of services that pharmacists are permitted to provide. Eligible services would continue to be governed by state laws just as they are for other health professions.
The legislation promotes increased access to care for patients who are otherwise medically underserved. Specifically, the legislation focuses on care for underserved beneficiaries in MUAs, MUPs, and HPSAs, as designated by HRSA. As the shortage of primary care physicians increases, so too will the challenges that patients in underserved communities face, especially those related to access. This legislation can help address provider shortages and access issues in underserved areas.
The bill promotes cost-effective health care by increasing access to care and opportunities for early intervention at cost-effective settings so as to minimize long-term health care costs such as those associated with preventable higher-cost conditions. Consistent with precedent established in the Social Security Act for nurse practitioners and physician assistants, pharmacist services would be reimbursed at 85% of the physician fee schedule, unless they are operating under the direct supervision of a physician, in which case they would be reimbursed at 100% of the physician fee schedule.
ASHP, as part of the Patient Access to Pharmacists’ Care Coalition, was instrumental in shaping the legislation.
Ask Your Members of Congress to Support the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/S. 314)
As a pharmacist and a constituent, you have tremendous influence with your members of Congress. And as ASHP and the profession work to build support for the legislation, it is more important than ever for you to reach out to your elected officials so that they understand how provider recognition will improve patient care for some of our nation’s most vulnerable patients.
Here’s what you can do:
- Contact your representative and ask them to co-sponsor the legislation. Personalize the provided email with examples from your practice that demonstrate your critical role on the health care team.
- Make an appointment to meet with your House member while he or she is back home during a recess or district work period. Use this opportunity to go into more detail about your work with patients.
- Ask colleagues at your practice site to join you. Every voice counts!
It is critical that every ASHP member works diligently to ensure the bill’s passage. Please take advantage of this opportunity to build congressional support for the legislation so that pharmacists are finally recognized for who we are: health care providers.
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