Signing Home Care Orders NP

[NPJGQ]

Looking for input from other California NPs.   I am new to California and work with the VA in the Bay Area.    I have been signing home health orders without a problem for most of the agencies out there, but one questioned my authority to do so today (previously practiced in Colorado and Florida where it was also never an issue).  I can only point to the Cares Act of 2020 as the basis for my ability to direct home care but the agency was un-swayed.    The new NP103 classification clearly states NPs with that license designation can sign but is there anything that says that those without it can't sign?   I don't know anyone that has successfully obtained their NP103 and with the 3-year requirement of practice in California it will be some time for me.   Anyone been down this Rabit hole with something to share?

[NRSKarenRN, BSN, RN]

Times have changed!

Prior to March 1, 2020   Medicare  certified home heath agencies  were required to follow MEDICARE regulations which didn't permit NP's signing admission and recertification of home care plans of care.  Otherwise verbal orders for treatment, medications, labs, some DME accepted. State Medicaid regs can vary; I'm familiar with PA MA --they followed Medicare HH regs.  NP groups I worked with especially home visiting NP's previously had their collaborating MD/DO sign home health plans of care which we accepted even though doc never saw the patient.

NEW Medicare regs under the Cares Act -- 409.43 Plan of care requirements permits "Allowed practitioner"  to sign for home health plan of care and home care services

Quote

Allowed practitioner means a physician assistant, nurse practitioner, or clinical nurse specialist as defined at this part.

Full Medicare info booklet on APRN's, AA, PA's home health changes can be shared with agencies unaware new regulations

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare-Information-for-APRNs-AAs-PAs-Booklet-ICN-901623.pdf