Currently, the Centers for Medicare and Medicaid Services (CMS) allows certain non-physician providers to perform the initial comprehensive visit, admission orders, and all required visits and orders for non-Medicare A patients. This information is located in the CMS State Operations Manual Appendix PP SOM - Appendix PP (cms.gov), See F712 and the corresponding information referenced in Table 1.

While CMS allows non-physician providers to conduct visits more broadly, Minnesota State rules remain more restrictive. MDH does plan to update the rules at 4658.0710 - MN Admission Orders and Physician Evaluations Administrative Rule to align with CMS. During the interim MDH is suggesting facilities request a waiver to the state rule. A waiver to 4658.0710 would allow physician assistants, nurse practitioners, and clinical nurse specialists to perform tasks allowed by CMS but currently prohibited by Minnesota state rule.

MAGIC encourages facilities and providers to collaborate to determine whether a waiver is needed to comply with patient visits, given the known physician shortage in Long-Term and Post-Acute Care.

If a waiver is needed, the facility should request a waiver with such language as included in Appendix A. Facilities can submit waiver requests to: Health.CM-cert@state.mn.us.

Appendix A: SNF/NF Waiver Request Template