Role of Physician Assistant in Hospice

You all received a document from Gina last week titled The Physicians Assistant’s New Role in Medicare Home Health. I am attaching it again here for you.

I am writing today to clarify that the authority now granted to PAs as described in this document – only applies to homecare and not to hospice.

CMS reviewed the role of a Physician Assistant in hospice over the past year as well. This resulted in minor changes that do not mirror the authority of APRNs.

The current Hospice Conditions of Participation are as follows:

Physician Assistants

The Medicare Patient Access to Hospice Act, took effect Jan. 1, 2019. It allows PAs to serve as the attending physician to hospice patients and to provide hospice care within their scope of practice.  While they are authorized to serve as a patient’s chosen attending physician, they may not:

  • Certify terminal illness
  • Complete the face-to-face visit
  • Replace the hospice physician in the IDT
  • Order drugs for the hospice patient
  • The federal hospice Conditions of Participation currently do not include PA’s in the allowable clinicians that can order drugs in hospice care.
  • §418.106(b) Standard: Ordering of drugs.

Only a physician as defined by Section 1861(r)(1) of the Act, or a nurse practitioner in accordance with the plan of care and State law, may order drugs for the patient.

Nurse Practitioner

An NP can complete face-to-face visits and serve as a patient’s chosen attending physician however, they may not:

  • Certify terminal illness
  • Replace the hospice physician in the IDT

NPs may write orders for care per the allowance in their state’s Advanced Nurse Act.

Professional ResourcesState Boards of Nursing (all nursing levels), Hospice and Palliative Nurses Association, National Board for Certification of Hospice and Palliative Nurses

Janice McDermott

Director of Hospice & Palliative Care

Home Care, Hospice & Palliative Care Alliance of NH

603 225 5597


PA’s New Role in Home Health Care