From: Allen Meadows
Sent: Tuesday, March 15, 2016 6:29 PM
Dear Dr. Noel:
As the Chair of the Advocacy Council of the ACAAI, and on behalf of our members as well as the AAOA, we would like to personally thank you for your prompt response to our email. We are very pleased that WPS will remove the paragraph on multi-allergen immunotherapy from the LCD as well as all related edits.
We would like to bring to your attention another concern we have with the LCD. In the section entitled Providers of Immunotherapy on pages 5-6 of the LCD, it states that a nurse practitioner cannot provide direct supervision of allergy immunotherapy injections because Medicare regulations at 42 CFR Section 410.68(b)(2)(ii) state that only a physician or someone under a physician’s supervision can administer antigens. However, we would like to refer you to additional sections of the Medicare regulations that we believe allow for nurse practitioners (NPs) to supervise allergy injections. First, subsection (a) of 410.68 allows for coverage of “antigens that are furnished as services incident to a physician’s professional services. . .” Second, Medicare regulations at 410.26 state that “incident to” services include services of non-physician practitioners such as nurse practitioners. Third, Section 410.75 states that Medicare Part B covers services of nurse practitioners, including services “incident to” the services of nurse practitioners if the individual is legally authorized to perform the service under state licensure laws and is working in collaboration with a physician if required by state law.
Based on this, we believe NPs should be able to supervise administration of allergy injections, provided they are licensed to do so under state law and have appropriate training. NPs have been safely providing direct supervision of allergy injections for many years. In fact, it is common practice for allergists to employ NPs and for NPs to supervise administration of allergy injections by an RN or other clinical staff. This regulation would require a significant departure from clinical practice and is not, we believed, a change that is required by Medicare law or regulations nor one that is necessary for patient safety. We would hope that this change could also be addressed in the change being posted on May 1.
Again, we thank you very much for your responsiveness. If you have any questions or if our organizations can be of any assistance to you in the future, please do not hesitate to contact us.
J. Allen Meadows, MD
Chair, Advocacy Council of the American College of Allergy, Asthma and Immunology