1730 K Street, NW • Suite 800 • Washington, DC 20006

(202) 653-7220 • Fax: (202) 653-7238 • www. m e d p a c . g o v

M e d i c a r e C o ve r ag e o f N o n p h y s i ci a n P r a ct i t io n er s | J u ne 2 0 0 2 

What would be the cost implications of recognizing additional mental health 

providers in the Medicare program? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6

Other barriers take precedence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7

3 M e d i c a re coverage of clinical pharmacists’ serv i c e s . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1

B a c k g r o u n d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3

Drug management services may improve the quality of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3

Benefit design should balance physician and pharmacist roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4

Costs unknown. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4

A promising idea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5

A p p e n d i x

Commissioners’ voting on re c o m m e n d a t i o n s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 7

M o re about MedPA C

Commission members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3

Commission staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5

Executive summary

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M e d i c a r e C o v er a g e o f N o n ph ys i c i an P r ac t i t io n e r s | J u ne 20 0 2 v 

and registered nurse first assistants, is covered as part of the prospective payment to the facility (usually

the hospital). We see no compelling reason to change how Medicare pays for first assistant at surgery 

services performed by surgical technologists, a group of providers licensed in only one state. A c c o r d i n g l y,

the Commission recommends that the Congress should not expand the list of providers eligible to bill

Medicare Part B for first assistant services to include surgical technologists.

M a rriage and family therapists, pastoral counselors, 

and licensed professional counselors of mental health

There has been concern that Medicare beneficiaries lack adequate access to mental health services—

particularly in rural areas—and it has been suggested that this could be addressed by allowing additional

nonphysician providers to bill Medicare directly. Beneficiaries’access to mental health services in both

urban and rural areas is hindered by many barriers such as high copayments and lifetime limits on inpatient 

psychiatric care. Addressing the barriers to mental health services embedded in Medicare payment and

coverage policies may have greater potential to improve mental health services for the largest number of

beneficiaries than would expanding the list of recognized providers. Expanding the list of covered providers

would likely increase costs to the Medicare program without improving access proportionately in problem

areas. On this basis, the Commission concludes that the Congress should not allow marriage and family

therapists, licensed professional counselors of mental health, or pastoral counselors to bill Medicare 

independently for mental health services.
v i i i Ex ec ut i v e s um ma r y 
technologists when functioning as 

first surgical assistants

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Congress should not expand the list of providers eligible to bill Medicare for first

assistant services to include certified surgical technologists. 

*YES: 14 • NO: 0 • NOT VOTING: 0 • ABSENT: 3 

*COMMISSIONERS’ VOTING RESULT S
M e d i c a r e C o v er a g e o f N o n ph ys i c i an P r ac t i t io n e r s | J u ne 20 0 2 

Nurse practitioners were added as first assistant providers in rural areas through the Social Security

Amendments Act of 1994. Shortly thereafter, the Balanced Budget Act of 1997 expanded coverage for

first assisting to include nurse practitioners and clinical nurse specialists in all settings, and raised the 

payment rates for the three nonphysician groups to 85 percent of the physicians’ first assist fee. Residents—

the primary providers of first assistant services in teaching hospitals—are ineligible to bill for Part B 

payment for first assisting. Payment for their services is covered through Medicare’s graduate medical

education payments (Table 1-1).

Note: PA (physician assistant), NP (nurse practitioner), CNS (clinical nurse specialist).

Source: Centers for Medicare & Medicaid Services.

Payment for surgical services: current law

TABLE 

1-1

Provider Payment

Surgeon 100 percent of surgical fee

Co-surgeons 125 percent of surgical fee, equally divided

First assistants

Physician 16 percent of surgical fee

PA/NP/CNS 85 percent of physician first assistant fee

Resident Not paid separately by Medicare

Registered nurse first assistant Included in facility payment bundle

Surgical technologist Included in facility payment bundle
4 M e d i c a r e c o v e r ag e o f s ur g i ca l t ec hn ol o g i s ts w h e n fu n ct i o n i n g a s fi r s t su r g i c al as s i st a n t s

pgy () py py

s u rgery also are paid for surgical procedures performed in other settings, such as ambulatory surgical centers.

Current policy creates a financial incentive for hospitals to use first assistant providers who are eligible 

for separate payment under Part B instead of employing technologists or registered nurse first assistants.

Because the diagnosis related group (DRG) payment remains fixed, and because hospitals benefit financially

when they do not incur costs for first assistants, surgical technologists and other categories of nonphysician

first assistants who cannot bill Part B directly are at a competitive disadvantage. In addition, physicians

and other providers who are eligible for Part B payments may be used in situations in which their level of

training exceeds that necessary for the surgical procedure, thus resulting in higher costs to Medicare than

necessary to maintain surgical quality. Of course, in some facilities where the volume of surgeries is low

the use of more skilled practitioners may be necessary if adequately trained hospital personnel are not

available to provide first assistant services.

Several options exist for structuring payment for first assistant services, each with advantages and 

disadvantages. The overarching issue is whether to bundle the payment for these services, and if so,

whether to bundle it with the facility payment or with the surg e o n ’s payment (Figure 1-1). 

1 For illustrative purposes we refer to first assisting services for surgical procedures performed on an inpatient basis in hospitals and the

corresponding inpatient prospective payment system payments. Any changes made to payments for first assisting services would need to

be applied across all settings in which surgical procedures are performed.
M e d i c a r e C o ve r ag e o f N o n ph y s i c i an P r ac t i t io n e r s | J u ne 2 0 0 2 

Bundled payments

Bundling payment for first assistant services raises several important considerations. The advantages of

such a payment structure include:

• eliminating inconsistencies in current payment policy that, from the hospital perspective, favor use 

of those first assistant providers who may bill Medicare Part B directly;

• encouraging the recipient of the bundled payment to use the least expensive type of personnel 

consistent with acceptable surgical quality; and

• simplifying claims administration for Medicare carriers and fiscal intermediaries.

Disadvantages associated with bundling payment for first assistant services include:

• redistributing the cost of first assistant services paid under Part B across all hospitals performing surg e r y,

regardless of who performs the first assisting service. Teaching hospitals that can use residents as first

assistants would see an increase in payments without incurring any additional costs. Community 

hospitals, in contrast, would get the same payment increase but also would incur the additional costs

of paying the physician or nonphysician practitioner who functions as a first assistant;

Note: PA (physician assistant), NP (nurse practitioner), CNS (clinical nurse specialist).
6 M e d i c a r e c o v e r ag e o f s ur g i ca l t ec hn ol o g i s ts w h e n fu n ct i o n i n g a s fi r s t su r g i c al as s i st a n t s

create an environment viewed by surgeons as more adversarial and disrupt current practice arrangements.

Medicare pays about $200 million each year for first assistant services billed under Part B. Because residents

provide the majority of first assistant services in teaching hospitals, the Part B payments are generally made

for surgical procedures performed in community hospitals. Accounting for the costs of first assistant services

in the inpatient prospective payment would redistribute the pool of money for first assistants across surg e r i e s

performed in all hospitals, which would generally lead to underpayment for surgeries in community hospitals

hospitals. It is in these facilities, where surgical volume is low and highly skilled hospital personnel may be 

unavailable, that using a physician first assistant is necesssary to ensure high-quality surgical care. Teaching hosp

would benefit under this policy by receiving higher payments for facility services in addition to the payment 

they receive for training residents. A similar change in the distribution of payments would occur if the first assis

payment were bundled with the surgeon's fee.

One variation of bundling payments to facilities for first assistant services would be to exclude physicians

working as first assistants and continue to pay them separately. This option would encourage the use of

physicians as first assistants because they would continue to be paid under Part B. If physicians were 

substituted for nonphysician providers, this policy might increase overall costs to the Medicare program, 

compared with a policy that included costs for physician first assistants in the bundled payment. Reducing

the payment rates for physician first assistants would address the issue of costs to Medicare but might

reduce the pool of physicians willing to perform first assistant duties.
M e d i c a r e C o v er a g e o f N o n ph ys i c i an P r ac t i t io n e r s | J u ne 20 0 2 

The rationale for the current inconsistency in the payment structure is unclear, but it is probably rooted 

in the evolving roles, state licensure, and employment status of different nonphysician provider groups.

Physician assistants and advanced practice nurses generally are employed by surgeons or companies 

providing first assistants, or they function as independent contractors. By contrast, most surgical technologists

and about half of registered nurse first assistants tend to be hospital employees (although as state laws

have been expanded to provide direct payment by private insurers and Medicaid to registered nurse first

assistants there appears to be a trend toward these providers working as independent contractors as well)

(AORN 1996). Employment relationships between providers of first assistant services and the facilities 

in which they work vary considerably.

Financial incentives to choose a particular type of first assistant could be eliminated if Part B payments

were extended to all nonphysician practitioners who function as first assistants, but this approach has 

disadvantages. Increasing the number of fee-for-service providers could encourage overuse of services,

increasing Medicare’s costs. In addition, the volume of billings that CMS must process would increase if

additional nonphysician practitioners became eligible for Part B payments, which would tend to increase

the administrative costs of the Medicare program.

On balance, we see no compelling reason to change how Medicare pays for first assistant at surgery services.

Overall program payments for first assistant services have fallen since the physician fee schedule was

implemented more than 10 years ago. In addition, since nonphysician providers became eligible for direct

payment of first assistant services, the proportion of surgeries assisted by physicians has declined to about

80 percent. The financial incentives embedded in the current payment system do not appear to have

encouraged inappropriate use of first assistants.
8 M e d i c a r e c o v e r ag e o f s ur g i ca l t ec hn ol o g i s ts w h e n fu n ct i o n i n g a s fi r s t su r g i c al as s i st a n t s

this function, as only one state licenses these providers. To add surgical technologists as eligible providers

would require carriers to verify providers’ credentials with previous employers and educational institutions—

a role more appropriate for state licensing and regulatory agencies.
M e d i c a r e C o v er a g e o f N o n ph ys i c i an P r ac t i t io n e r s | J u ne 20 0 2 

Medicare coverage of nonphysician 

providers of mental health services

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Congress should not allow marriage and family therapists, licensed professional 

counselors, and pastoral counselors to bill Medicare independently for mental health services.

*YES: 12 • NO: 2 • NOT VOTING: 0 • ABSENT: 3

*COMMISSIONERS’ VOTING RESULT S
M e d i c a r e C o ver ag e o f N o n p h y s i ci a n P r a ct i t io n er s | J u ne 2 0 0 2 1 

malformed body member. Services provided by nonphysician mental health professionals must be delivered

by Medicare-recognized practitioners who are legally authorized to perform them under state l a w, and

must be otherwise covered if performed by a physician. Currently, Medicare makes direct payments only 

to psychologists, licensed clinical social workers, nurse practitioners with the equivalent of a master’s in 

p s y c h o t h e r a p y, and clinical psychiatric nurse specialists as nonphysician providers of mental health services.

The current policy raises three questions:

• Do Medicare beneficiaries have difficulty getting access to mental health services, including psychiatric

diagnostic evaluations and psychotherapy?

• Which categories of nonphysician practitioners have the appropriate education and licensure to provide

psychiatric diagnostic evaluations and psychotherapy?

• What would be the cost implications of recognizing additional mental health providers in the Medicare

program? 

1 Services provided by nonphysician providers may be reimbursed at 100 percent of the physician fee schedule if they are billed by the

physician as “incident to” services. Such services must meet the following requirements: (1) the services must be provided by employees

of a physician and under the physician’s direct supervision; (2) the physician must be in the office suite while the service is being pro v i d e d

and immediately available to provide assistance and direction; and (3) the physician also must have initiated the course of treatment and

must furnish subsequent services at a frequency consistent with active management of the course of treatment.

2 The American Medical Association current procedural terminology defines psychotherapy as “the treatment for mental illness and 

behavioral disturbances in which the clinician establishes a professional contract with the patient and, through definitive therapeutic 

communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage

personality growth and development.” In addition, it states that psychiatric diagnostic evaluations include a history, mental status exam,

and a disposition, and may include communication with family or other sources, and ordering and medical interpretation of laboratory

or other medical diagnostic studies (AMA 2001). 
1 4 M e d i c a r e c o v e r ag e o f n o np h ys i c i a n pr o v i d er s o f m e n ta l he a lt h se r v i c e s

in their lives. This arbitrary limit does not exist for medical treatment in hospitals. 

In addition, a recent report by the U.S. Department of Health and Human Services’O ffice of Inspector

General (OIG) found that more than 8 percent of reviewed medical records suggested that beneficiaries

may not have received needed mental health services. According to many of these records, patients who

were receiving psychotherapy services should have been evaluated for psychotropic medication. On the

other hand, 22 percent of the reviewed medical records revealed that Medicare beneficiaries received 

mental health services beyond what was medically indicated or necessary (OIG 2001a). In these cases, 

the medical record did not justify the duration or frequency of psychotherapy services. 

P r e v i o u s l y, the Congress has used Medicare payment policy in an attempt to bridge gaps in access to 

primary care health professionals in rural and underserved communities—a potential benefit both to

Medicare beneficiaries and to the entire population of the area served by these providers. A primary 

motivation behind Medicare’s earlier policies for certain nonphysician providers, such as nurse practitioners,

was to entice them to provide services in areas that suffered a shortage of physicians. When nonphysician

providers were present in a community this change in payment policy may have improved beneficiaries’

access to services. However, in communities where practitioners were not present, many nonphysician

providers were reluctant to relocate their practices to underserved areas—citing reasons such as quality 

of life and proximity to the amenities of urban areas, the same reasons that physicians gave (ACP-ASIM

2000). Moreover, some researchers suggest that telepsychiatry also may address certain access problems

in health professional shortage areas (Summer 2001). 
M e d i c a r e C ov er ag e o f N o n p h ys i ci a n P r a ct it io n er s | J un e 2 0 0 2 1 

clinical counseling. Historically, licensed professional counselors have received their degrees through 

a university’s education department and worked in a variety of settings, including schools and colleges,

community and government agencies, businesses, and private practice. While LCs are similar to other

mental health providers, their counseling can be distinguished by its developmental and preventive 

orientation as well as its focus on the individual within an environmental context (DHHS 2001b). LCs 

are licensed or certified in 45 states and the District of Columbia. They also are covered by the CHAMPUS/

TRICARE program. 

Pastoral counselors

Pastoral counseling integrates behavioral science with the spiritual aspects of mental health. PCs are

ordained clergy—or are otherwise recognized and endorsed by a religious denomination—who are also

mental health professionals. Some PCs have master’s degrees in a related counseling discipline, such as

marriage and family therapy or psychology. Others have completed graduate coursework, but the focus

may be in divinity, theology, or philosophy rather than in a counseling discipline. In the latter group, courses

in clinical counseling and related subjects are required for certification. The American Association of

Pastoral Counselors is seeking direct billing rights only for those PCs recognized through certification as

“fellows”—a designation requiring at least a master’s degree. 

Only 6 states now have licensure or certification for PCs, but 37 states license them under another counseling

discipline (for example, pastoral counseling preparation can meet the criteria for licensure as an M F T or LC).

PCs are recognized providers for CHAMPUS/TRICARE and for federal employees in certain u n d e r s e r v e d

3 As defined by the Health Resources and Services Administration, core mental health professionals include: psychiatrists, clinical psychologists,

clinical social workers, psychiatric nurse specialists, and marriage and family therapists. In designating mental health professional short a g e

a reas, states can use either a population-to-psychiatrist ratio or a ratio of population-to-core mental health professionals (HRSA 1995).
1 6 M e d i c a r e c o v e r ag e o f n o np h ys i c i a n pr o v i d er s o f m e n ta l he a lt h se r v i c e s

complex and/or beyond their scope.” OIG concluded that current state scopes of practice “create potential

vulnerabilities, both from payment and quality of care standpoints” (OIG 2001b). Thus, state licensure

laws may not provide sufficient or appropriate guidance to Medicare for coverage decisions about additional

groups of providers of mental health services. 

What would be the cost implications of recognizing additional mental

health providers in the Medicare pro g r a m ?

Approaches to improving Medicare beneficiaries’ access to necessary mental health services cover a 

wide range of policy options with varying cost implications. Increased costs should be anticipated and 

are appropriate in areas where recognition of additional mental health providers fulfills unmet demand.

The combination of costs associated with fulfilling unmet needs and the costs associated with creating

additional capacity for outpatient mental health services is likely to negate any program savings that 

may accrue as a result of provider substitution or decreases in the incidence of inappropriate physician 

or emergency room visits.

Some studies have found conflicting evidence of the impact on costs to government and private payers for

nonphysician practitioners with newly expanded service and payment prerogatives (OIG 2001b, Hartley 

et al. 2002). In a report examining payments for the services of physician assistants, nurse practitioners,

and clinical nurse specialists whose billing rights were expanded by the Balanced Budget Act of 1997,

OIG determined that billings rose rapidly after geographic restrictions on payments to these providers

were lifted (OIG 2001b). However, OIG acknowledged that because some of these services otherwise
M e d i c a r e C o ver ag e o f N o n p h y s i ci a n P r a ct i t io n er s | J u ne 2 0 0 2 1 

Other barriers take pre c e d e n c e

Although additional Medicare providers may help alleviate mental health professional shortages in some

areas, a multidimensional approach is needed to address the cultural traditions, geographic and economic

barriers that prevent beneficiaries from accessing mental health services. Addressing the many financial

barriers to mental health services embedded in Medicare payment and coverage policy may have greater

potential to improve mental health services for the largest number of beneficiaries. 

R E C O M M E N D A T I O N

The Congress should not allow marriage and family therapists, licensed professional 

counselors, and pastoral counselors to bill Medicare independently for mental health serv i c e s .

Although Medicare beneficiaries in certain areas may benefit by allowing additional providers to bill

Medicare, this change would not address other important barriers to mental health services in both urban

and rural areas. Across the board, beneficiaries seeking mental health care face significant cost-sharing

requirements, and those with serious mental illness face lifetime caps on inpatient psychiatric care. 

Further limiting use of services are practical barriers such as limited transportation to health care providers.

Stigmas associated with mental health problems keep individuals of all ages and races from seeking 

treatment, and present a challenge to providing beneficiaries with needed care that cannot be addressed

through Medicare policy alone. 
1 8 M e d i c a r e c o v e r ag e o f n o np h ys i c i a n pr o v i d er s o f m e n ta l he a lt h se r v i c e s
M e d i c a r e C o ver ag e o f N o n p h y s i ci a n P r a ct i t io n er s | J u ne 2 0 0 2 

May 14, 2002.

Department of Health and Human Services, Substance Abuse and Mental Health Services A d m i n i s t r a t i o n ,

Center for Mental Health Services. Mental health, United States, 2000. Rockville (MD), U.S. Government

Printing Office. 2001b.

Hartley D, Ziller E, Lambert D, Loux S, Bird D, University of Southern Maine. Effects of licensure laws

and rules on access to mental health services in rural areas. Preliminary executive summary. April 2002.

O ffice of Inspector General, Department of Health and Human Services. Medicare Part B payments for

mental health services, Washington (DC), OIG. May 2001a.

O ffice of Inspector General, Department of Health and Human Services. Medicare coverage of 

non-physician practitioner services, Washington (DC), OIG. June 2001b.

Summer CR. Telepsychiatry: challenges in rural aging, Journal of Rural Health. Fall 2001, Vol. 17, No. 4,

p. 370-373.

Medicare coverage of 

clinical pharmacists’ services

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Secretary should assess models for collaborative drug therapy management services in

outpatient settings.

*YES: 15 • NO: 0 • NOT VOTING: 0 • ABSENT: 2

*COMMISSIONERS’ VOTING RESULT S
M e d i c a r e C o ver ag e o f N o n p h y s i ci a n P r a ct i t io n er s | J u ne 2 0 0 2 2 3

• assist physicians to improve medication management and continuity of care,

• select, initiate, modify, continue, discontinue, and monitor patients’ drug therapy,

• o r d e r, perform, and interpret medication-related laboratory tests,

• assess patients’ responses to therapy,

• counsel and educate patients on medications, and

• administer medications. 

In practice, drug management focuses largely on managing the drug therapy treatment of high-risk p a t i e n t s,

those taking a wide array of medications, or those with specific diseases, such as asthma, diabetes, h e a r t

attack, or hypertension. Aprimary role of clinical pharmacists is to develop and/or implement drug 

treatment protocols for specific medical conditions. State Medicaid demonstration projects in Iowa,

Mississippi, Wisconsin, and Washington are currently testing this approach, but no data are yet available.

D rug management services may improve the quality of care

Drug management has the potential to improve the quality of care for Medicare beneficiaries by: 

• reducing the incidence of adverse drug eff e c t s ,

• improving patient outcomes, and 

• improving patient compliance with drug therapy.
2 4 M e d i c a r e c o v e r ag e o f c l i n i c al p ha rm ac i s t s’ se r v i c e s

share the risk and responsibility for patient outcomes. The physicians ongoing involvement in the

p a t i e n t ’s care also would need to be clearly defined.

Costs unknown

While drug management may improve the quality of care for Medicare beneficiaries, the cost of widespread

implementation of this service has not been ascertained. Some studies suggest that involving clinical 

pharmacists in the medical therapy of patients may produce savings for the Medicare program by reducing

adverse drug events and improving patient compliance with medical therapy. These changes may result in

better clinical outcomes, which could decrease the number of physician visits or hospitalizations. A l t h o u g h

these studies describe positive financial benefits from more direct participation of clinical pharmacists in

patient care, they have been criticized for not including the additional costs of providing pharmacist services

(Schumock et al. 1996). Moreover, they generally have focused on pharmacists’ involvement in patient

care for specific subsets of patients. A key question is whether savings for a subset of Medicare beneficiaries

would be offset by widespread additional payments for clinical pharmacists.

The A C C P has estimated that the annual cost of drug management under Part B of the Medicare program

would be between $500 million and $1.7 billion, depending on the structure and use of the benefit. T h e

lower figure assumes 2 outpatient visits per year for 8 million beneficiaries, and the higher number is

based on 4 visits per year for 12 million patients. These estimates assume an hourly payment rate for 

pharmacists of $60, with 65 percent of visits lasting 15 minutes, 25 percent lasting 30 minutes, and 10 

percent lasting 60 minutes (ACCP2002). More recently, the results of a cost analysis of proposed legislation

(S. 974/H.R. 2799) conducted for several pharmacy-related organizations suggest that paying pharmacists 
M e d i c a r e C ov er ag e o f N o n p h ys i ci a n P r a ct it io n er s | J un e 2 0 0 2 2 

R E C O M M E N D A T I O N

The Secre t a ry should assess models for collaborative drug therapy management serv i c e s

in outpatient settings.

Many options are available for designing and carrying out drug management services in concert with

implementation of a Medicare drug benefit. The Congress may seek to include drug management as a

service provided that pharmacy benefit managers, the potential private sector administrators of a drug 

benefit, are required to provide to certain Medicare beneficiaries. They also may choose to establish this 

benefit through the physician fee schedule and pay providers accordingly. Or, as part of multi-faceted

program reforms, the Congress could consider drug management services together with comprehensive

care coordination for Medicare beneficiaries. Embedded in each of these options is the need to clearly

define the roles and responsibilities of pharmacists, physicians, and other providers on the patient care team. 
2 6 M e d i c a r e c o v e r ag e o f c l i n i c al p ha rm ac i s t s’ se r v i c e s

Moran DW, Poole VH, Kirby KM, Braid MJ. The Moran Company. The Medicare Pharmacist Services

Coverage Act of 2001: estimates of CBO scoring. Presented to Pharmacist Provider Coalition, Fairfax

( VA), The Moran Company. May 2002.

Schumock GT, Meek PD, Ploetz PA, et al. Economic evaluations of clinical pharmacy services 

1988-1995, Pharmacotherapy. 1996, Vol. 16, No. 6, p. 11 8 8 - 1 2 0 8 .
Commissioners

 voting 

on recommendations

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M e d i c a r e C o ver ag e o f N o n p h y s i ci a n P r a ct i t io n er s | J u ne 2 0 0 2 2 

R e i s c h a u e r, Smith, Stowers 

No: DeBusk, Wa k e f i e l d

Absent: Burke, Rosenblatt, Rowe

Chapter 3: Medicare coverage of clinical pharmacists’ serv i c e s

The Secretary should assess models for collaborative drug therapy management services in outpatient settings.

Yes: Braun, DeBusk, Feezor, Hackbarth, Loop, Muller, Nelson, Newhouse, Newport, Raphael, 

R e i s c h a u e r, Rosenblatt, Smith, Stowers, Wa k e f i e l d

A b s e n t : Burke, Rowe 

More about MedPAC

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M e d i c a r e C o ver ag e o f N o n p h y s i ci a n P r a ct i t io n er s | J u ne 2 0 0 2 3 

f y

Santa Ana, CA

C a rol Raphael

Visiting Nurse Service of New Yo r k

New York, NY

M a ry K. Wakefield, Ph.D., 

R.N., F. A . A . N .

Center for Rural Health

University of North Dakota

Grand Forks, ND

R o b e rt D. Reischauer, Ph.D.

David A. Smith

A F L - C I O

Washington, DC

Ray E. Stowers, D.O.

Oklahoma State University College of

Osteopathic Medicine

Tulsa, OK

Ralph W. Muller

University of Chicago 

Hospitals and Health Systems

Chicago, IL

Joseph P. Newhouse, Ph.D.

H a rv a rd University

Boston, MA

Alice Rosenblatt, F.S.A., M.A.A.A.

WellPoint Health Networks

Thousand Oaks, CA

John W. Rowe, M.D.

Aetna Inc.

Hartford, CT

M e d i c a r e C ov er ag e o f N o n p h ys i ci a n P r a ct it io n er s | J un e 2 0 0 2 3 

Anne Mutti, M.P. A .

Susanne Seagrave, Ph.D.

Mae T h a m e r, Ph.D.

Ariel Wi n t e r, M.P. P.

Chantal Worzala, Ph.D.

Daniel Zabinski, Ph.D.


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