Senators Susan Collins (R-ME), the Ranking Minority Member on the Senate Special Committee on Aging, and Charles Schumer (D-NY), who serves on the Senate Finance Committee with jurisdiction over Medicare, have circulated a Dear Colleague Letter urging support of their bill, S.1332, the "Home Health Care Planning Improvement Act," which would allow nurse practitioners, clinical nurse specialists, nurse midwives, and physicians' assistants to certify Medicare home health plans of care. Their bill currently has 9 Senate cosponsors. They have asked NAHC members to help get more cosponsors on the bill.
Senator Collins has introduced the same legislation in past Congresses, and committed to NAHC members during the March on Washington earlier this year that she would reintroduce the bill during the 113th Congress. Representatives Greg Walden (R-OR) and Allyson Schwartz (D-PA) have introduced a companion bill in the House (H.R. 2504), which currently has 68 cosponsors.
Senator Collins has frequently lauded the important role these health care professionals have in health care delivery and said the legislation would help "ensure that our seniors and disabled citizens have timely access to home health services under the Medicare program." The National Association for Home Care & Hospice (NAHC) assisted with the preparation and drafting of this legislation and is helping gather support for its passage.
"Nurse practitioners, physician assistants, certified nurse midwives, and clinical nurse specialists are all playing increasingly important roles in the delivery of health care services, particularly in rural and medically underserved areas of our country where physicians may be in scarce supply," Collins said in arguing the need for this legislation. In 1997, Congress authorized Medicare to begin paying for physician services provided by additional health professionals when the scopes of their services are within their scope of practice under state law.
Senator Collins pointed out that non-physician health care professionals often have the best understanding of and relationship with the patient. "Under current law, only physicians are allowed to certify or initiate home health care for Medicare patients, even though they may not be as familiar with the patient's case as the non-physician provider," she noted. "In fact, in many cases, the certifying physician may not even have a relationship with the patient and must rely upon the input of the nurse practitioner, physician assistant, clinical nurse specialist, or certified nurse midwife to order the medically necessary home health care."
The requirement that only a physician can certify a home health plan of care "adds more paperwork and a number of unnecessary steps to the process before home care can be provided," Collins contended. "It can lead to needless delays in getting Medicare patients the home health care they need," she said, "simply because a physician is not available to sign the form."
In a previous statement to the Senate – as well as in similar statements to NAHC and other groups - Senator Collins described the inability of non-physician providers to order home health care as "particularly burdensome for Medicare beneficiaries in medically underserved areas where these providers may be the only health care professionals available."
Collins recounted a series of examples to illustrate the urgency of need for this change in home health care certification. In one of several cases she cited, a Medicare patient had care delayed for over a week because a physician assistant was the only health care professional serving the patient's small rural town. The supervising physician was 60 miles away.
NAHC has long urged the adoption of this overdue reform. In addition to NAHC, AARP, the American Nurses Association, the American Academy of Physician Assistants, American Association of Nurse Practitioners, the American College of Nurse Midwives, and the Visiting Nurse Associations of America have all endorsed the Home Health Care Planning Improvement Act.
NAHC encourages all of its members to contact their Senators and Representatives through the NAHC Legislative ActionNetwork and ask them to become sponsors of this important piece of legislation. You may also deliver the message by phone.
Congressional contact information is available here: Contact Your Elected Officials. When calling, ask the receptionist to connect you with the staffer who handles health care issues.
To read the Dear Colleague letter, please click here.