110 HR 1178 IH: To amend title XVIII of the Social Security Act to permit U.S. House of Representatives 2007-02-16 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 110th CONGRESS 1st Session H. R. 1178 IN THE HOUSE OF REPRESENTATIVES February 16, 2007 Mr. Towns (for himself and Mr. English of Pennsylvania) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to permit a physician assistant, when delegated by a physician, to order or provide post-hospital extended care services, home health services, and hospice care under the Medicare Program.

1.

Short title

This Act may be cited as the Physician Assistants Continuity of Care Act of 2007.

2.

Findings

Congress finds the following: (1)In 2006, approximately 286 million prescriptions were written by physician assistants and more than 230 million patient visits were made for physician assistant services. Such services are particularly needed in communities that experience health disparities, especially rural communities and communities with high minority populations. (2)Physician assistants furnish services in almost all health care settings and in every medical and surgical specialty, providing quality, cost-effective medical care. They deliver a broad range of medical and surgical services to diverse populations. (3)All 50 States, the District of Columbia, and Guam regulate physician assistant services so as to permit physician assistants to practice medicine subject to the oversight of physicians and to have the authority to write prescriptions subject to such oversight. (4)In 1997, the Balanced Budget Act of 1997 amended the Medicare program to extend coverage for medical services provided by physician assistants, as permitted under applicable State law, thus providing for a uniform rate of reimbursement for certain services furnished by physician assistants who work in health care practice settings subject to the oversight of a physician. (5)Physician assistants and physicians work together as a team. However, supervising physicians need not be physically present when physician assistants provide medical care. In medically underserved communities, a physician assistant may be the only onsite health care professional accessible during the time when a patient needs immediate care. Health care furnished by physician assistants is therefore critical to providing medical care for the most vulnerable and at-risk populations in the United States. (6)In some rural areas, physician assistants are the only providers of care immediately available. However, Medicare beneficiaries have faced delays of weeks in receiving hospice care because care delivered by physician assistants may not be reimbursed under the Medicare program. (7)Some critical access hospitals have reported difficulty with discharge planning because the Medicare program does not provide reimbursement for services related to skilled nursing facility orders or home health orders that have been signed by a physician assistant. (8)The continuity of care of a terminally ill Medicare beneficiary may be interrupted because a physician assistant may not be reimbursed under the Medicare program for furnishing such beneficiary with certain services, such as hospice care, even though a physician assistant may have been such beneficiary’s primary health care provider prior to the diagnosis of the terminal illness. Such break downs in the continuity of care of Medicare beneficiaries may cause additional costs for the Medicare program.

3.

Permitting physician assistants when delegated by a physician to order or provide post-hospital extended care services, home health services, and hospice care under the Medicare program

(a)

Post-hospital extended care services

Section 1814(a)(2) of the Social Security Act (42 U.S.C. 1395f(a)(2)) is amended, in the matter before subparagraph (A)— (1)by inserting or a physician assistant as delegated by a physician after a physician the first place it appears; and (2)by inserting a physician assistant as delegated by a physician, after a physician, the second place it appears. (b)

Home health services

(1)

Under part A

Section 1814(a)(2)(C) of such Act (42 U.S.C. 1395f(a)(2)(C)) is amended— (A)by inserting by a physician or by a physician assistant as delegated by a physician, after established; and (B)by inserting or a physician assistant as delegated by a physician after a physician each place it appears. (2)

Under part B

Section 1835(a)(2) of such Act (42 U.S.C. 1395n(a)(2)) is amended— (A)in the matter before subparagraph (A), by inserting or a physician assistant as delegated by a physician, after a physician; and (B)in each of clauses (ii) and (iii) of subparagraph (A)(ii), by inserting or a physician assistant as delegated by a physician after a physician. (c)

Hospice care

(1)

Certification of terminal illness

Section 1814(a)(7)(A) of such Act is (42 U.S.C. 1395f(a)(7)(A)) is amended— (A)in clause (i)(I), by inserting or a physician assistant as delegated by such attending physician after nurse practitioner); and (B)in clause (ii), by inserting or physician assistant after physician. (2)

Including professional services of physician assistant

Section 1861(dd)(1)(F) of such Act (42 U.S.C. 1395x(dd)(1)(F)) is amended by inserting after physicians' services the following: and services which would be physicians' services if furnished by a physician (as defined in subsection (r)(1)) and which are performed by a physician assistant under the supervision of a physician (as so defined) and which the physician assistant is legally authorized to perform in the State in which the services are performed. (d)

Effective date

The amendments made by this section shall apply to services furnished on or after January 1, 2007.