[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 296 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                 S. 296

 To amend title XVIII of the Social Security Act to ensure more timely 
  access to home health services for Medicare beneficiaries under the 
                           Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 31, 2019

Ms. Collins (for herself and Mr. Cardin) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to ensure more timely 
  access to home health services for Medicare beneficiaries under the 
                           Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Home Health Care Planning 
Improvement Act of 2019''.

SEC. 2. IMPROVING CARE PLANNING FOR MEDICARE HOME HEALTH SERVICES.

    (a) Part A Provisions.--Section 1814(a) of the Social Security Act 
(42 U.S.C. 1395f(a)) is amended--
            (1) in paragraph (2)--
                    (A) in the matter preceding subparagraph (A), by 
                inserting ``, a nurse practitioner or clinical nurse 
                specialist who is working in collaboration with a 
                physician in accordance with State law, a certified 
                nurse-midwife (as defined in section 1861(gg)) as 
                authorized by State law, or a physician assistant (as 
                defined in section 1861(aa)(5)) under the supervision 
                of a physician'' after ``1866(j)''; and
                    (B) in subparagraph (C)--
                            (i) by inserting ``, a nurse practitioner, 
                        a clinical nurse specialist, a certified nurse-
                        midwife, or a physician assistant (as the case 
                        may be)'' after ``physician'' the first 2 times 
                        it appears; and
                            (ii) by striking ``, and, in the case of a 
                        certification made by a physician'' and all 
                        that follows through ``face-to-face encounter'' 
                        and inserting ``, and, in the case of a 
                        certification made by a physician after January 
                        1, 2010, or by a nurse practitioner, clinical 
                        nurse specialist, certified nurse-midwife, or 
                        physician assistant (as the case may be) after 
                        January 1, 2020, prior to making such 
                        certification the physician, nurse 
                        practitioner, clinical nurse specialist, 
                        certified nurse-midwife, or physician assistant 
                        must document that the physician, nurse 
                        practitioner, clinical nurse specialist, 
                        certified nurse-midwife, or physician assistant 
                        has had a face-to-face encounter'';
            (2) in the second sentence, by inserting ``certified nurse-
        midwife,'' after ``clinical nurse specialist,'';
            (3) in the third sentence--
                    (A) by striking ``physician certification'' and 
                inserting ``certification'';
                    (B) by inserting ``(or on January 1, 2020, in the 
                case of regulations to implement the amendments made by 
                section 2 of the Home Health Care Planning Improvement 
                Act of 2019)'' after ``1981''; and
                    (C) by striking ``a physician who'' and inserting 
                ``a physician, nurse practitioner, clinical nurse 
                specialist, certified nurse-midwife, or physician 
                assistant who''; and
            (4) in the fourth sentence, by inserting ``, nurse 
        practitioner, clinical nurse specialist, certified nurse-
        midwife, or physician assistant'' after ``physician''.
    (b) Part B Provisions.--Section 1835(a) of the Social Security Act 
(42 U.S.C. 1395n(a)) is amended--
            (1) in paragraph (2)--
                    (A) in the matter preceding subparagraph (A), by 
                inserting ``, a nurse practitioner or clinical nurse 
                specialist (as those terms are defined in 1861(aa)(5)) 
                who is working in collaboration with a physician in 
                accordance with State law, a certified nurse-midwife 
                (as defined in section 1861(gg)) as authorized by State 
                law, or a physician assistant (as defined in section 
                1861(aa)(5)) under the supervision of a physician'' 
                after ``1866(j)''; and
                    (B) in subparagraph (A)--
                            (i) in each of clauses (ii) and (iii) of 
                        subparagraph (A) by inserting ``, a nurse 
                        practitioner, a clinical nurse specialist, a 
                        certified nurse-midwife, or a physician 
                        assistant (as the case may be)'' after 
                        ``physician''; and
                            (ii) in clause (iv), by striking ``after 
                        January 1, 2010'' and all that follows through 
                        ``face-to-face encounter'' and inserting ``made 
                        by a physician after January 1, 2010, or by a 
                        nurse practitioner, clinical nurse specialist, 
                        certified nurse-midwife, or physician assistant 
                        (as the case may be) after January 1, 2020, 
                        prior to making such certification the 
                        physician, nurse practitioner, clinical nurse 
                        specialist, certified nurse-midwife, or 
                        physician assistant must document that the 
                        physician, nurse practitioner, clinical nurse 
                        specialist, certified nurse-midwife, or 
                        physician assistant has had a face-to-face 
                        encounter'';
            (2) in the third sentence, by inserting ``, nurse 
        practitioner, clinical nurse specialist, certified nurse-
        midwife, or physician assistant (as the case may be)'' after 
        physician;
            (3) in the fourth sentence--
                    (A) by striking ``physician certification'' and 
                inserting ``certification'';
                    (B) by inserting ``(or on January 1, 2020, in the 
                case of regulations to implement the amendments made by 
                section 2 of the Home Health Care Planning Improvement 
                Act of 2019)'' after ``1981''; and
                    (C) by striking ``a physician who'' and inserting 
                ``a physician, nurse practitioner, clinical nurse 
                specialist, certified nurse-midwife, or physician 
                assistant who''; and
            (4) in the fifth sentence, by inserting ``, nurse 
        practitioner, clinical nurse specialist, certified nurse-
        midwife, or physician assistant'' after ``physician''.
    (c) Definition Provisions.--
            (1) Home health services.--Section 1861(m) of the Social 
        Security Act (42 U.S.C. 1395x(m)) is amended--
                    (A) in the matter preceding paragraph (1)--
                            (i) by inserting ``, a nurse practitioner 
                        or a clinical nurse specialist (as those terms 
                        are defined in subsection (aa)(5)), a certified 
                        nurse-midwife (as defined in section 1861(gg)), 
                        or a physician assistant (as defined in 
                        subsection (aa)(5))'' after ``physician'' the 
                        first place it appears; and
                            (ii) by inserting ``, a nurse practitioner, 
                        a clinical nurse specialist, a certified nurse-
                        midwife, or a physician assistant'' after 
                        ``physician'' the second place it appears; and
                    (B) in paragraph (3), by inserting ``, a nurse 
                practitioner, a clinical nurse specialist, a certified 
                nurse-midwife, or a physician assistant'' after 
                ``physician''.
            (2) Home health agency.--Section 1861(o)(2) of the Social 
        Security Act (42 U.S.C. 1395x(o)(2)) is amended--
                    (A) by inserting ``, nurse practitioners or 
                clinical nurse specialists (as those terms are defined 
                in subsection (aa)(5)), certified nurse-midwives (as 
                defined in section 1861(gg)), or physician assistants 
                (as defined in subsection (aa)(5))'' after 
                ``physicians''; and
                    (B) by inserting ``, nurse practitioner, clinical 
                nurse specialist, certified nurse-midwife, physician 
                assistant,'' after ``physician''.
    (d) Home Health Prospective Payment System Provisions.--Section 
1895 of the Social Security Act (42 U.S.C. 1395fff) is amended--
            (1) in subsection (c)(1), by inserting ``, the nurse 
        practitioner or clinical nurse specialist (as those terms are 
        defined in section 1861(aa)(5)), the certified nurse-midwife 
        (as defined in section 1861(gg)), or the physician assistant 
        (as defined in section 1861(aa)(5)),'' after ``physician''; and
            (2) in subsection (e)--
                    (A) in paragraph (1)(A), by inserting ``, a nurse 
                practitioner or clinical nurse specialist (as those 
                terms are defined in section 1861(aa)(5)), a certified 
                nurse-midwife (as defined in section 1861(gg)), or a 
                physician assistant (as defined in section 
                1861(aa)(5))'' after ``physician''; and
                    (B) in paragraph (2)--
                            (i) in the heading, by striking ``Physician 
                        certification'' and inserting ``Rule of 
                        construction regarding requirement for 
                        certification''; and
                            (ii) by striking ``physician''.
    (e) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2020.
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