[Congressional Record Volume 155, Number 173 (Friday, November 20, 2009)]
[Senate]
[Page S11885]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Mr. Conrad):
  S. 2814. A bill tb amend title XVIII of the Social Security Act to 
ensure more timely access to home health services for Medicare 
beneficiaries under the Medicare program; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise today on behalf of myself and 
Senator Conrad to introduce legislation to ensure that our seniors and 
disabled citizens have timely access to home health services under the 
Medicare program.
  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. In recognition of their growing role, Congress, in 
1997, authorized Medicare to begin paying for physician services 
provided by these health professionals as long as those services are 
within their scope of practice under state law.
  Despite their expanded role, these advanced practice registered 
nurses and physician assistants are currently unable to order home 
health services for their Medicare patients. 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. 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. At best, 
this requirement adds more paperwork and a number of unnecessary steps 
to the process before home health care can be provided. At worst, it 
can lead to needless delays in getting Medicare patients the home 
health care they need simply because a physician is not readily 
available to sign the form.
  The inability of advanced practice registered nurses and physician 
assistants to order home health care is particularly burdensome for 
Medicare beneficiaries in medically underserved areas, where these 
providers may be the only health care professionals available. For 
example, needed home health care was delayed by more than a week for a 
Medicare patient in Nevada because the physician assistant was the only 
health care professional serving the patient's small town, and the 
supervising physician was located 60 miles away.
  A nurse practitioner told me about another case in which her 
collaborating physician had just lost her father and was not available. 
As a consequence, the patient experienced a two-day delay in getting 
needed care while they waited to get the paperwork signed by another 
physician. Another nurse practitioner pointed out that it is ridiculous 
that she can order physical and occupational therapy in a subacute 
facility but cannot order home health care. One of her patients had to 
wait 11 days after being discharged before his physical and 
occupational therapy could continue simply because the home health 
agency had difficulty finding a physician to certify the continuation 
of the same therapy that the nurse practitioner had been able to 
authorize when the patient was in the facility.
  The Home Health Care Planning Improvement Act will help to ensure 
that our Medicare beneficiaries get the home health care that they need 
when they need it by allowing physician assistants, nurse 
practitioners, clinical nurse specialists and certified nurse midwives 
to order home health services. Our legislation is supported by the 
National Association for Home Care and Hospice, the American Nurses 
Association, the American Academy of Physician Assistants, the American 
College of Nurse Practitioners, the American College of Nurse Midwives, 
the American Academy of Nurse Practitioners, and the Visiting Nurse 
Associations of America. I urge all of my colleagues to join us as 
cosponsors of this important legislation.
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