[Congressional Record Volume 161, Number 33 (Thursday, February 26, 2015)]
[Senate]
[Pages S1163-S1164]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Mr. Schumer):
  S. 578. 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; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise today on behalf of myself and 
Senator Schumer 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 2 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 eleven 
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 a broad 
coalition of organizations, including the AARP, the National Council on 
Aging, the American Geriatrics Society, the National Association for 
Home Care and Hospice, the American Nurses Association, the American 
Association of Nurse Practitioners, the American Academy of Physician 
Assistants, the American College of Nurse Midwives, and the Visiting 
Nurse Associations of America. I urge my colleagues to join us as 
cosponsors of this important legislation.
  Mr. President, I ask unanimous consent that a letter of support be 
printed in the Record.
  There being no objection, the text of the material was ordered to be 
printed in the Record, as follows:

                                                February 25, 2015.
     Hon. Susan Collins,
     U.S. Senate, Washington, DC.
     Hon. Chuck Schumer,
     U.S. Senate, Washington, DC.
       Dear Senator Collins and Senator Schumer: Thank you for 
     introducing the bipartisan Home Health Care Planning 
     Improvement Act of 2015. We, the undersigned groups, pledge 
     our continued support of your efforts to obtain passage of 
     this important legislation in the 114th Congress. As you 
     know, the bill authorizes nurse practitioners, clinical nurse 
     specialists, certified nurse-midwives and physician 
     assistants as eligible health care professionals who can 
     certify patient eligibility for home health care services 
     under Medicare. This critical

[[Page S1164]]

     change would improve access to important home health care 
     services, and potentially prevent additional hospital, sub-
     acute care facility and nursing home admissions--all of which 
     are costly to the consumer, the taxpayer and Medicare.
       The undersigned organizations are committed to ensuring 
     that consumers have access to health care providers who are 
     qualified, educated, and certified to provide high quality 
     primary care, chronic care management, and other services 
     that keep them living a high quality life, with dignity, in 
     locations of their choice.
       Although current law has long recognized advanced practice 
     registered nurses and physician assistants as authorized 
     Medicare providers, and allows these clinicians to certify 
     eligibility for nursing home care for their patients, it 
     precludes these same practitioners from certifying patient 
     eligibility for home health care services. This is an 
     unnecessary barrier to care and adds at least one more step 
     in the process of accessing home health care services by 
     requiring the provider to find a physician to certify 
     eligibility. In addition, time delays to locate a physician 
     to certify eligibility, particularly in rural and underserved 
     areas, can result in an extended hospital stay or nursing 
     home admission because the beneficiary could not be moved 
     back to or remain at home without home health care services.
       There are decades of data supporting the ability of these 
     providers to deliver high quality care to people of all ages, 
     including Medicare recipients with multiple chronic 
     conditions. Advanced practice registered nurses are often the 
     only care providers available in health professional shortage 
     areas such as urban, rural, and frontier regions. Given the 
     existing and future projected primary care physician 
     shortages, and the coming of increased numbers of Medicare 
     eligible patients, the need will be even greater for all 
     qualified providers to be allowed to certify home health care 
     eligibility.
       The Home Health Care Planning Improvement Act would help to 
     ensure that Medicare beneficiaries in need of home health 
     care services whose providers are nurse practitioners, 
     clinical nurse specialists, certified nurse midwives, and 
     physician assistants would be able to directly access home 
     health care by referral from their providers. This bill would 
     provide beneficiaries continued access to care and increase 
     the likelihood that they would experience better health and a 
     higher quality of life. Additionally, outside experts 
     assessed the impact of the bill earlier last year and 
     projected a Medicare savings of $7.1 million in 2015 and up 
     to a ten-year savings of $252.6 million. This analysis also 
     notes the potential to reduce beneficiary admissions to and 
     lengths of stay in institutional settings under the policy 
     change.
       We appreciate your continued leadership and are committed 
     to working with you to ensure that this bipartisan 
     legislation is passed and placed on the President's desk for 
     signature at the first opportunity. The time is now to ensure 
     that patients have timely access to the quality, cost 
     effective care they need. For any questions, please contact 
     [email protected] or 703-740-2529.
       Thank you for your help.
           Sincerely,
       AARP, AFT Nurses and Health Professionals, AMDA-The Society 
     for Post-Acute and Long-Term Care Medicine, Alzheimer's 
     Foundation of America, American Academy of Nursing, American 
     Academy of Physician Assistants, American Association of 
     Colleges of Nursing, American Association of Heart Failure 
     Nurses, American Association of Nurse Practitioners, American 
     Association of Occupational Health Nurses, American College 
     of Nurse-Midwives, American Geriatrics Society, American 
     Nephrology Nurses' Association, American Nurses Association, 
     American Organization of Nurse Executives.
       American Pediatric Surgical Nurses Association, American 
     Psychiatric Nurses Association, Association of Community 
     Health Nursing Educators, Association of Public Health 
     Nurses, Association of Rehabilitation Nurses, Center for 
     Medicare Advocacy, Gerontological Advance Practice Nurses 
     Association, International Society of Psychiatric-Mental 
     Health Nurses, The Jewish Federations of North America, 
     Justice in Aging, Leading Age, Medicare Rights Center, 
     National Academy of Elder Law Attorneys, National Association 
     for Home Care & Hospice.
       National Association of Clinical Nurse Specialists, 
     National Association of Neonatal Nurses, National Association 
     of Neonatal Nurse Practitioners, National Association of 
     Pediatric Nurse Practitioners, National Association of 
     Professional Geriatric Care Managers, National Black Nurses 
     Association, National Committee to Preserve Social Security 
     and Medicare, National Consumer Voice for Quality Long-Term 
     Care, National Council on Aging, National Organization of 
     Nurse Practitioner Faculties, Organization for Associate 
     Degree Nursing, OWL--The Voice of Women 40+, Public Health 
     Nursing Section, American Public Health Association, VNAA--
     The Visiting Nurse Associations of America, Women's Institute 
     for a Secure Retirement.
                                 ______