[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.
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