[Congressional Record Volume 168, Number 97 (Tuesday, June 7, 2022)]
[House]
[Pages H5242-H5249]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





 IMPROVING ACCESS TO WORKERS' COMPENSATION FOR INJURED FEDERAL WORKERS 
                              ACT OF 2022

  Mr. COURTNEY. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 6087) to amend chapter 81 of title 5, United States Code, to 
cover, for purposes of workers' compensation under such chapter, 
services by physician assistants and nurse practitioners provided to 
injured Federal workers, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 6087

       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 ``Improving Access to Workers' 
     Compensation for Injured Federal Workers Act of 2022''.

     SEC. 2. INCLUSION OF PHYSICIAN ASSISTANTS AND NURSE 
                   PRACTITIONERS IN FEDERAL EMPLOYEES' 
                   COMPENSATION ACT.

       (a) Inclusion.--Section 8101 of title 5, United States 
     Code, is amended--
       (1) in paragraph (3), by inserting ``, other eligible 
     providers,'' after ``osteopathic practitioners'';
       (2) by striking ``and'' at the end of paragraphs (18) and 
     (19);
       (3) by striking the period at the end of paragraph (20) and 
     inserting ``; and''; and
       (4) by adding at the end the following:
       ``(21) `other eligible provider' means a nurse practitioner 
     or physician assistant within the scope of their practice as 
     defined by State law.''.
       (b) Conforming Amendments.--Chapter 81 of title 5, United 
     States Code, is amended--
       (1) in section 8103(a)--
       (A) by inserting ``or other eligible provider'' after 
     ``physician'' in each instance; and
       (B) in paragraph (3), by inserting ``or other eligible 
     providers'' after ``physicians'';
       (2) in section 8121(6), by inserting ``or other eligible 
     provider'' after ``physician''; and
       (3) in section 8123(a)--
       (A) by inserting ``or other eligible provider'' after ``The 
     employee may have a physician''; and
       (B) by inserting ``or other eligible provider'' after 
     ``United States and the physician''.
       (c) Regulations.--Not later than 6 months after the date of 
     enactment of this Act, the Secretary shall finalize rules to 
     carry out the amendments made by this Act.

     SEC. 3. DETERMINATION OF BUDGETARY EFFECTS.

       The budgetary effects of this Act, for the purpose of 
     complying with the Statutory Pay-As-You-Go Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this Act, 
     submitted for printing in the Congressional Record by the 
     Chairman of the House Budget Committee, provided that such 
     statement has been submitted prior to the vote on passage.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Connecticut (Mr. Courtney) and the gentleman from Michigan (Mr. 
Walberg) each will control 20 minutes.
  The Chair recognizes the gentleman from Connecticut.


                             General Leave

  Mr. COURTNEY. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and insert extraneous material on H.R. 6087, the Improving Access to 
Workers' Compensation for Injured Federal Workers Act
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Connecticut?
  There was no objection.
  Mr. COURTNEY. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, today, we are considering a straightforward bipartisan 
bill that will alleviate some of the barriers Federal workers face 
seeking treatment and care after they have been injured on the job.
  Right now, whether we represent urban districts or rural districts, 
we are all hearing about the very real shortage of physicians, whether 
it is in general practice or specialty practices. That is why it is 
important for Congress to surgically and intelligently reform outdated, 
antiquated policies in place that prevent qualified providers from 
treating patients who need their care.
  This bill achieves that goal for Federal employees who need treatment 
for workplace injuries or illness and will allow qualified, licensed 
nurse practitioners and physician assistants to treat these patients 
safely and competently and be reimbursed under the Federal Employees' 
Compensation Act.
  The bill explicitly states, in section 2, that such treatment must 
adhere to the scope of practice for nurse practitioners and physician 
assistants, as defined by State law. I repeat: The bill was carefully 
crafted so that it does not encroach on the authority of State health 
licensing boards to determine the scope of practice. That is one of the 
reasons why the Committee on Education and Labor came together on a 
bipartisan basis to unanimously endorse passage of this bill.
  Right now, injured Federal workers who serve our Nation at agencies 
such as the Department of Homeland Security, the Postal Service, and 
our National Parks, to name a few, can only receive the care they are 
entitled to under the Federal workers' compensation law if it is 
provided by a physician, and only a physician can certify a claim 
regardless of whether the State the worker resides in allows nurse 
practitioners and PAs to practice independently.
  As any healthcare patient in America knows, nurse practitioners and 
physician assistants are a growing portion of primary care and 
healthcare workforce nationwide, especially in rural areas. Patients 
are ably and safely treated by NPs and PAs in these settings every day 
and having the capability to be treated by a nurse practitioner or a 
physician assistant increases access to more timely treatment, 
particularly in parts of the country experiencing physician shortages.
  The benefit of increased access was confirmed by the Congressional 
Budget Office in their analysis of this bill, which found that it would 
have no impact on direct spending by the government.
  Given the challenges some Federal workers have in accessing their 
Federal workers' comp benefits, allowing these providers to be 
reimbursed for the care they provide within the scope of their practice 
is an extremely commonsense improvement. CBO has even stated that this 
legislation would help injured Federal workers return to the job 
faster. In this labor market, anything we can do to improve workers' 
healthy recovery and job retention is worthwhile.
  This bill has been endorsed by the National Rural Health Association, 
the American Nursing Association, the American Association of Nurse 
Practitioners, the American Academy of Physician Assistants, as well as 
a diverse coalition of unions representing Federal employees, such as 
the National Treasury Employees Union and the National Postal Mail 
Handlers Union.
  Further, the Department of Labor's Office of the Workers' 
Compensation Programs which administers the Federal Employees' 
Compensation Act for Federal workers in agencies as diverse as the 
Pentagon, Department of Homeland Security, Interior, and Veterans 
Affairs, has confirmed this legislation will help alleviate barriers 
that create delays for FECA claimants and would expand injured workers 
access to medical treatment.
  Madam Speaker, I have the honor to represent the largest military 
installation in New England, Naval Submarine Base New London, which 
employs over 1,000 civilian Federal workers who perform outstanding 
work to support 16 attack submarines that deploy from that base.
  Some of that work is physically demanding, such as firefighters, 
police, and crane operators, and injuries do happen. This bill will 
create healthcare parity for those patriots by ensuring that they will 
have their claims handled and treated the same as any other workers who 
reside in Connecticut and Rhode Island. This is an overdue and 
important, but commonsense, way to bring this program in line with the 
reality of 21st century healthcare delivery.
  Madam Speaker, I thank my Republican counterpart, Mr. Walberg, for 
his great support and work to bring this issue forward. I also thank 
Chairman Scott and Ranking Member Foxx for their bipartisan work 
supporting this bill and getting it through committee.
  Madam Speaker, I strongly urge a ``yes'' vote on this bipartisan and 
commonsense measure, and I reserve the balance of my time.
  Mr. WALBERG. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, H.R. 6087, the Improving Access to Workers' 
Compensation for Injured Federal Workers Act,

[[Page H5243]]

is a commonsense bill to improve access to care for workers under the 
Federal Employees' Compensation, or FECA, program.
  I rise in support of this bill that I have co-led with my friend and 
colleague, Representative Courtney, and thank him, his staff, my staff, 
the staff of the Committee on Education and Labor for their diligent 
work on this legislation.

  The bill simply allows nurse practitioners or physician assistants to 
care for Federal employees under the Federal workers' compensation 
program so long--and I make this clear--so long as that care is within 
their scope of practice under State law.
  Under current Federal law, only a physician can diagnose, certify, 
and oversee the treatment of an injured Federal worker receiving 
compensation benefits. This requirement places an additional burden on 
Federal employees who may have to drive great distances to receive care 
from an approved provider.
  Additionally, it limits the injured individual's choice, depriving 
them from receiving healthcare from the provider with whom they are 
most comfortable. A majority of States already allow NPs and PAs to 
diagnose, certify an injury, and oversee the patient's treatment and 
care for their State workers' compensation programs. So it is time that 
the Federal Government do the same under the Federal disability 
program. Furthermore, our bill will align the FECA program with other 
Federal programs.
  Currently, the Federal Government allows care provided or overseen by 
PAs and NPs in Medicare, Medicaid, the Federal Employee Health Benefits 
Program, and TRICARE. Additionally, since 2017, the Social Security 
Administration has considered PAs and NPs, along with physicians, as 
acceptable sources of information for documenting the existence of an 
impairment for purposes of determining a disability.
  Madam Speaker, across the country, nurse practitioners and physician 
assistants provide critical care, especially in rural communities where 
there may not be a physician within a reasonable distance. In Michigan, 
there are 5,300 practicing physician assistants and nearly 9,000 nurse 
practitioners. They are an important part of our primary care workforce 
in our State.
  Our bill updates Federal law to grant Federal employees more choice 
in selecting their healthcare provider, improve access to care, and 
enable better continuity of care. Again, I sincerely thank my 
colleague, Representative Courtney, and his staff for their great work 
on this bipartisan, commonsense bill.
  Madam Speaker, I urge all Members to support it, and I reserve the 
balance of my time.
  Mr. COURTNEY. Madam Speaker, I again applaud Mr. Walberg for his 
leadership on this legislation.
  Madam Speaker, I yield 3 minutes to the gentleman from the great 
Commonwealth of Virginia (Mr. Scott), chairman of the Committee on 
Education and Labor.
  Mr. SCOTT of Virginia. Madam Speaker, I thank the gentleman from 
Connecticut for yielding.
  Madam Speaker, more than 2 million Federal employees provide key 
services to the public. In fact, during the height of the pandemic, 
Federal workers were critical in delivering vaccines, personal 
protective equipment, and other COVID relief to the American people. So 
it stands to reason that when a Federal worker gets sick or injured on 
the job, we are obligated to provide them and their families with the 
resources and medical care that they need.
  Today, we can improve that effort by providing expanded healthcare 
access for injured Federal workers who are seeking healthcare covered 
by Federal workers' compensation. We live in a country where people are 
increasingly turning to nurse practitioners and physician assistants as 
their primary healthcare provider. This is particularly true in rural 
America where they are disproportionately impacted by physician 
shortages.
  Unfortunately, Federal law now limits what can be reimbursed under 
Federal workers' compensation, forcing injured workers to see only a 
physician to certify the injury and disability as work-related and to 
deliver services. It is time to correct this lag in access to 
healthcare. After all, core Federal healthcare programs, including 
Medicare and the Veterans Affairs' system, already recognize services 
delivered by nurse practitioners and physician assistants if provided 
within the scope of practice allowed by State law.
  This bill would allow nurse practitioners and physician assistants to 
receive reimbursement for healthcare services they are providing to 
injured Federal workers if, and only if, those services are already 
permissible under their State laws.
  Madam Speaker, a ``yes'' vote on this bill is a step to expand the 
group of available healthcare providers consistent with existing State 
law so that we can ensure injured Federal workers and their families 
get the support and care they deserve.
  I thank the gentleman from Connecticut (Mr. Courtney) for his 
leadership on the bill, along with the distinguished member of the 
Committee on Education and Labor, the gentleman from Michigan (Mr. 
Walberg), and the committee's ranking member, Dr. Foxx, for their 
support of this legislation.
  Madam Speaker, I urge my colleagues to support the Improving Access 
to Workers' Compensation for Injured Federal Workers Act.
  Mr. WALBERG. Madam Speaker, I yield 2 minutes to the gentleman from 
Maryland (Mr. Harris), my friend, the MD.
  Mr. HARRIS. Madam Speaker, I thank the gentleman for yielding the 
time.
  Madam Speaker, I rise with concern about H.R. 6087, Improving Access 
to Workers' Compensation for Injured Federal Workers Act. It was 
mentioned that it is fine if healthcare practitioners are qualified to 
deliver workmen's comp. Certainly, in some States, nurse practitioners 
and physician assistants--nurse practitioners, specifically, can 
practice without a physician oversight, but the question is whether 
that is appropriate for workmen's compensation.
  Remember, workmen's compensation includes people who have been 
injured or claimed to have been injured on the job. These employees 
deserve the highest level of care, the highest level of evaluation, of 
diagnosis, certification, and treatment. And what this bill does is 
turns over the qualifications for who is going to treat those injured 
Federal workers to the State to make the decision. Because it says, 
Well, if in a State they decide that a physician assistant practicing 
independently is just fine, well, that Federal worker is not going to 
have the benefit of having a physician involved in that care.

                              {time}  1515

  Madam Speaker, this is a serious policy debate. This debate should be 
taking place, I believe, not on a suspension calendar but actually come 
under a regular rule and be debated for whether or not this is the way 
we want to treat Federal employees, that we want to subject them to a 
State level of care as opposed to a level of care that we think is 
appropriate, again, for an injured Federal worker.
  So, Madam Speaker, I include in the Record a letter from the American 
Medical Association strongly opposing H.R. 6087.

                                 American Medical Association,

                                                     June 5, 2022.
     Hon. Nancy Pelosi,
     U.S. House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     U.S. House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Minority Leader McCarthy: On behalf 
     of the physician and medical student members of the American 
     Medical Association (AMA), I am writing in strong opposition 
     to H.R. 6087, the ``Improving Access to Workers' Compensation 
     for Injured Federal Workers Act.'' This legislation would 
     allow nurse practitioners (NPs) and physician assistants 
     (PAs) to diagnose, prescribe, treat, and certify an injury 
     and extent of disability for purposes of compensating federal 
     workers under the Federal Employees' Compensation Act (FECA).
       Current law prohibits non-physician health professionals 
     from making these determinations and reserves this function 
     to physicians who have the education, training, and expertise 
     to make these evaluations. The AMA remains steadfast in its 
     commitment to patients who have said repeatedly that they 
     want and expect physicians leading their health care team. In 
     a recent survey of U.S. voters, 68 percent say it is very 
     important for a physician to be involved in their

[[Page H5244]]

     diagnosis and treatment decisions. However, H.R. 6087 
     effectively removes physicians from the care team and sets up 
     our federal workers for suboptimal health outcomes and 
     increased costs, without improving access to care. At a time 
     when inflation is at an all-time high and our economy is 
     still struggling to recover from the costs associated with 
     the COVID-19 pandemic, now is especially not the time for 
     Congress to enact this type of policy change.


EDUCATION MATTERS: PATIENTS WANT PHYSICIANS INVOLVED IN THEIR DIAGNOSIS 
                        AND TREATMENT DECISIONS

       The AMA is concerned that H.R. 6087, while perhaps well-
     intentioned for speedier workers' compensation 
     determinations, will actually jeopardize patient care. While 
     the bill purports to allow NPs and PAs to diagnose, 
     prescribe, treat, and certify an injury and extent of 
     disability within their state scope of practice laws, the 
     federal government dictating this scope expansion will have 
     the effect of setting the benchmark for the states. We have 
     seen this repeatedly with Medicare coverage determinations, 
     for example, setting the benchmark for private plan coverage 
     determinations. Moreover, while all health care professionals 
     play a critical role in providing care to patients, and NPs 
     and PAs are important members of the care team, their 
     skillsets are not interchangeable with that of fully educated 
     and trained physicians. This is fundamentally evident based 
     on the difference in education and training between the 
     distinct professions. Physicians complete four years of 
     medical school plus a three-to-seven-year residency program, 
     including 10,000-16,000 hours of clinical training. By 
     contrast, NPs, complete only two to three years of education, 
     have no residency requirement, and only 500-720 hours of 
     clinical training. The current PA education model is two 
     years in length with only 2,000 hours of clinical care and no 
     residency requirement. Patients expect the most qualified 
     person--physician experts with unmatched training, education, 
     and experience--to be diagnosing and treating injured federal 
     workers and making often complex clinical determinations on 
     the nature of an injury and extent of disability. NPs and PAs 
     do not have the education and training to make these 
     determinations and we should not be offering a lower standard 
     of care to our federal workers who are injured.
       But it is more than just the vast difference in hours of 
     education and training; it is also the difference in rigor 
     and standardization between medical school/residency and NP 
     and PA programs that matter and must be assessed. During 
     medical school, students receive a comprehensive education in 
     the classroom and in laboratories, where they study the 
     biological, chemical, pharmacological, and behavioral aspects 
     of the human condition. This period of intense study is 
     supplemented by two years of patient care rotations through 
     different specialties, during which medical students assist 
     licensed physicians in the care of patients. During clinical 
     rotations, medical students continue to develop their 
     clinical judgment and medical decision-making skills through 
     direct experience managing patients in all aspects of 
     medicine. Following graduation, students must then pass a 
     series of examinations to assess a physician's readiness for 
     licensure. At this point, medical students ``match'' into a 
     three-to-seven-year residency program during which they 
     provide care in a select surgical or medical specialty under 
     the supervision of experienced physician faculty. As resident 
     physicians gain experience and demonstrate growth in their 
     ability to care for patients, they are given greater 
     responsibility and independence. NP programs do not have 
     similar time-tested standardizations. For example, between 
     2010-2017, the number of NP programs grew by more than 30 
     percent with well over half of these programs offered mostly 
     or completely online, meaning less in-person instruction and 
     hands-on clinical experience. In addition, many programs 
     require students to find their own preceptor to meet their 
     practice hours requirement, resulting in much variation among 
     students' clinical experiences. Our injured federal workers 
     deserve better--they deserve and have a right to have 
     physicians leading their health care team.


   INCREASING SCOPE OF PRACTICE OF NPS AND PAs CAN LEAD TO INCREASED 
                           HEALTH CARE COSTS

       There is strong evidence that increasing the scope of 
     practice of NPs and PAs has resulted in increased health care 
     costs due to overprescribing and overutilization of 
     diagnostic imaging and other services. For example, a 2020 
     study published in the Journal of Internal Medicine found 3.8 
     percent of physicians (MDs/DOs) compared to 8.0 percent of 
     NPs met at least one definition of overprescribing opioids 
     and 1.3 percent of physicians compared to 6.3 percent of NPs 
     prescribed an opioid to at least 50 percent of patients. The 
     study further found that, in states that allow independent 
     prescribing, NPs were 20 times more likely to overprescribe 
     opioids than those in prescription-restricted states.
       Multiple studies have also shown that NPs order more 
     diagnostic imaging than physicians, which increases health 
     care costs and threatens patient safety by exposing patients 
     to unnecessary radiation. For example, a study in the Journal 
     of the American College of Radiology, which analyzed skeletal 
     x-ray utilization for Medicare beneficiaries from 2003 to 
     2015, found ordering increased substantially--more than 400 
     percent--by non-physicians, primarily NPs and PAs, during 
     this time frame. A separate study published in JAMA Internal 
     Medicine found NPs ordered more diagnostic imaging than 
     primary care physicians following an outpatient visit. The 
     study controlled for imaging claims that occurred after 
     a referral to a specialist. The authors opined this 
     increased utilization may have important ramifications on 
     costs, safety, and quality of care. They further found 
     greater coordination in health care teams may produce 
     better outcomes than merely expanding NP scope of practice 
     alone.
       In addition, a recent study from the Hattiesburg Clinic in 
     Mississippi found that allowing NPs and PAs to function with 
     independent patient panels under physician supervision in the 
     primary care setting resulted in higher costs, higher 
     utilization of services, and lower quality of care compared 
     to panels of patients with a primary care physician. 
     Specifically, the study found that non-nursing home Medicare 
     ACO patient spend was $43 higher per member, per month for 
     patients on a NP/PA panel compared to those with a primary 
     care physician. Similarly, patients with an NP/PA as their 
     primary care provider were 1.8 percent more likely to visit 
     the ER and had an 8 percent higher referral rate to 
     specialists despite being younger and healthier than the 
     cohort of patients in the primary care physician panel. On 
     quality of care, the researchers examined 10 quality measures 
     and found that physicians performed better on 9 of the 10 
     measures compared to the non-physicians.
       The findings are clear: NPs and PAs tend to prescribe more 
     opioids than physicians, order more diagnostic imaging than 
     physicians, and overprescribe antibiotics--all which increase 
     health care costs and threaten patient safety. The 
     Hattiesburg Clinic study further confirms these findings and 
     the need for physician-led team-based care. Before expanding 
     the scope of practice of all NPs and PAs and essentially 
     removing physicians from the care team, we encourage Congress 
     to carefully review these studies. We believe you will agree 
     that the results are startling and have significant impact on 
     the assessment of risk to the health and welfare of patients, 
     as well as the impact on the cost of health care in the 
     United States.
       Finally, proponents of H.R. 6087 cite recognition of NPs 
     and PAs within the FECA as necessary in order to assist with 
     diagnosing and treating patients who contract COVID-19 in the 
     workplace. They claim that permitting NPs and PAs to diagnose 
     and treat individuals suffering from COVID-19 injuries is 
     believed to help patients get back to work faster so they can 
     continue to provide for their families. Yet, COVID-19, a 
     virus that is already responsible for the death of over one 
     million individuals just in the United States, is a complex 
     disease with varying impacts based on patient co-morbidities. 
     Furthermore, pre-existing conditions and other complicating 
     health factors have a tremendous impact on whether vaccines 
     and therapeutics are appropriate for patients who have 
     contracted COVID-19. These complexities highlight the fact 
     that physician experts are best suited to be assessing, 
     diagnosing, and treating patients in the FECA program.


 SCOPE EXPANSIONS HAVE NOT PROVEN TO INCREASE ACCESS TO CARE IN RURAL 
                                 AREAS

       Proponents of scope expansion have argued that legislation 
     like H.R. 6087 is necessary to expand access to care. This 
     promise has been made for years by NPs and PAs seeking scope 
     expansions at the state-level, but it has not proven true. In 
     reviewing the actual practice locations of primary care 
     physicians compared to NPs and PAs, it is clear that 
     physicians and non-physicians tend to practice in the same 
     areas of the state. This is true even in those states where, 
     for example, NPs can practice without physician involvement. 
     The Graduate Nurse Demonstration Project (the Project), 
     conducted by the Centers for Medicare & Medicaid Services, 
     confirmed this as well. One goal of the Project was to 
     determine whether increased funding for Advanced Practice 
     Registered Nursing (APRNs) programs would increase the number 
     of APRNs practicing in rural areas. The results found that 
     this did not happen. In fact, only 9 percent of alumni from 
     the program went on to work in rural areas.
       Moreover, workforce studies in various states have shown a 
     growing number of NPs are not entering primary care. For 
     example, the Oregon Center for Nursing found only 25 percent 
     of NPs practice primary care. Similarly, the Center for 
     Health Workforce Studies conducted a study on the NP 
     workforce in New York that found, ``[w]hile the vast majority 
     of NPs report a primary care specialty certification, about 
     one-third of active NPs are considered primary care NPs, 
     which is based on both NP specialty certification and 
     practice setting.'' In addition, the study found newly 
     graduated NPs were more likely to enter specialty or 
     subspecialty care rather than primary care. In short, the 
     evidence is clear that expanding scope for NPs and PAs will 
     not necessarily lead to better access to care in rural 
     America.
       Rather than supporting an unproven path forward, Congress 
     should consider proven solutions to increase access to care, 
     including supporting physician-led team-based care. Evidence 
     shows that states that require physician-led team-based care 
     have seen a greater overall increase in the number of NPs 
     compared to states that allow independent practice. The 
     Congressional Budget Office estimates the cost of this 
     legislation is zero

[[Page H5245]]

     and includes in its assumptions that while some workers may 
     get services more quickly, increasing costs to the federal 
     government, that these workers might also return to work more 
     quickly saving the federal government money for a net cost of 
     zero. However, this analysis fails to take into account the 
     cost to the health care system when patients do not receive 
     the right care at the right time. Eliminating physicians from 
     workers' compensation determinations increases this 
     likelihood exponentially and is a gamble with the health of 
     our federal workers that Congress should not be willing to 
     take.


     ENACTMENT UNDER SUSPENSION OF THE HOUSE RULES IS INAPPROPRIATE

       The AMA is also concerned that the House of Representatives 
     is attempting to pass H.R. 6087 under ``suspension of the 
     rules,'' a procedural tactic that is often used to act 
     expeditiously on legislation that is typically non-
     controversial. Bills considered ``under suspension'' receive 
     limited floor debate, all floor amendments are prohibited, 
     and a two-thirds vote of all members present is required for 
     final passage.
       H.R. 6087 does not meet the definition of a ``non-
     controversial'' bill and, therefore, should not be considered 
     under suspension of the rules. First and foremost, the strong 
     concerns we raise in this letter should be sufficient for 
     lawmakers to recognize that legislation that would be 
     detrimental to the health and welfare of federal workers 
     should not be considered under this fast-track parliamentary 
     procedure. While it passed out of the House Education and 
     Labor Committee in mid-March 2022, H.R. 6087 was formally 
     introduced two months ago and has only generated 18 total 
     cosponsors. Bills enacted under suspension of the rules 
     typically garner hundreds of cosponsors, thus indicating a 
     high level of bipartisan support. It is unclear whether a 
     strong collection of bipartisan members of the House of 
     Representatives support this legislation that inappropriately 
     expands non-physician practitioner scope of practice. While 
     the AMA opposes final passage of this legislation, we urge 
     the House of Representatives to reject enactment of this bill 
     under suspension of the rules.


                               CONCLUSION

       For all the reasons above, we strongly encourage you to 
     protect the health and safety of our injured federal workers 
     and oppose passage of H.R. 6087.
           Sincerely,
                                              James L. Madara, MD.

  Mr. HARRIS. Madam Speaker, they give reasons. They say, look, 
education matters. Patients want physicians involved in their diagnosis 
and treatment decisions. I think that is true.
  They say that increasing the scope of practice of nurse practitioners 
or physician assistants can lead to increased healthcare costs, 
specifically mentioning the fact that there are studies now that show 
that when a nurse practitioner is involved or a physician assistant----
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. WALBERG. Madam Speaker, I yield an additional 30 seconds to the 
gentleman.
  Mr. HARRIS. Madam Speaker, they mention that, for instance, opioid 
overprescribing occurs four times as much when a nurse practitioner is 
involved. Obviously, in a workers' comp case where injury may be 
determined, this could be significant. This is something we should deal 
with.
  Finally, even the AMA recognized that they are concerned that we are 
attempting to pass this under suspension of the rules usually, 
typically, reserved for noncontroversial bills.
  Madam Speaker, I thank the gentleman for yielding me time.
  Mr. COURTNEY. Madam Speaker, I yield myself such time as I may 
consume.
  Just briefly, I agree with the gentleman from Maryland that the goal 
here should be what is best for Federal employees, who do critical work 
for our country, but I think also what we want is what is best for 
people who are protected by Social Security Disability Insurance, by 
the Federal Employees Health Benefits Program, which are programs in 
which independent practice of nurse practitioners and physician 
assistants has been well established and, again, subject to scope of 
practice in the State where the patient resides.
  Again, this is just simply conforming Federal workers' compensation 
law with existing practice and a whole host of other Federal programs 
involving really important populations that all of us have a duty to 
protect.
  Madam Speaker, I yield 2 minutes to the gentlewoman from North 
Carolina (Ms. Adams), a member of the Education and Labor Committee who 
does outstanding work on the Workforce Protections Subcommittee as its 
chair.
  Ms. ADAMS. Madam Speaker, I thank the gentleman for yielding and for 
his work on this bill. I rise in support of the Improving Access to 
Workers' Compensation for Injured Federal Workers Act of 2022, a bill 
that I am proud to have cosponsored.
  North Carolina is home to over 45,000 Federal employees who are 
restricted from having a nurse practitioner or physician assistant 
diagnose or oversee the patient's treatment and care for their workers' 
compensation claim. North Carolina is one of many States that currently 
authorize nurse practitioners to provide this care for non-Federal 
employees.
  H.R. 6087 will increase patient choice for the tens of thousands of 
Federal employees in my State by making the Federal Employees' 
Compensation Act consistent with State law.
  As chairwoman of the Workforce Protections Subcommittee, I am 
disheartened to hear that my colleagues on the other side of the aisle 
argue that we are rushing this bill.
  H.R. 6087 has gone through the normal legislative order. My 
subcommittee held a hearing on this bill in December 2021, and the 
Education and Labor Committee held a markup on the bill in March just a 
few months ago.
  Of note, the bill passed out of committee with a bipartisan, 
unanimous voice vote.
  This is a commonsense bill, and I urge my colleagues to vote ``yes'' 
on H.R. 6087.
  Mr. WALBERG. Madam Speaker, I yield myself such time as I may 
consume.
  I add to the comments about concerns about the care that is being 
provided. Repeated studies over the decades have shown that NPs and PAs 
provide outstanding quality of care, improve health outcomes, and 
increase cost-effectiveness.
  Additionally, these healthcare professionals have advanced degrees 
from nationally accredited programs that include both classroom and 
clinical rotations and must demonstrate clinical competency.
  Once more, if there were legitimate concerns about the quality of 
care, whether it is a Federal program or State program, provided by NPs 
and PAs to injured workers, then States would not license them to treat 
or diagnose these workers under State workers' compensation programs. 
However, the vast majority of States do recognize nurse practitioners 
and physician assistants as eligible providers for diagnosing and 
treating disability claims.
  Madam Speaker, I yield 1 minute to the gentleman from North Carolina 
(Mr. Murphy), my good friend.
  Mr. MURPHY of North Carolina. Madam Speaker, I thank the gentleman 
for allowing me to speak today.
  I rise in opposition to H.R. 6087. I do this as a physician where I 
understand that diagnosing, treating, and certifying disability claims 
takes an expert's opinion--not general medicine, an expert's opinion--
and physicians have exceedingly more training and experience in dealing 
with what are truly complex medical issues.
  Let's be very clear: Disability is a complex issue. It is a lifelong 
problem. This particular instance requires diagnosis, treatment, and 
evaluations continually. There is nothing wrong with the system that we 
have in this country. In many instances, we find that we work together 
well as a team. But I think our Federal workers really, in this 
specific avenue, deserve better, and I urge them to understand that 
physicians are the best ones to do this.
  Using the claim that there is a physician shortage should not be an 
excuse to lower what I believe are standards for expert care.
  Madam Speaker, I urge my colleagues to vote ``no'' on this bill.
  Mr. COURTNEY. Madam Speaker, I reserve the balance of my time.
  Mr. WALBERG. Madam Speaker, I yield such time as she may consume to 
the gentlewoman from North Carolina (Ms. Foxx), the ranking member of 
the Education and Labor Committee and my good friend and colleague.
  Ms. FOXX. Madam Speaker, I thank my colleague from Michigan for 
yielding.
  I rise in support of this bipartisan legislation to allow nurse 
practitioners and physician assistants to act as eligible providers 
under the Federal Employees' Compensation Act program

[[Page H5246]]

within the scope of their practice under State law.
  Under current law, nurse practitioners and physician assistants are 
unable to treat Federal workers covered by FECA, even though most State 
workers' compensation programs authorize them to provide this care for 
private-sector employees.
  To be clear, H.R. 6087 defers to State law and does not expand the 
scope of practice. This legislation aligns FECA with other Federal 
programs that already include care provided by nurse practitioners and 
physician assistants, such as Medicare and the Veterans Health 
Administration program.
  H.R. 6087 would increase healthcare access and choice for Federal 
employees when many areas of our country are grappling with provider 
shortages, especially in rural areas.
  According to the National Rural Health Association, nurse 
practitioners and physician assistants account for a third of all 
primary care clinicians treating Medicare beneficiaries nationwide, and 
they are closer to half of the primary care clinicians in rural areas.
  Improving healthcare access for FECA beneficiaries would allow 
injured Federal employees to return to the workforce more quickly, 
benefiting both employees and taxpayers.
  I urge my colleagues to support this commonsense, bipartisan 
improvement to our Federal workers' compensation program. I thank my 
committee colleagues, Representatives Walberg and Courtney, and 
Chairman Scott for advancing this important legislation.
  Mr. COURTNEY. Madam Speaker, I yield myself such time as I may 
consume.
  Just briefly, again, I thank the ranking member, Congresswoman Foxx, 
for her remarks and Mr. Walberg, who I think very effectively and 
specifically addressed some of the issues that we have heard in this 
brief debate regarding whether or not this is opening the door to 
practitioners who really aren't qualified to engage in the handling of 
workers' compensation claims.
  Right now, today, there are 27 States that actually allow nurse 
practitioners and physician assistants to handle workers' compensation 
claims under State law, including, by the way, North Carolina and 
Maryland. Just going down the list, it is from all different regions of 
the country, and, again, I think it has demonstrated that the system 
functions smoothly. As the Congressional Budget Office indicated, it 
allows for quicker care because you have more access when you have a 
broader, larger pool of qualified practitioners.
  That is really what this bill is aimed at. It is just to make sure 
that Federal workers will have that same opportunity to access care, 
particularly when they are in underserved parts of the country.
  To sort of frame it, I mentioned earlier the New London sub base 
where they have a really sizable firefighters contingent there. Again, 
fires on submarines and Navy ships is a demanding, highly specialized 
area of practice. If they get injured on the job, they do not have the 
same rights as a firefighter who works for the city of New London who 
gets injured on the job, in terms of having access to a nurse 
practitioner or a physician assistant to handle that individual's 
treatment and care and their disability claim.
  That is really what this bill is doing. It is just simply 
establishing parity for Federal workers who reside in those 28 States 
that recognize independent practice by physician assistants and nurse 
practitioners.
  I have some letters of support, Madam Speaker, which I include in the 
Record: one from the National Postal Mail Handlers Union, one from the 
National Treasury Employees Union, one from the National Rural Health 
Association, one from the American Association of Nurse Practitioners, 
and one from the American Association of Physician Assistants.

                                              National Postal Mail


                                               Handlers Union,

                                                   Washington, DC.
     Hon. Joe Courtney,
     House of Representatives,
     Washington, DC.
       Dear Congressman Courtney: On behalf of the National Postal 
     Mail Handlers Union, which represents over 50,000 mail 
     handlers across the country, I write in support of H.R. 6087, 
     the Improving Access to Workers' Compensation for injured 
     Federal Workers Act.
       Your legislation is a commonsense solution to amend the 
     Federal Employees' Compensation Act to grant injured postal 
     and federal workers wider access medical care from eligible 
     providers. This will ensure they are able to claim workers' 
     compensation and receive necessary care in a timely manner.
       As it can be difficult to expeditiously schedule 
     appointments with physicians for work-related injuries, H.R. 
     6087 extends eligible providers to include physician 
     assistants and nurse practitioners. It is an unfortunate fact 
     that postal employees are the largest group of beneficiaries 
     under current FECA regulations. Your legislation will ensure 
     those injured on the job will have access to medical care and 
     can see their preferred primary care provider.
       I look forward to seeing H.R. 6087 gain support within the 
     House Education and Labor Committee, and its advancement 
     through the House.
           In solidarity,

                                            Paul V. Hogrogian,

                                               National President,
     National Postal Mail Handlers Union.
                                  ____


                                             The National Treasury


                                              Employees Union,

                                                     June 6, 2022.
       Dear Representative: This week, the House of 
     Representatives is expected to vote on suspension on the 
     Improving Access to Workers' Compensation for Injured Federal 
     Workers Act of 2022 (HR 6087). The National Treasury 
     Employees Union (NTEU) strongly supports this legislation and 
     urges you to vote YES.
       This bill would improve access to benefits under the 
     Federal Employees' Compensation Act (FECA), which serves as 
     the workers' compensation program for federal employees. It 
     does so by allowing workers to have their medical care 
     provided by a Nurse Practitioner (NP) or Physician Assistant 
     (PA), as well as have NPs and PAs provide certification of 
     injury. This bipartisan bill was introduced by Rep. Joseph 
     Courtney (CT) and Rep. Timothy Walberg (MI) and passed out of 
     the Education & Labor Committee on a bipartisan basis.
       Thank you for your consideration of our views. Please feel 
     free to contact Kurt Vorndran of the NTEU Department of 
     Legislation if you have any questions.
           Sincerely,
                                               Anthony M. Reardon,
     National President.
                                  ____

                                                    National Rural


                                           Health Association,

                                     Washington, DC, June 6, 2022.
     Re H.R. 6087, the Improving Access to Workers' Compensation 
         for Injured Federal Workers Act, under suspension in the 
         House of Representatives.

     Hon. Nancy Pelosi,
     Speaker,
     House of Representatives.
     Hon. Kevin McCarthy,
     Minority Leader,
     House of Representatives.
       Dear Speaker Pelosi and Minority Leader McCarthy: The 
     National Rural Health Association (NRHA) writes in support of 
     House passage for H.R. 6087, the Improving Access to Workers' 
     Compensation for Injured Federal Workers Act, which is 
     scheduled to be considered by the House of Representatives 
     this week. This legislation would allow nurse practitioners 
     (NP) and physician assistants (PA) to diagnose, treat, and 
     provide care for federal employees who are injured at work, 
     consistent with state scope of practice. In fact, most states 
     already authorize NPs to provide this care for non-federal 
     employees.
       NRHA is a non-profit membership organization with more than 
     21,000 members nationwide that provides leadership on rural 
     health issues. Our membership includes every component of 
     rural America's health care, including rural community 
     hospitals, critical access hospitals, doctors, nurses, and 
     patients. We provide leadership on rural health issues 
     through advocacy, communications, education, and research.
       NRHA is supportive of this legislation as NPs and PAs are 
     common primary care providers in rural communities. According 
     to MedPAC, in 2018 advanced practice registered nurses (APRN) 
     and PAs accounted for a third of all primary care clinicians 
     treating Medicare beneficiaries nationwide. In rural 
     communities, their presence is closer to half of the primary 
     care clinicians. Because of the significant presence of NPs 
     and PAs, and the quality of care they provide, NRHA urges 
     swift passage of this legislation. This commonsense bill will 
     ensure increased access to needed services in our rural 
     areas.
       Thank you for your consideration of this important 
     legislation. If you have questions, please contact Josh 
     Jorgensen.
           Sincerely,

                                                  Alan Morgan,

                                          Chief Executive Officer,
     National Rural Health Association.
                                  ____


                                           American Association of


                                          Nurse Practitioners,

                                                    March 4, 2022.
     Hon. Joe Courtney,
     Washington, DC.
     Hon. Tim Walberg,
     Washington, DC.
       Dear Representatives Courtney and Walberg: The American 
     Association of Nurse Practitioners (AANP), representing more 
     than 325,000 nurse practitioners (NPs) in the United States, 
     is pleased to support H.R. 6087, the Improving Access to 
     Workers'

[[Page H5247]]

     Compensation for injured Federal Workers Act. This 
     legislation would retire outdated barriers in the Federal 
     Employees' Compensation Act (FECA) that limit the ability of 
     NPs to provide care and treatment for injured or ill federal 
     employees. AANP thanks you for you continued efforts to 
     improve the health care system for our nation's federal 
     employees.
       Currently, federal employees can select an NP as their 
     health care provider under the Federal Employees Health 
     Benefits Program (FEHPB), and the majority of states 
     authorize NPs to provide the diagnosis and treatment for a 
     workplace related injury. However, contrary to the workers' 
     compensation process in most states, FECA requires that only 
     a physician can make the diagnosis, certify the injury and 
     extent of the disability, and oversee the patient's treatment 
     and care. This barrier places an additional burden on the 
     over two million federal employees, depriving them from 
     receiving health care from their provider of choice, as well 
     as hindering timely access to care and continuity of care.
       As you know, H.R. 6087 would update the federal workers' 
     compensation program and authorize NPs to certify 
     disabilities and oversee treatment for injured or ill federal 
     employees under FECA. This would improve access to health 
     care for injured or ill federal employees, particularly in 
     rural and underserved communities, and better align the 
     federal workers' compensation program with the majority of 
     states and FEHBP. By updating FECA to authorize federal 
     employees to select their health care provider of choice when 
     they are injured or become ill in the course of their federal 
     employment, greater access, overall efficiency and better 
     continuity of care can be achieved. We thank you for this 
     impactful legislation and look forward to continuing to work 
     with you to ensure H.R. 6087 becomes law.
       Thank you again for your tireless efforts on behalf of 
     federal employees. Should you have comments or questions, 
     please direct them to MaryAnne Sapio, V.P. Federal Government 
     Affairs.
           Sincerely,

                                   Jon Fanning, MS, CAE, CNED,

                                          Chief Executive Officer,
     American Association of Nurse Practioners.
                                  ____


                                                         AAPA,

                                   Alexandria, VA, March 15, 2022.
     Hon. Joe Courtney,
     Washington, DC.
     Hon. Tim Walberg,
     Washington, DC.
       Dear Representatives Courtney and Walberg: On behalf of the 
     more than 151,000 PAs (physician assistants) throughout the 
     United States, the American Academy of PAs (AAPA) lends 
     strong support to H.R. 6087, the Improving Access to Worker's 
     Compensation for Injured Federal Workers Act. AAPA thanks you 
     for your continued support of the federal workforce and 
     unwavering commitment to ensuring that all Americans have 
     access to high-quality healthcare.
       As you know, U.S. federal and postal employees receive 
     workers compensation coverage through the Federal Employee's 
     Compensation Act (FECA) for employment-related injuries and 
     occupational disease. However, as currently written, FECA 
     does not cover medical care provided by PAs within the 
     definition of ``medical, surgical, and hospital services . . 
     .'' and FECA claims signed by PAs are routinely denied. This 
     undue restriction negatively impacts federal employees, 
     especially those in rural and underserved areas, who receive 
     primary care from PAs.
       PAs practice in all medical and surgical specialties in all 
     50 states, the District of Columbia, U.S. territories, and 
     the uniformed services. PAs provide high-quality, cost-
     effective medical care in every specialty and setting, 
     undertake rigorous education and clinical training, and are 
     well established as medical professionals. PAs are recognized 
     as qualified healthcare providers under Medicare, Medicaid, 
     and almost every state and federal healthcare program, 
     including state workers' compensation programs. PAs are also 
     included in the definition of an ``acceptable medical 
     source'' by the Social Security Administration for the 
     purposes of certifying that an individual has a medically 
     determinable impairment. Further, thousands of PAs are 
     employed by the federal government as healthcare providers 
     and work within the Department of Veterans Affairs, the 
     Department of Defense, the Public Health Service, and Indian 
     Health Services. However, PAs are not considered healthcare 
     providers within FECA, an oversight that does not align with 
     state or other federal programs.
       H.R. 6087 would ensure that federal employees can access 
     high-quality healthcare from the provider of their choice, as 
     well as further align FECA with state workers compensation 
     programs which recognize PAs as covered providers. It is well 
     within the education and training of PAs to provide treatment 
     to federal employees who are injured in the course of their 
     work for the government, and it is time to remove this 
     outdated and unnecessary restriction.
       AAPA appreciates your work and dedication to the federal 
     workforce and our nation's healthcare system. If we can be of 
     assistance to you on this or any issue, please do not 
     hesitate to contact Tate Heuer, AAPA Vice President, Federal 
     Advocacy.
           Sincerely
                                              Lisa M. Gables, CPA,
                                          Chief Executive Officer.

  Mr. COURTNEY. Madam Speaker, I reserve the balance of my time.
  Mr. WALBERG. Madam Speaker, I yield myself such time as I may 
consume.
  I appreciate that information being shared, but I would like to 
address some of the concerns that my good friends from the Doc Caucus 
have presented.
  We have discussed this in committee representing districts that are 
rural, urban, and suburban, and the challenges that are there. Again, 
the issue of States' rights and the ability of States to make 
decisions, there is a primacy that is there that we ought to consider 
very strongly.
  A majority of States already allow nurse practitioners and PAs to 
diagnose, certify an injury, and oversee patients' treatment. 
Furthermore, if we are talking about precedent, our bill will align the 
FECA program with other Federal programs currently in place. Currently, 
the Federal Government allows care provided or overseen by PAs and NPs 
in, I state it again, Medicare, Medicaid, the Federal Employees Health 
Benefits Program, and TRICARE.
  That is significant. Those are textbook studies on how it is working 
already. Adding to this just seems like it is justified and very 
important to do.
  Going back to the States' concerns, as well, if diagnosing or 
treating a particular workplace injury is outside of the scope of 
practice for a nurse practitioner or a physician assistant under their 
State's law, then they would not be covered under this bill, plain and 
simple. The bill preserves States' rights to make those determinations.
  H.R. 6087 is simply expanding choice, important at this time, 
especially with inflation and the cost that is going on in coming out 
of a pandemic and getting in endemic situations.
  The Congressional Budget Office, I repeat, noted that the bill would 
not affect direct spending. In fact, CBO noted in its score that the 
bill may result in injured workers receiving treatment faster and, as 
my colleague Representative Courtney said, thereby returning them to 
work and productivity more quickly and reducing the actual cost for 
some FECA costs in the process.
  Getting workers healthy and back to work is not only good for the 
individual but also good for our economy as we look to get through 
these worrisome economic times.

                              {time}  1530

  I accept the concerns of the medical doctors. I understand that they 
have committed themselves to significant training and significant time 
in the classroom and in the hospital itself, but we also know that we 
have come of an age where doctors very regularly use the services and 
need the services of nurse practitioners and physician assistants.
  There are communities in my district, in rural areas, where the 
doctor is a physician assistant. The people appreciate them and receive 
good care as well.
  Madam Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. 
Rodney Davis).
  Mr. RODNEY DAVIS of Illinois. Madam Speaker, I thank my good friend, 
Mr. Walberg, and appreciate his leadership on this issue and also, the 
bipartisanship that is being shown to the American people today to 
address an issue that is important--to Ranking Member Foxx, too--to our 
communities.
  Madam Speaker, I rise in support of H.R. 6087 because of what has 
been said. The positive impact that this bill can have within our 
medical communities, and giving Americans access to the healthcare that 
they deserve is something that deserves all of our support.
  This bill would include physician assistants and nurse practitioners 
in the Federal workers' compensation program and put them in line with 
the State scope of practice. It is also going to improve access to care 
for injured Federal workers and postal employers, especially in the 
areas that I serve--in rural and underserved areas--like central and 
southwestern Illinois.
  Getting people back to work as soon as they can once they recover 
from an injury is now more important than ever given the record 
inflation we are seeing and the staggering 11.4 million open jobs in 
this country.
  This is a commonsense piece of legislation. I am glad to support the 
work

[[Page H5248]]

of my friend, Congressman Tim Walberg, on this bill to ensure that 
injured Federal employees return to the workforce quickly.
  Madam Speaker, I encourage all of my colleagues to vote ``yes'' on 
this important bill.
  Mr. COURTNEY. Madam Speaker, I include in the Record a letter from 
the Nursing Community Coalition, which represents 63 national nursing 
organizations all across America.

                                  Nursing Community Coalition,

                                                     June 7, 2022.
     Hon. Joe Courtney,
     Washington, DC.
     Hon. Tim Walberg,
     Washington, DC.
       Dear Representatives Courtney and Walberg: On behalf of the 
     Steering Committee of the Nursing Community Coalition (NCC), 
     which represents 63 national nursing organizations, we are 
     pleased to support H.R. 6087, the Improving Access to 
     Workers' Compensation for Injured Federal Workers Act, which 
     would retire outdated barriers in the Federal Employees' 
     Compensation Act (FECA) that limit the ability of Nurse 
     Practitioners (NPs) to provide care and treatment for injured 
     or ill federal employees. The NCC is a cross section of 
     education, practice, research, and regulation within the 
     nursing profession representing Registered Nurses (RNs), 
     Advanced Practice Registered Nurses (APRNs), nurse leaders, 
     students, faculty, and researchers. We appreciate your 
     continued efforts to improve the health care system for our 
     nation's federal employees and strongly support passage of 
     H.R. 6087.
       Currently, federal employees can select an NP as their 
     health care provider under the Federal Employees Health 
     Benefits Program (FEHPB), and the majority of states 
     authorize NPs to provide the diagnosis and treatment for a 
     workplace related injury. However, contrary to the workers' 
     compensation process in most states, FECA requires that only 
     a physician can make the diagnosis, certify the injury and 
     extent of the disability, and oversee the patient's treatment 
     and care. This barrier places an additional burden on the 
     over two million federal employees, depriving them from 
     receiving health care from their provider of choice, as well 
     as hindering timely access to care and continuity of care.
       H.R. 6087 would update the federal workers' compensation 
     program and authorize NPs to certify disabilities and oversee 
     treatment for injured or ill federal employees under FECA. 
     This would improve access to health care for injured or ill 
     federal employees, particularly in rural and underserved 
     communities, and better align the federal workers' 
     compensation program with the majority of states and FEHBP. 
     By updating FECA to authorize federal employees to select 
     their health care provider of choice when they are injured or 
     become ill in the course of their federal employment, greater 
     access, overall efficiency and better continuity of care can 
     be achieved.
       We appreciate this important legislation and strongly 
     support passage of H.R. 6087, the Improving Access to 
     Workers' Compensation for Injured Federal Workers Act. Should 
     you have any questions or if the Nursing Community Coalition 
     can be of any additional assistance please contact the 
     coalition's Executive Director, Rachel Stevenson.
           Sincerely,
       American Association of Colleges of Nursing, American 
     Association of Nurse Anesthesiology, American Association of 
     Nurse Practitioners, American Nurses Association, Association 
     of Women's Health, Obstetric and Neonatal Nurses, National 
     Association of Pediatric Nurse Practitioners, National 
     Council of State Boards of Nursing, National League for 
     Nursing, Oncology Nursing Society.

  Mr. COURTNEY. Madam Speaker, I am prepared to close and I reserve the 
balance of my time.
  Mr. WALBERG. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, we have all heard of the physician shortage in 
America. Nurse practitioners and physician assistants are a critical 
component in fulfilling the provider gap. There are 355,000 nurse 
practitioners and more than 150,000 physician assistants across the 
country.
  These healthcare professionals have advanced degrees from nationally 
accredited programs and include both classroom and clinical rotations 
and must demonstrate clinical competency.
  Allowing nurse practitioners and physician assistants to diagnose, 
certify, and treat injured Federal workers to the full extent of their 
State license is not only common sense but is smart economic policy to 
ensure workers get back to work more quickly and off government 
supported programs.
  The bill will not remove physicians from providing care to an injured 
worker if that is who the patient chooses. The bill is simply giving 
injured workers more choice to get the timely care they need.
  The CBO scored the bill as having insignificant impact on direct 
spending and noted, may result, in fact, in injured workers receiving 
treatment faster, thereby returning to work more quickly and reducing 
costs for the FECA program.
  Lastly, the FECA program is virtually the last remaining Federal 
health program that does not recognize the role that PAs and NPs play 
in modern healthcare delivery. They can already provide and oversee 
care in Medicare, Medicaid, the Federal Employee Health Benefits 
program, the VA, DOD, Indian Health Service, and the Bureau of Prisons, 
and are recognized by the Social Security Administration.
  Furthermore, the bill aligns with the majority of States which 
already authorize NPs and PAs to certify and oversee healthcare for 
patients in their State workers' compensation programs.
  This is a commonsense, bipartisan bill that will make the Federal 
workers' compensation program more efficient and ensure workers have 
access to a health provider of their choice.
  Madam Speaker, I thank Chairman Scott, Ranking Member Foxx, and Mr. 
Courtney for their support of this bill, and I urge the rest of my 
colleagues to support this bill. I yield back the balance of my time.
  Mr. COURTNEY. Madam Speaker, I yield myself the balance of my time. 
Mr. Walberg's eloquence, and comprehensive closing statement I think 
really said it all. I tip my hat to him, Ranking Member Foxx, Mr. Davis 
from the minority side of the aisle, and the speakers on this side that 
really represent a bipartisan message that we are prepared to get our 
Federal Employee Workers' Compensation Act modernized so that the hard 
work of nurse practitioners and physician assistants and the work that 
they do every single day around the country is now extended to a 
critical part of our healthcare system and also our Federal disability 
benefits system.
  This is really about giving patients a choice. There is nothing in 
this bill that mandates that they can't go to a physician or that they 
don't have that option. In some areas people just don't have that 
choice. If you are in a place where the only real access is to a 
physician assistant or a nurse practitioner, sometimes for even a life-
threatening injury, we need to open the door to give people that 
opportunity. That is precisely what this bill does.
  It came out of committee with a unanimous vote. I strongly urge all 
of my colleagues from both sides of the aisle to follow the lead of the 
Education and Labor Committee and pass this bill with an overwhelming 
majority.
  Madam Speaker, I yield back the balance of my time.
  Ms. JACKSON LEE. Madam Speaker, as a steadfast ally of the men and 
women serving in the federal government, I rise in support of H.R. 
6087, the ``Improving Access to Workers' Compensation for Injured 
Federal Workers Act.''
  This bill allows for injured federal workers to consult with nurse 
practitioners or physician assistants for the diagnosis and treatment 
of injuries covered by workers' compensation.
  H.R. 6087 will make a needed correction to the Federal Employees 
Compensation Act, increasing the accessibility of healthcare for nearly 
three million federal employees.
  Nurse practitioners and physician assistants represent a growing 
portion of American primary care providers, especially for medically 
underserved communities.
  We must prioritize the needs of our invaluable federal workers. 
Lowering the bureaucratic obstacles blocking federal workers' access to 
benefits is a necessary measure to protect them.
  When Congress has an opportunity to remedy real-world issues with 
bipartisan action, especially when it improves the lives of government 
employees, it is our responsibility to act.
  H.R. 6087 is especially critical in the face of the increasing 
workplace risks associated with COVID-19, in which situation an 
expanded list of approved medical providers can help fill the coverage 
gap.
  The pandemic has already stressed the health and wellbeing of federal 
workers. Amending the Federal Employees Compensation Act is imperative 
to lessen that burden.
  According to the Office of Personnel Management, Texas has 143,087 
federal workers. I will always fight for these workers by standing up 
for their access to healthcare.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Connecticut (Mr.

[[Page H5249]]

Courtney) that the House suspend the rules and pass the bill, H.R. 
6087, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mrs. GREENE of Georgia. Madam Speaker, on that I demand the yeas and 
nays.
  The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution 
8, the yeas and nays are ordered.
  Pursuant to clause 8 of rule XX, further proceedings on this motion 
are postponed.

                          ____________________