Statements on Introduced Bills and Joint Resolutions

Floor Speech

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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.

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