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Susan Collins

Home Health Care Planning Improvement Act
By Senator Susan Collins
Jul 7, 2007 - 9:41:06 AM

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Senator Susan M. Collins represents the State of Maine in the U.S. Senate.
Home health care has proven to be a compassionate and cost-effective alternative to institutional care. Nurse practitioners, physician assistants, certified nurse midwives, and clinical nurse specialists are all playing increasingly important roles in the delivery of home 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, ten years ago, Congress authorized Medicare to begin paying for physician services provided by these health professionals to our seniors and disabled citizens, 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 home health care simply because a physician is not readily available to sign the form.

In order to ensure that the elderly and disabled have timely access to the home health services that they need when they need them, I recently introduced the Home Health Care Planning Improvement Act of 2007. This bipartisan legislation would correct the flaw in current law by allowing physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives to order home health services.

In developing this legislation, I heard from many advanced practice registered nurses and physician assistants who told me that their inability to order home health care is particularly burdensome for Medicare beneficiaries in large rural states like Maine, 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 one Medicare patient because the physician assistant was the only health care professional serving the patient's small rural town, and the supervising physician was located 60 miles away.

A nurse practitioner described another case in which her collaborating physician had just lost her father and was not available. As a consequence, her patient experienced a two-day delay in getting needed care while waiting to get the paperwork signed by another physician. Another nurse practitioner pointed out that she can order physical and occupational therapy in a skilled nursing facility but cannot order the same services for a home health setting. 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. This situation defies common sense and clearly is not in the best interests of the patient.

I am pleased that my legislation is supported by the National Association for Home Care and Hospice, the American Nurses Association, the American Academy of Physician Assistants, the American College of Nurse Practitioners, the American College of Nurse Midwives, the American Academy of Nurse Practitioners, and the Visiting Nurse Associations of America. The Home Health Care Planning Improvement Act will help improve Medicare law by helping our most frail and vulnerable citizens avoid hospitals and nursing homes, and stay just where they want to be - in the comfort and security of their own homes.

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