Bill to Enable Non-Physician Practitioners to Certify Home Health Introduced in Senate

Long-time home care champions Senators Susan Collins (R-ME) and Ben Cardin (D-MD) have introduced the Home Health Care Planning Improvement Act (S. 296) in the 116^th Congress. This long-standing NAHC priority legislation would enable non-physician practitioners the authority to certify home health orders under Medicare. In the past, this legislation has enjoyed strong, widespread bipartisan support in both the House of Representatives and Senate. While the policy has many supporters, there has been a longstanding concern within Congress as to how much the legislation’s enactment might cost the federal government. The Congressional Budget Office (CBO) has never produced an estimated score of the expected outlay. NAHC, in a desire to break through this logjam, has taken preliminary steps in working with Congress on obtaining an official score from CBO. This is seen as the most important step towards legislative success. Non-physician practitioners (NPPs) are playing are playing an increasingly vital role in our nation’s health care. PAs and NPs are eligible for reimbursement for certain physician services under Medicare. They can also certify Medicare eligibility for skilled nursing facility services. The Centers for Medicare and Medicaid Services (CMS) allows PAs and NPs to sign Certificates of Medical Necessity required to file a claim for home medical equipment under Medicare. Certified nurse midwives have been authorized to provide maternity-related services to the relatively small population of disabled women of child-bearing years who are Medicare-eligible. Yet, despite all these responsibilities bestowed on NPPs, the Centers for Medicare & Medicaid Services (CMS) continues to prohibit them from certifying home health services for Medicare beneficiaries. The Home Health Care Planning Improvement Act would remedy this inconsistency by allowing NPPs to certify these services. By doing so, beneficiaries will endure fewer days spent in institutional settings waiting for regulatory requirements to be met, which will lead to savings for the Medicare program. Beneficiaries will also be able to continue to receive care from their chosen providing, producing improved patient satisfaction and health outcomes. Under current policy, the physician being asked to certify need might not have any relationship to the patient, which can lead to delays in care and deceased patient satisfaction and outcomes. The bill deserves support because it acknowledges common and present day practices, wherein Nurse Practitioners, Clinical Nurse Specialists, Clinical Nurse Midwives, and Physician Assistants are increasingly providing necessary medical services to Medicare beneficiaries, especially in rural and underserved areas. NPPs commonly serve as Primary Care Providers in rural or underserved areas and in such situations are more familiar with their patients than the physician burdened with certifying need for home care. In these instances, allowing NPPs to sign orders is the most appropriate practice.  In addition, they are sometimes more readily available than physicians to expedite the processing of paperwork, ensuring that home health agencies will be reimbursed in a timely manner and that care to the beneficiary will not be interrupted. The Institute of Medicine released a study which recommends that NPs and CNSs be allowed to certify eligibility for Medicare home health services (IOM, The Future of Nursing: Leading Change, Advancing Health, October 5, 2010). Over 40 states signed on to the submitted letter endorsing this necessary change. Source: NAHC Report