Bill to Permit Non-Physician Practitioners to Certify Medicare Home Health Orders Introduced in the House

A bipartisan group of legislators introduced a bill in the House of Representatives on Tuesday, April 9, to allow non-physician practitioners to certify home health orders under Medicare. Commonly referred to as the “NPP bill”, the legislation would extend certification authority to nurse practitioners, physician assistants, nurse midwives, and clinical nurse specialists.

These NPPs play a critical role in managing and delivering health care to millions of Americans, and are often the practitioners who are most familiar with a patient – sometimes far more familiar than any actual physician. Nevertheless, under current law they are forced to hand off their patients to a physician, who is authorized to certify a patient for Medicare home health. Apart from delaying treatment (possibly jeopardizing the health of a patient because of the delay), the current procedural burden increases the cost to Medicare by requiring the involvement of additional providers with reimbursement rates far higher than those of non-physician practitioners.

Introduced by Congresswoman Jan Schakowsky (D-IL), H.R. 2150 is co-sponsored by Representatives Buddy Carter (R-GA), Ron Kind (D-WI), Mike Kelly (R-PA), Susan Wild (D-PA), and David Joyce (R-OH).

“Nurse practitioners, certified-nurse midwives, clinical nurse specialists, and physician assistants offer invaluable, personal, professional care to so many people around the country,” said Congresswoman Schakowsky. “This legislation will make their cost-saving, high quality services more directly accessible to Medicare patients in need, while greatly reducing the costs of these services. A win for patients, a win for providers, and a win for Medicare’s bottom line.”

“As a pharmacist for more than 30 years, I understand the importance of the entire health care team,” said Congressman Carter. “Nurse practitioners, nurse-midwives, clinical nurse specialists and physician assistants provide critical home health services and we need to ensure patients have access to these services. This legislation will increase access to this care while lowering costs at the same time. I am glad to see this legislation has bipartisan support and I hope it will move swiftly through Congress.”

This legislation is a companion bill to a Senate version, S. 296, being led by Senators Susan Collins (R-ME) and Ben Cardin (D-MD), S. 296. In past Congresses these measures have enjoyed broad bipartisan, bicameral support. An official cost estimate from the Congressional Budget Office (CBO) has not been produced, and is believed to be the biggest obstacle to its legislative success.

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 CBO has never produced an estimated score of the expected outlay. NAHC, in a desire to break through this logjam, is working with Congress and other stakeholder groups —  the American Association of Nurse Practitioners (AANP), the American Academy of Physician Assistants (AAPA), the American Nurses Association (ANA), and the American College of Nurse Midwives (ACNM) — on advocacy efforts, as well as securing an official score from the CBO.

NAHC members are encouraged to contact their Congressional delegation and urge their support of S. 296/H.R. 2150. The NAHC Legislative Action Network is set up to automatically send a pre-drafted message to your Senators and Representative on your behalf. This is a quick and simple process requiring less than one minute of your time.

Source: NAHC