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Headlines from the Hill


MEDICARE HAS RECOGNIZED the independent practice of advanced practice registered nurses (APRNs) for nearly two decades. Unfortunately, a quirk in Medicare law has kept APRNs from signing home health plans of care and certifying Medicare patients for
the home health benefit. In areas where access to physicians is limited, this outdated prohibition has led to delays in healthcare delivery, which cause inconvenience to patients and their families. Additionally, delays can increase costs to the Medicare system when patients are unnecessarily left in more expensive institutional settings. (For more information on how nurses deal with this issue, read “Break the home care barrier” in the Inside ANA section.)

To address this issue, Congress has reintroduced the Home Health Care Planning Improvement Act (S. 227). This legislation, reintroduced in the Senate by Susan Collins (R-ME) and Kent Conrad (D-ND), would allow APRNs—nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs), and physician assistants, to order home health services under Medicare in accordance with state law. In addition, S. 227 clarifies the new requirement for a face-to-face encounter between a patient and a provider before certification for home health services. Current law allows these nonphysician providers to substitute for a physician for the purposes of the face-to-face
requirement. However, it does not allow them to sign the final plan of care at the end of the process. S. 227 would give APRNs this authority.

The American Nurses Association (ANA) and National Association for Home Care and Hospice (NAHC) commissioned a study conducted by Dobson, Da-Vanzo, and Associates that determined the Home Health Care Planning Improvement Act would yield a cost savings for Medicare. (See chart by clicking the PDF icon above.) Most importantly, it would ensure that Medicare patients receive care in a timely and cost-efficient manner.

In addition to ANA and NAHC, the Home Health Care Planning Improvement Act is supported by other organizations, including the American Academy of Physician Assistants, American College of Nurse Practitioners, American College of Nurse Midwives, American Academy of Nurse Practitioners, and Visiting Nurse Association of America. Although all of these groups have voiced their support, it is essential that members
of Congress hear from nurses who are on the front lines. ANA urges you to visit http://www.rnaction.org/site/PageServer?pagename=nstat_take_action_home_health to voice support for the Home Health Care Planning Improvement Act.

Rachel Conant is the associate director of ANA’s Department of Government Affairs.

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