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Improve Medicare Patient Access to Home Health Services

ACTION NEEDED: Amend Title XVIII of the Social Security Act to ensure more timely access to Home Health services for beneficiaries under the Medicare program. The Home Health Care Planning Improvement Act of 2019, S. 296/H.R. 2150, will authorize Nurse Practitioners (NPs) to certify patient eligibility for Medicare Home Health services.


NPs are advanced practice registered nurses (APRNs) who are prepared at the masters or doctoral level to provide primary, acute, chronic and specialty care to patients of all ages and walks of life. Daily practice includes: assessment; ordering, performing, supervising and interpreting diagnostic and laboratory tests; making diagnoses; initiating and managing treatment including prescribing medication and non-pharmacologic treatments; coordinating care; counseling; and educating patients and their families and communities. NPs practice in nearly every health care setting including home health, long-term care facilities, clinics, hospitals, Veterans Health Administration and Indian Health Services facilities, emergency rooms, urgent care sites, private physician or NP practices (both managed and owned by NPs), nursing homes, schools, colleges, retail clinics, public health departments, nurse managed clinics, and homeless clinics. NPs hold prescriptive authority in all 50 states and the District of Columbia. NPs complete more than one billion patient visits annually and approximately one third of all Medicare patients receive care from a nurse practitioner.

Under the current structure, an NP must find a physician to document that a face-to-face assessment has taken place, and have the physician certify and recertify the patient’s eligibility for home health care services. NPs that are health care providers for patients in the Medicare home health care program are not able to initiate or make necessary adjustments to medication or treatment without obtaining a physician signature. These are services that NPs can perform for all Medicare patients outside of the home health care benefit. The current structure delays access to treatment and puts patients at risk for avoidable complications. Delays in care are especially problematic for home health care patients who suffer from more chronic conditions and report more limitations on activities of daily living than the non-home health care Medicare beneficiary population. NPs are qualified to provide this care without physician certification and are already the largest home-based primary care providers for Medicare patients. We note that the Medicare home health conditions of participation also apply to the Medicaid program.

Passage of this legislation will make it possible for nurse practitioners to provide necessary services for their Medicare patients by allowing them to document the face-to-face assessment, certify and recertify their patients’ eligibility for home health care services, and make the necessary changes to the plans of care. This legislation will reduce Medicare spending by eliminating duplicative services while also improving the quality and timeliness of care for beneficiaries who need home health services.


AANP calls on Members of Congress to cosponsor S. 296/H.R. 2150 to amend Title XVIII of the Social Security Act to ensure more timely access to Home Health services for beneficiaries under the Medicare program.

For additional information, please contact the AANP Government Affairs Office at 703-740-2529 or

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