Improve Medicare Patients’ Access to Home Health Care

ACTION NEEDED: Cosponsor SB 445/HR 1825 to Amend Title XVIII of the Social Security Act to Ensure More Timely Access to Home Health Services for Medicare Beneficiaries Under the Medicare Program

This legislation would authorize nurse practitioners (NPs) to certify patient eligibility for medicare home health services.

Background

Today’s NPs play an important role in managing and delivering health care to Americans. NPs are recognized under state laws and regulations to complete and sign physical examination forms and other medical certification documents. Since 1998, NPs have been authorized Part B Medicare providers, recognized to furnish, order and refer for services under their provider numbers. NPs order physical therapy, occupational therapy, bill as consultants when providing services through telemedicine, order and bill for performing and interpreting diagnostic tests within their scope of practice and certify patients eligible for skilled nursing care. They may also bill for services as attending providers and for services “incident to” their own service.

NPs have demonstrated the ability to deliver safe, cost-effective and responsible health care to the patients they serve. They have expert knowledge that allows them to provide high-level assessments of patient needs and recognize when additional care such as home health care is needed. Given their proven track record and the authorization of the Balanced Budget Act of 1997 for the care of seniors and the disabled, it is illogical and impractical that NPs are recognized as Part B Medicare providers but are still unable to document face-to-face patient assessments and certify home health care plans of care for their patients.

Currently, NPs with patients who need home health care services must locate a physician who will document the NP’s assessment for this care. Further, even though NPs are authorized to perform a face-to-face assessment of the patient’s needs, the Affordable Care Act now requires that a physician documents that the encounter has taken place—even if the physician is not involved in the assessment. These delays in treatment jeopardize the health of the patient and cause the Medicare program to incur additional costs by requiring the participation of additional providers with reimbursement rates higher than those of NPs.

Introduction of and ultimately passage of legislation addressing this issue will make it possible for NPs to provide necessary services for their Medicare patients by allowing them to certify patients, under their care, to be eligible for home health care services. Passage of 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.

Request

AANP calls on members of Congress to cosponsor SB 445/HR 1825 to Amend Title XVIII of the Social Security Act to Ensure More Timely Access to Home Health Services for Medicare Beneficiaries Under the Medicare Program.

For additional information, please contact the AANP Government Affairs Office at 703-740-2529 or governmentaffairs@aanp.org.

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