Pending Legislation Seeks to Alleviate Impediments to Quality Care

By Stephanie Jordan
Managing Editor
Connections

In this edition of Connections, we focus on the certification of home health care services. At the national level, two bills were introduced this year that address the authorization of nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants to certify home health care services for their Medicare patients.

Nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants are playing increasingly important roles in the delivery of primary health care services. This is especially true in rural and medically underserved areas. As it stands today, Medicare recognizes these four categories of Advanced Practice Regsitered Nurses (APRNs) for the care they provide in home health settings; however, only a physician may certify that a patient is eligible for Medicare home health services. This is a barrier to care given that a Medicare beneficiary that needs home health and is under the care of a nurse practitioner now also must call a physician – who may not serve as the patient’s primary care practitioner – to certify the need for home health services.

Case-after-case, this red tape has proven to result in delays in care. This procedural burden also increases the overall cost to the Medicare program by requiring participation of additional providers with reimbursement rates much higher than those of these practitioners.

To address this issue, federal lawmakers are pushing new legislation that would make it easier for patients to gain access to home health care, specifically by widening the scope of who can certify the need for home health services under Medicare rules.

The Home Health Care Planning Improvement Act of 2019 (S. 296), was introduced by Senators Susan Collins (R-ME) and Ben Cardin (D-MD) in the Senate. In the House, a companion bill (H.R. 2150) was introduced by Reps. Jan Schakowsky (D-IL), Buddy Carter (R-GA), Ron Kind (D-WI), and Mike Kelly (R-PA). The legislation would authorize nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants to certify home health care services for their Medicare patients to ensure that beneficiaries have timely access to the home health care they need, and to reduce costs for Medicare.

“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 Jan Schakowsky, a Senior Chief Deputy Whip and co-author of H.R. 2150, when the bill was introduced in April. “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.”

In January, when the Home Health Care Planning Improvement Act of 2019 S.296 was introduced, it had bipartisan support with 31 co-sponsors.

In a statement, Keith Myers, Chairman of the Partnership for Quality Home Healthcare – a coalition of home health leaders – remarked, “This bipartisan, bicameral bill reflects an effort that is responsive to the needs of America’s oldest and sickest seniors who want to remain in their homes, by ensuring home health is more accessible to these patients. We urge lawmakers in the House and Senate to advance this legislation, which is strongly supported by the home health community.”

CANP Sacramento Chapter member Ron Ordona, DNP, FNP-BC, provides primary and urgent care to older adult patients, most of whom are too sick to leave their homes for routine medical care. Ordona has been a strong proponent of the need for policy change to allow APRNs to certify (or recertify) home health care.

Ordona gives an example of why this is so important to him: in December, Ordona ordered a hospice evaluation for a patient with dementia who was moving toward the end of life. While the home health agency that would perform the evaluation and dispatch a hospice nurse waited for Ordona’s collaborating physician to sign off on the order, the patient declined to the point where she needed emergency care.

“You can only imagine,” says Ordona, expressing frustration at his patient’s ordeal, “someone with dementia, already feeling confused and combative, and in the ER – she didn’t need that.”

Be sure to read more about Ordona and his ongoing advocacy efforts and beliefs in this edition of Connections.

Surani Hayre-Kwan MSN, MBA, FNP-BC, FACHE, FAANP, is also featured in this edition of Connections as she shares a position paper she recently authored that provides a background on current Medicare regulations to certify home health care services, and why it is time for the policy change the two bills will bring. 

Several organizations have come forward to support this legislation, including the American Association of Nurse Practitioners, the American Academy of Physician Assistants, the American College of Nurse-Midwives, the American Nurses Association, and the National Association for Home Care & Hospice. 

CANP highly encourages every member to connect with her or his Congressional representative to add your voice in support of these bills.