Action Alert :

Please encourage your congressional legislators to add their names as cosponsors of the Home Health Care Access Protection Act (H.R. 5803; S. 3315) introduced by Reps. Jim McGovern (D-MA) and Walter Jones (R-NC) and Sens. Susan Collins (R-ME) and Russ Feingold (D-WI). Go to NAHC Report, 7/15/10 for more information about this bill.


In light of the recent CMS rule that proposes to cut home health payments by 3.79 percent in 2010 and 3.79 in 2011 based on an unfounded allegation of "case mix creep" (NAHC Report, 7/19/10), this legislation is vitally important to preserve access to home health services because it would establish a fairer and more transparent process for evaluating case mix changes. Home health advocates also should ask their legislators to convey these significant concerns about payment cuts to CMS.

Click here and enter your zip code to find your federal legislators and their contact information. To access the text of the House bill and a list of House cosponsors, click here. To see the text of the Senate bill and a list of Senate cosponsors, click here. If your legislators have not yet cosponsored H.R. 5803 or S. 3315, please contact their offices and encourage them to do so. When calling, ask to speak with the staffer who handles Medicare issues. For talking points, click here.

To send an email on this issue to your members of Congress using the NAHC Legislative Action Network, click here. We encourage you to edit the sample email provided there by adding information about your own background and experience and the impact these payment cuts could have on home health patients in your state.

NAHC Report Article


Thursday, June 17, 2010

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Fifty Representatives Endorse Home Health Care Planning Improvement Act

Bills Would Allow NPs, PAs, and Other Professionals to Sign Home Health Plans of Care

With the help of home care advocates, Rep. Allyson Schwartz (D-PA) has garnered 50 cosponsors for her legislation, the Home Health Planning Improvement Act of 2010 (H.R. 4993). The National Association for Home Care & Hospice (NAHC) thanks all home care advocates who helped encourage their representatives' support for this legislation (NAHC Report, 4/28/10) The bill would allow nurse practitioners (NPs), clinical nurse specialists, and physician assistants (PAs) to order home health services under Medicare in accordance with state law.

Rep. Schwartz -- who serves on the House Ways and Means Committee, which has jurisdiction over Medicare and Medicaid -- and the bill's Republican cosponsor, Walter Jones (R-NC), have been circulating a new, bipartisan "dear colleague" letter describing the bill and seeking cosigners among fellow House members.

"Even though nurse practitioners and physician assistants are currently able to order nursing home care for Medicare beneficiaries, they are not able to order less costly home care services," Schwartz and Jones point out in the letter. "The Home Health Care Planning Improvement Act, H.R. 4993, would ensure that our Medicare beneficiaries get the home health care they need in a timely manner." You can help by downloading the letter and forwarding it to your representative's office -- see below for information to help you do so. In addition, Sens. Susan Collins (R-ME) and Kent Conrad (D-ND) have introduced a Senate companion bill (S. 2814), and NAHC urges all home care advocates to encourage their senators to add their names as cosponsors.

TAKE ACTION: Have your congressional legislators added their names to these important bills?

Click here and enter your zip code to find your federal legislators and their contact information. If your members of the House and Senate have not yet cosponsored H.R. 4993 or S. 2814, respectively, please contact their offices and encourage them to do so. When calling, ask to speak with the staffer who handles Medicare issues. To send an email on this issue to your members of Congress using the NAHC Legislative Action Network, click here.

Advance Practice Reform

I was recently asked, why allowing advance practice providers to order and supervise patients under homecare services was needed. Here was my response:

First everyone needs to be clear what the Federal Register states:

§ 484.18 Condition of participation: Acceptance of patients, plan of care, and medical supervision states, “Care follows a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine.”

This federal regulation supersedes any state nurse practice acts that would allow nurse practitioners to provide this oversight. There are multiple reasons why H.R. 4993 bill or S. 2814 needs to be passed. Senator Collins (D-Maine) did a wonderful job outlining some of these reasons in her statement in November of 2009. Her statement can be found in one of my previous blogs.

I see this legislation being a critical first step in reforming home health care and positioning the industry to be a critical player in overall healthcare reform. There are several possible changes that will occur over the next few years as a result of healthcare reform. These changes include value-based purchasing (A.K.A. pay for performance) and post-acute bundling. I envision nurse practitioners as key solutions for these challenges.

I predict that nurse practitioners will be on staff in many home health agencies during the next decade. They will be in charge of disease management programs, case managing complex patients, and providing direct care to patients. The direct care will consist of caring for those patients exhibiting acute exacerbations of their disease. Instead of going to the ER or delaying treatment while waiting for a physician appointment, the NP would see those patients at home and order the appropriate treatment. This would decrease healthcare costs while accelerating patient outcomes and increasing patients’ overall satisfaction.

An example would be a Chronic Congestive Heart Failure patient beginning to experience an acute exacerbation. Currently, most agencies would notify the physician who then would instruct the patient to go to the ER. The ER physician, not knowing this patient feels this patient need to be hospitalized to be diuresed. After the expensive ER visit and several days in the hospital, the patient is diuresed.

Instead say that nurse notified the NP on staff. They see the patient in home and complete an assessment. Complete any necessary lab work then orders diuretics for the patient while at home. The agency increased the visits over the next few days until the patient stabilizes. This would cost a fraction of the ER/hospitalization bill.

In order to achieve this first step towards higher quality patient care, H.R. 4993 needs to be passed now. As health care reform becomes clearer, many groups will be aiming to be on top of the heap. If these bills are not passed now, I worry that physician lobbyist groups will fight much more fiercely in the future to not allow advance practice providers to practice in the homecare setting as is the case now. The home health industry is in a terrific position to become a major player in health reform. In order to situate ourselves to be a major stakeholder with Healthcare Reform, we must pass H.R. 4993.

Care Plan Oversight

As I mentioned last month, Senator Collins (R-ME) and Senator Conrad (D-ND) introduced senate bill 2814 on November 20, 2009. This bill would allow for advance practice providers other than physician to order and monitor home care services for patients. Despite several State laws that already allow this, it is not allowed by the Federal Government so it is prohibited under federal reimbursed payment systems such as Medicare and Medicaid.

At the time I last blogged about this issue, it was not clear if this would allow for Advance Practice Providers to bill for care plan oversight. I did receive a letter from Senator Conrad stating that it would not allow for this provision. This is a shame. The Senate needs pressure from its home health constituents to pass this senate bill and add a provision for care plan oversight. I would take the bill as is but if Advance Practice Providers like Nurse Practioners are doing the equability work of a physician they should be reimbursed for that.

This bill still remains in the Senate Finance Committee for review. I would be interested in your feedback.

Advance Practice Providers Ordering Home Care

Senator Collins (R-ME) and Senator Conrad (D-ND) introduced senate bill 2814 on November 20, 2009. This bill would allow for advance practice providers other than physician to order and monitor home care services for patients. Despite several State laws that already allow this, it is not allowed by the Federal Government so it is prohibited under federal reimbursed payment systems such as Medicare and Medicaid.

This legislation is way overdue. Not clear is if it will allow for these advance practice providers to bill for Care Plan Oversight. This should be allowed due to the regulatory requirements for reviewing and communicating with the home health agency.