Home Health Care Planning Improvement Act of 2019

II 116TH CONGRESS 1ST SESSION S. 296 To amend title XVIII of the Social Security Act to ensure more timely access to home health services for Medicare beneficiaries under the Medi- care program. IN THE SENATE OF THE UNITED STATES JANUARY 31, 2019 Ms. COLLINS (for herself and Mr. CARDIN) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL 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. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Home Health Care 4 Planning Improvement Act of 2019’’. 5 SEC. 2. IMPROVING CARE PLANNING FOR MEDICARE HOME 6 HEALTH SERVICES. 7 (a) PART A PROVISIONS.—Section 1814(a) of the So- 8 cial Security Act (42 U.S.C. 1395f(a)) is amended— 9 VerDate Sep 11 2014 02:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S296.IS S296 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 296 IS (1) in paragraph (2)— 1 (A) in the matter preceding subparagraph 2 (A), by inserting ‘‘, a nurse practitioner or clin- 3 ical nurse specialist who is working in collabo- 4 ration with a physician in accordance with 5 State law, a certified nurse-midwife (as defined 6 in section 1861(gg)) as authorized by State law, 7 or a physician assistant (as defined in section 8 1861(aa)(5)) under the supervision of a physi- 9 cian’’ after ‘‘1866(j)’’; and 10 (B) in subparagraph (C)— 11 (i) by inserting ‘‘, a nurse practi- 12 tioner, a clinical nurse specialist, a cer- 13 tified nurse-midwife, or a physician assist- 14 ant (as the case may be)’’ after ‘‘physi- 15 cian’’ the first 2 times it appears; and 16 (ii) by striking ‘‘, and, in the case of 17 a certification made by a physician’’ and 18 all that follows through ‘‘face-to-face en- 19 counter’’ and inserting ‘‘, and, in the case 20 of a certification made by a physician after 21 January 1, 2010, or by a nurse practi- 22 tioner, clinical nurse specialist, certified 23 nurse-midwife, or physician assistant (as 24 the case may be) after January 1, 2020, 25 VerDate Sep 11 2014 02:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S296.IS S296 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 296 IS prior to making such certification the phy- 1 sician, nurse practitioner, clinical nurse 2 specialist, certified nurse-midwife, or physi- 3 cian assistant must document that the 4 physician, nurse practitioner, clinical nurse 5 specialist, certified nurse-midwife, or physi- 6 cian assistant has had a face-to-face en- 7 counter’’; 8 (2) in the second sentence, by inserting ‘‘cer- 9 tified nurse-midwife,’’ after ‘‘clinical nurse spe- 10 cialist,’’; 11 (3) in the third sentence— 12 (A) by striking ‘‘physician certification’’ 13 and inserting ‘‘certification’’; 14 (B) by inserting ‘‘(or on January 1, 2020, 15 in the case of regulations to implement the 16 amendments made by section 2 of the Home 17 Health Care Planning Improvement Act of 18 2019)’’ after ‘‘1981’’; and 19 (C) by striking ‘‘a physician who’’ and in- 20 serting ‘‘a physician, nurse practitioner, clinical 21 nurse specialist, certified nurse-midwife, or phy- 22 sician assistant who’’; and 23 VerDate Sep 11 2014 02:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S296.IS S296 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 296 IS (4) in the fourth sentence, by inserting ‘‘, nurse 1 practitioner, clinical nurse specialist, certified nurse- 2 midwife, or physician assistant’’ after ‘‘physician’’. 3 (b) PART B PROVISIONS.—Section 1835(a) of the So- 4 cial Security Act (42 U.S.C. 1395n(a)) is amended— 5 (1) in paragraph (2)— 6 (A) in the matter preceding subparagraph 7 (A), by inserting ‘‘, a nurse practitioner or clin- 8 ical nurse specialist (as those terms are defined 9 in 1861(aa)(5)) who is working in collaboration 10 with a physician in accordance with State law, 11 a certified nurse-midwife (as defined in section 12 1861(gg)) as authorized by State law, or a phy- 13 sician assistant (as defined in section 14 1861(aa)(5)) under the supervision of a physi- 15 cian’’ after ‘‘1866(j)’’; and 16 (B) in subparagraph (A)— 17 (i) in each of clauses (ii) and (iii) of 18 subparagraph (A) by inserting ‘‘, a nurse 19 practitioner, a clinical nurse specialist, a 20 certified nurse-midwife, or a physician as- 21 sistant (as the case may be)’’ after ‘‘physi- 22 cian’’; and 23 (ii) in clause (iv), by striking ‘‘after 24 January 1, 2010’’ and all that follows 25 VerDate Sep 11 2014 02:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S296.IS S296 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 296 IS through ‘‘face-to-face encounter’’ and in- 1 serting ‘‘made by a physician after Janu- 2 ary 1, 2010, or by a nurse practitioner, 3 clinical nurse specialist, certified nurse- 4 midwife, or physician assistant (as the case 5 may be) after January 1, 2020, prior to 6 making such certification the physician, 7 nurse practitioner, clinical nurse specialist, 8 certified nurse-midwife, or physician assist- 9 ant must document that the physician, 10 nurse practitioner, clinical nurse specialist, 11 certified nurse-midwife, or physician assist- 12 ant has had a face-to-face encounter’’; 13 (2) in the third sentence, by inserting ‘‘, nurse 14 practitioner, clinical nurse specialist, certified nurse- 15 midwife, or physician assistant (as the case may 16 be)’’ after physician; 17 (3) in the fourth sentence— 18 (A) by striking ‘‘physician certification’’ 19 and inserting ‘‘certification’’; 20 (B) by inserting ‘‘(or on January 1, 2020, 21 in the case of regulations to implement the 22 amendments made by section 2 of the Home 23 Health Care Planning Improvement Act of 24 2019)’’ after ‘‘1981’’; and 25 VerDate Sep 11 2014 02:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S296.IS S296 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 296 IS (C) by striking ‘‘a physician who’’ and in- 1 serting ‘‘a physician, nurse practitioner, clinical 2 nurse specialist, certified nurse-midwife, or phy- 3 sician assistant who’’; and 4 (4) in the fifth sentence, by inserting ‘‘, nurse 5 practitioner, clinical nurse specialist, certified nurse- 6 midwife, or physician assistant’’ after ‘‘physician’’. 7 (c) DEFINITION PROVISIONS.— 8 (1) HOME HEALTH SERVICES.—Section 9 1861(m) of the Social Security Act (42 U.S.C. 10 1395x(m)) is amended— 11 (A) in the matter preceding paragraph 12 (1)— 13 (i) by inserting ‘‘, a nurse practitioner 14 or a clinical nurse specialist (as those 15 terms are defined in subsection (aa)(5)), a 16 certified nurse-midwife (as defined in sec- 17 tion 1861(gg)), or a physician assistant (as 18 defined in subsection (aa)(5))’’ after ‘‘phy- 19 sician’’ the first place it appears; and 20 (ii) by inserting ‘‘, a nurse practi- 21 tioner, a clinical nurse specialist, a cer- 22 tified nurse-midwife, or a physician assist- 23 ant’’ after ‘‘physician’’ the second place it 24 appears; and 25 VerDate Sep 11 2014 02:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S296.IS S296 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 296 IS (B) in paragraph (3), by inserting ‘‘, a 1 nurse practitioner, a clinical nurse specialist, a 2 certified nurse-midwife, or a physician assist- 3 ant’’ after ‘‘physician’’. 4 (2) HOME HEALTH AGENCY.—Section 5 1861(o)(2) of the Social Security Act (42 U.S.C. 6 1395x(o)(2)) is amended— 7 (A) by inserting ‘‘, nurse practitioners or 8 clinical nurse specialists (as those terms are de- 9 fined in subsection (aa)(5)), certified nurse-mid- 10 wives (as defined in section 1861(gg)), or physi- 11 cian assistants (as defined in subsection 12 (aa)(5))’’ after ‘‘physicians’’; and 13 (B) by inserting ‘‘, nurse practitioner, clin- 14 ical nurse specialist, certified nurse-midwife, 15 physician assistant,’’ after ‘‘physician’’. 16 (d) HOME HEALTH PROSPECTIVE PAYMENT SYSTEM 17 PROVISIONS.—Section 1895 of the Social Security Act (42 18 U.S.C. 1395fff) is amended— 19 (1) in subsection (c)(1), by inserting ‘‘, the 20 nurse practitioner or clinical nurse specialist (as 21 those terms are defined in section 1861(aa)(5)), the 22 certified nurse-midwife (as defined in section 23 1861(gg)), or the physician assistant (as defined in 24 section 1861(aa)(5)),’’ after ‘‘physician’’; and 25 VerDate Sep 11 2014 02:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S296.IS S296 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 296 IS (2) in subsection (e)— 1 (A) in paragraph (1)(A), by inserting ‘‘, a 2 nurse practitioner or clinical nurse specialist (as 3 those terms are defined in section 1861(aa)(5)), 4 a certified nurse-midwife (as defined in section 5 1861(gg)), or a physician assistant (as defined 6 in section 1861(aa)(5))’’ after ‘‘physician’’; and 7 (B) in paragraph (2)— 8 (i) in the heading, by striking ‘‘PHY- 9 SICIAN CERTIFICATION’’ and inserting 10 ‘‘RULE OF CONSTRUCTION REGARDING RE- 11 QUIREMENT FOR CERTIFICATION’’; and 12 (ii) by striking ‘‘physician’’. 13 (e) EFFECTIVE DATE.—The amendments made by 14 this section shall apply to items and services furnished on 15 or after January 1, 2020. 16 Æ VerDate Sep 11 2014 02:24 Feb 08, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\S296.IS S296 pamtmann on DSKBFK8HB2PROD with BILLS