II 

112TH CONGRESS 

1ST SESSION S. 227 

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. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 31, 2011 

Ms. COLLINS (for herself and Mr. CONRAD) 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Home Health Care 

5 Planning Improvement Act of 2011’’. 

6 SEC. 2. IMPROVING CARE PLANNING FOR MEDICARE HOME 

7 HEALTH SERVICES. 

8 (a) PART A PROVISIONS.—Section 1814(a) of the So9 cial Security Act (42 U.S.C. 1395f(a)) is amended— 


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1 (1) in paragraph (2)— 

2 (A) in the matter preceding subparagraph 

3 (A), by inserting ‘‘, a nurse practitioner or clin4 ical nurse specialist who is working in collabo5 ration with a physician in accordance with 

6 State law, a certified nurse-midwife (as defined 

7 in section 1861(gg)) as authorized by State law, 

8 or a physician assistant (as defined in section 

9 1861(aa)(5)) under the supervision of a physi10 cian’’ after ‘‘1866(j)’’; and 

11 (B) in subparagraph (C)— 

12 (i) by inserting ‘‘, a nurse practi13 tioner, a clinical nurse specialist, a cer14 tified nurse-midwife, or a physician assist15 ant (as the case may be)’’ after ‘‘physi16 cian’’ the first 2 times it appears; and 

17 (ii) by striking ‘‘, and, in the case of 

18 a certification made by a physician’’ and 

19 all that follows through ‘‘face-to-face en20 counter’’ and inserting ‘‘, and, in the case 

21 of a certification made by a physician after 

22 January 1, 2010, or by a nurse practi23 tioner, clinical nurse specialist, certified 

24 nurse-midwife, or physician assistant (as 

25 the case may be) after January 1, 2012, 


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1 prior to making such certification the phy2 sician, nurse practitioner, clinical nurse 

3 specialist, certified nurse-midwife, or physi4 cian assistant must document that the 

5 physician, nurse practitioner, clinical nurse 

6 specialist, certified nurse-midwife, or physi7 cian assistant has had a face-to-face en8 counter’’; 

9 (2) in the second sentence, by inserting ‘‘cer10 tified nurse-midwife,’’ after ‘‘clinical nurse spe11 cialist,’’; 

12 (3) in the third sentence— 

13 (A) by striking ‘‘physician certification’’ 

14 and inserting ‘‘certification’’; 

15 (B) by inserting ‘‘(or on January 1, 2012, 

16 in the case of regulations to implement the 

17 amendments made by section 2 of the Home 

18 Health Care Planning Improvement Act of 

19 2011)’’ after ‘‘1981’’; and 

20 (C) by striking ‘‘a physician who’’ and in21 serting ‘‘a physician, nurse practitioner, clinical 

22 nurse specialist, certified nurse-midwife, or phy23 sician assistant who’’; and 


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1 (4) in the fourth sentence, by inserting ‘‘, nurse 

2 practitioner, clinical nurse specialist, certified nurse3 midwife, or physician assistant’’ after ‘‘physician’’. 

4 (b) PART B PROVISIONS.—Section 1835(a) of the So5 cial Security Act (42 U.S.C. 1395n(a)) is amended— 

6 (1) in paragraph (2)— 

7 (A) in the matter preceding subparagraph 

8 (A), by inserting ‘‘, a nurse practitioner or clin9 ical nurse specialist (as those terms are defined 

10 in 1861(aa)(5)) who is working in collaboration 

11 with a physician in accordance with State law, 

12 a certified nurse-midwife (as defined in section 

13 1861(gg)) as authorized by State law, or a phy14 sician assistant (as defined in section 

15 1861(aa)(5)) under the supervision of a physi16 cian’’ after ‘‘1866(j)’’; 

17 (B) in subparagraph (A)— 

18 (i) in each of clauses (ii) and (iii) of 

19 subparagraph (A) by inserting ‘‘, a nurse 

20 practitioner, a clinical nurse specialist, a 

21 certified nurse-midwife, or a physician as22 sistant (as the case may be)’’ after ‘‘physi23 cian’’; and 

24 (ii) in clause (iv), by striking ‘‘after 

25 January 1, 2010’’ and all that follows 


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1 through ‘‘face-to-face encounter’’ and in2 serting ‘‘made by a physician after Janu3 ary 1, 2010, or by a nurse practitioner, 

4 clinical nurse specialist, certified nurse5 midwife, or physician assistant (as the case 

6 may be) after January 1, 2012, prior to 

7 making such certification the physician, 

8 nurse practitioner, clinical nurse specialist, 

9 certified nurse-midwife, or physician assist10 ant must document that the physician, 

11 nurse practitioner, clinical nurse specialist, 

12 certified nurse-midwife, or physician assist13 ant has had a face-to-face encounter’’; 

14 (2) in the third sentence, by inserting ‘‘, nurse 

15 practitioner, clinical nurse specialist, certified nurse16 midwife, or physician assistant (as the case may 

17 be)’’ after physician; 

18 (3) in the fourth sentence— 

19 (A) by striking ‘‘physician certification’’ 

20 and inserting ‘‘certification’’; 

21 (B) by inserting ‘‘(or on January 1, 2012, 

22 in the case of regulations to implement the 

23 amendments made by section 2 of the Home 

24 Health Care Planning Improvement Act of 

25 2011)’’ after ‘‘1981’’; and 


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1 (C) by striking ‘‘a physician who’’ and in2 serting ‘‘a physician, nurse practitioner, clinical 

3 nurse specialist, certified nurse-midwife, or phy4 sician assistant who’’; and 

5 (4) in the fifth sentence, by inserting ‘‘, nurse 

6 practitioner, clinical nurse specialist, certified nurse7 midwife, or physician assistant’’ after ‘‘physician’’. 

8 (c) DEFINITION PROVISIONS.— 

9 (1) HOME HEALTH SERVICES.—Section 

10 1861(m) of the Social Security Act (42 U.S.C. 

11 1395x(m)) is amended— 

12 (A) in the matter preceding paragraph 

13 (1)— 

14 (i) by inserting ‘‘, a nurse practitioner 

15 or a clinical nurse specialist (as those 

16 terms are defined in subsection (aa)(5)), a 

17 certified nurse-midwife (as defined in sec18 tion 1861(gg)), or a physician assistant (as 

19 defined in subsection (aa)(5))’’ after ‘‘phy20 sician’’ the first place it appears; and 

21 (ii) by inserting ‘‘, a nurse practi22 tioner, a clinical nurse specialist, a cer23 tified nurse-midwife, or a physician assist24 ant’’ after ‘‘physician’’ the second place it 

25 appears; and 


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1 (B) in paragraph (3), by inserting ‘‘, a 

2 nurse practitioner, a clinical nurse specialist, a 

3 certified nurse-midwife, or a physician assist4 ant’’ after ‘‘physician’’. 

5 (2) HOME HEALTH AGENCY.—Section 

6 1861(o)(2) of the Social Security Act (42 U.S.C. 

7 1395x(o)(2)) is amended— 

8 (A) by inserting ‘‘, nurse practitioners or 

9 clinical nurse specialists (as those terms are de10 fined in subsection (aa)(5)), certified nurse-mid11 wives (as defined in section 1861(gg)), or physi12 cian assistants (as defined in subsection 

13 (aa)(5))’’ after ‘‘physicians’’; and 

14 (B) by inserting ‘‘, nurse practitioner, clin15 ical nurse specialist, certified nurse-midwife, 

16 physician assistant,’’ after ‘‘physician’’. 

17 (d) HOME HEALTH PROSPECTIVE PAYMENT SYSTEM

18 PROVISIONS.—Section 1895 of the Social Security Act (42 

19 U.S.C. 1395fff) is amended— 

20 (1) in subsection (c)(1), by inserting ‘‘, the 

21 nurse practitioner or clinical nurse specialist (as 

22 those terms are defined in section 1861(aa)(5)), the 

23 certified nurse-midwife (as defined in section 

24 1861(gg)), or the physician assistant (as defined in 

25 section 1861(aa)(5)),’’ after ‘‘physician’’; and 


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1 (2) in subsection (e)— 

2 (A) in paragraph (1)(A), by inserting ‘‘, a 

3 nurse practitioner or clinical nurse specialist (as 

4 those terms are defined in section 1861(aa)(5)), 

5 a certified nurse-midwife (as defined in section 

6 1861(gg)), or a physician assistant (as defined 

7 in section 1861(aa)(5))’’ after ‘‘physician’’; and 

8 (B) in paragraph (2)— 

9 (i) in the heading, by striking ‘‘PHY10 SICIAN CERTIFICATION’’ and inserting 

11 ‘‘RULE OF CONSTRUCTION REGARDING RE12 QUIREMENT FOR CERTIFICATION’’; and 

13 (ii) by striking ‘‘physician’’. 

14 (e) EFFECTIVE DATE.—The amendments made by 

15 this section shall apply to items and services furnished on 

16 or after January 1, 2012. 

Æ 


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