I 

111TH CONGRESS 

2D SESSION H. R. 4993 

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 HOUSE OF REPRESENTATIVES 

APRIL 13, 2010 

Ms. SCHWARTZ (for herself, Mrs. CAPPS, Mrs. MCCARTHY of New York, Ms. 

BALDWIN, Ms. SHEA-PORTER, Mr. BRALEY of Iowa, Mr. COURTNEY, Ms. 

HARMAN, Mr. FARR, Mr. BLUMENAUER, Mr. GARAMENDI, Ms. WATSON, 

Ms. SCHAKOWSKY, Ms. PINGREE of Maine, Mrs. DAHLKEMPER, Mr. 

GRIJALVA, Mr. PERLMUTTER, Ms. DELAURO, and Mr. DEFAZIO) introduced the following bill; which was referred to the Committee on Ways 

and Means, and in addition to the Committee on Energy and Commerce, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

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 2010’’. 


pwalker on DSK8KYBLC1PROD with BILLS
2 

•HR 4993 IH

1 SEC. 2. IMPROVING CARE PLANNING FOR MEDICARE HOME 

2 HEALTH SERVICES. 

3 (a) IN GENERAL.—Section 1814(a)(2) of the Social 

4 Security Act (42 U.S.C. 1395f(a)(2)), in the matter pre5 ceding subparagraph (A), is amended— 

6 (1) by inserting ‘‘(as those terms are defined in 

7 section 1861(aa)(5))’’ after ‘‘clinical nurse spe8 cialist’’; and 

9 (2) by inserting ‘‘, or in the case of services de10 scribed in subparagraph (C), a physician, or a nurse 

11 practitioner or clinical nurse specialist who is work12 ing in collaboration with a physician in accordance 

13 with State law, or a certified nurse-midwife (as de14 fined in section 1861(gg)) as authorized by State 

15 law, or a physician assistant (as defined in section 

16 1861(aa)(5)) under the supervision of a physician’’ 

17 after ‘‘collaboration with a physician’’. 

18 (b) CONFORMING AMENDMENTS.—(1) Section 

19 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) 

20 is amended— 

21 (A) in paragraph (2)(C), by inserting ‘‘, a nurse 

22 practitioner, a clinical nurse specialist, a certified 

23 nurse-midwife, or a physician assistant (as the case 

24 may be)’’ after ‘‘physician’’ each place it appears; 

25 (B) in the second sentence, by striking ‘‘or clin26 ical nurse specialist’’ and inserting ‘‘clinical nurse 


pwalker on DSK8KYBLC1PROD with BILLS
3 

•HR 4993 IH

1 specialist, certified nurse-midwife, or physician as2 sistant’’; 

3 (C) in the third sentence— 

4 (i) by striking ‘‘physician certification’’ 

5 and inserting ‘‘certification’’; 

6 (ii) by inserting ‘‘(or on January 1, 2011, 

7 in the case of regulations to implement the 

8 amendments made by section 2 of the Home 

9 Health Care Planning Improvement Act of 

10 2010)’’ after ‘‘1981’’; and 

11 (iii) by striking ‘‘a physician who’’ and in12 serting ‘‘a physician, nurse practitioner, clinical 

13 nurse specialist, certified nurse-midwife, or phy14 sician assistant who’’; and 

15 (D) in the fourth sentence, by inserting ‘‘, 

16 nurse practitioner, clinical nurse specialist, certified 

17 nurse-midwife, or physician assistant’’ after ‘‘physi18 cian’’. 

19 (2) Section 1835(a) of the Social Security Act (42 

20 U.S.C. 1395n(a)) is amended— 

21 (A) in paragraph (2)— 

22 (i) in the matter preceding subparagraph 

23 (A), by inserting ‘‘or, in the case of services de24 scribed in subparagraph (A), a physician, or a 

25 nurse practitioner or clinical nurse specialist (as 


pwalker on DSK8KYBLC1PROD with BILLS
4 

•HR 4993 IH

1 those terms are defined in 1861(aa)(5)) who is 

2 working in collaboration with a physician in ac3 cordance with State law, or a certified nurse4 midwife (as defined in section 1861(gg)) as au5 thorized by State law, or a physician assistant 

6 (as defined in section 1861(aa)(5)) under the 

7 supervision of a physician’’ after ‘‘a physician’’; 

8 and 

9 (ii) in each of clauses (ii) and (iii) of sub10 paragraph (A) by inserting ‘‘, a nurse practi11 tioner, a clinical nurse specialist, a certified 

12 nurse-midwife, or a physician assistant (as the 

13 case may be)’’ after ‘‘physician’’; 

14 (B) 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 (C) in the fourth sentence— 

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

20 and inserting ‘‘certification’’; 

21 (ii) by inserting ‘‘(or on January 1, 2011, 

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 2010)’’ after ‘‘1981’’; and 


pwalker on DSK8KYBLC1PROD with BILLS
5 

•HR 4993 IH

1 (iii) 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 (D) in the fifth sentence, by inserting ‘‘, nurse 

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

8 (3) Section 1861 of the Social Security Act (42 

9 U.S.C. 1395x) is amended— 

10 (A) in subsection (m)— 

11 (i) 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 sec17 tion 1861(gg)), or a physician assistant (as 

18 defined in subsection (aa)(5)),’’ after ‘‘phy19 sician’’ the first place it appears; and 

20 (II) by inserting ‘‘a nurse practi21 tioner, a clinical nurse specialist, a cer22 tified nurse-midwife, or a physician assist23 ant’’ after ‘‘physician’’ the second place it 

24 appears; and 


pwalker on DSK8KYBLC1PROD with BILLS
6 

•HR 4993 IH

1 (ii) 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’’; and 

5 (B) in subsection (o)(2)— 

6 (i) by inserting ‘‘, nurse practitioners or 

7 clinical nurse specialists (as those terms are de8 fined in subsection (aa)(5)), certified nurse-mid9 wives (as defined in section 1861(gg)), or physi10 cian assistants (as defined in subsection 

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

12 (ii) by inserting ‘‘, nurse practitioner, clin13 ical nurse specialist, certified nurse-midwife, 

14 physician assistant,’’ after ‘‘physician’’. 

15 (4) Section 1895 of the Social Security Act (42 

16 U.S.C. 1395fff) is amended— 

17 (A) in subsection (c)(1), by inserting ‘‘, the 

18 nurse practitioner or clinical nurse specialist (as 

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

20 certified nurse-midwife (as defined in section 

21 1861(gg)), or the physician assistant (as defined in 

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

23 (B) in subsection (e)— 

24 (i) in paragraph (1)(A), by inserting ‘‘, a 

25 nurse practitioner or clinical nurse specialist (as 


pwalker on DSK8KYBLC1PROD with BILLS
7 

•HR 4993 IH

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

2 a certified nurse-midwife (as defined in section 

3 1861(gg)), or a physician assistant (as defined 

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

5 (ii) in paragraph (2)— 

6 (I) in the heading, by striking ‘‘PHY7 SICIAN CERTIFICATION’’ and inserting 

8 ‘‘RULE OF CONSTRUCTION REGARDING RE9 QUIREMENT FOR CERTIFICATION’’; and 

10 (II) by striking ‘‘physician’’. 

11 (c) RULE OF CONSTRUCTION.—Nothing in the 

12 amendments made by this section shall be construed as 

13 affecting the scope of practice authorized under State law 

14 of a certified nurse-midwife (as defined in section 

15 1861(gg) of the Social Security Act) or a nurse practi16 tioner, clinical nurse specialist, or physician assistant (as 

17 such terms are defined in section 1861(aa)(5) of such 

18 Act). 

19 (d) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply to items and services furnished on 

21 or after January 1, 2011. 

Æ 


pwalker on DSK8KYBLC1PROD with BILLS