I 

111TH CONGRESS 

2D SESSION H. R. 5270 

To amend the Federal Employees’ Compensation Act to cover services provided to injured Federal workers by physician assistants and nurse practitioners, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 11, 2010 

Mr. HARE (for himself, Mr. GEORGE MILLER of California, and Mr. SOUDER) 

introduced the following bill; which was referred to the Committee on 

Education and Labor 

A BILL 

To amend the Federal Employees’ Compensation Act to cover 

services provided to injured Federal workers by physician 

assistants and nurse practitioners, and for other purposes. 

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 ‘‘Improving Access to 

5 Workers’ Compensation for Injured Federal Workers 

6 Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 


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1 (1) Medical services and supplies provided by 

2 physician assistants (PAs), nurse practitioners 

3 (NPs), clinical nurse specialists (CNSs), certified 

4 nurse midwives (CNMs), and certified registered 

5 nurse anesthetists (CRNAs), are not included in the 

6 definition of ‘‘medical, surgical, and hospital services 

7 and supplies’’ in the Federal Employees’ Compensa8 tion Act (5 U.S.C. 8101 et seq.). PAs, NPs, CNSs, 

9 CNMs, and CRNAs are not included in the defini10 tion of ‘‘physician’’ in such Act, and claims signed 

11 by PAs, NPs, CNSs, CNMs, and CRNAs have been 

12 denied by the Office of Workers’ Compensation Pro13 grams of the Department of Labor. 

14 (2) In some rural areas where many of these 

15 providers are the only full-time providers of care, in16 jured Federal workers may have to travel more than 

17 100 miles to receive care that is reimbursable. 

18 (3) In some cases, Federal workers have been 

19 advised to use hospital emergency rooms for non20 emergency care, rather than receiving care after 

21 hours at local clinics where many of these providers 

22 are the only health care professionals on site. 

23 (4) PAs, NPs, CNSs, CRNAs, and CNMs are 

24 covered providers within Medicare, Medicaid, Tri25 Care, and most private insurance plans. 


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1 (5) PAs, NPs, CRNAs, and CNMs are legally 

2 regulated in all 50 States, the District of Columbia, 

3 and Guam. 

4 (6) All 50 States, the District of Columbia, and 

5 Guam authorize physicians to delegate prescriptive 

6 privileges to the PAs they supervise, authorize NPs 

7 to prescribe medications under their own signature; 

8 48 States, the District of Columbia, American 

9 Samoa, and Guam provide prescriptive authority to 

10 CNMs; and CRNAs have prescriptive authority in 

11 28 states (and the District of Columbia) and order 

12 and administer anesthesia medication and provide 

13 anesthesia and interventional pain management serv14 ices in all 50 states and the District of Columbia. 

15 (7) PAs, NPs, and CRNAs work in virtually 

16 every area of medicine and surgery and are also em17 ployed by the Federal Government to provide med18 ical care, including by the Department of Veterans 

19 Affairs, the Department of Defense, and the Public 

20 and Indian Health Services. 

21 (8) CNSs have clinical nursing expertise in di22 agnosis and provide direct care to prevent, reme23 diate, or alleviate illness and promote health. CNSs 

24 practice in hospitals, clinics, nursing homes, and 

25 other community-based settings. 


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1 (9) CNMs provide vital care to pregnant Fed2 eral workers who are injured on the job. 

3 (10) CRNAs, the oldest of the advanced prac4 tice nurse specialties, administer approximately 32 

5 million anesthetics to patients each year in the U.S., 

6 and in some States are the sole providers of anes7 thetics in nearly 100 percent of rural hospitals. 

8 (11) CRNAs work in almost every setting in 

9 which anesthesia is given, including operating rooms, 

10 dental offices, pain clinics, ambulatory surgical set11 tings, and provide interventional pain management 

12 service. 

13 (12) Amending the Federal Employees’ Com14 pensation Act to recognize PAs, NPs, CRNAs, 

15 CNSs, and CNMs as covered providers will bring 

16 this Act in line with the overwhelming majority of 

17 State workers’ compensation programs, which recog18 nize each of these providers as covered providers. 

19 (13) The exclusion of PAs, NPs, CNSs, CNMs, 

20 and CRNAs from the category of covered providers 

21 under the Federal Employees’ Compensation Act 

22 limits patients’ access to medical care, services, and 

23 supplies, disrupts continuity of care, and creates un24 necessary costs for the Office of Workers’ Com25 pensation Programs. 


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1 SEC. 3. INCLUSION OF PHYSICIAN ASSISTANTS AND AD2 VANCED PRACTICE REGISTERED NURSES IN 

3 FEDERAL EMPLOYEES’ COMPENSATION ACT. 

4 (a) INCLUSION.—Section 8101 of title 5, United 

5 States Code, is amended— 

6 (1) in paragraph (3), by inserting ‘‘other eligi7 ble providers,’’ after ‘‘chiropractors,’’; 

8 (2) by striking ‘‘and’’ at the end of paragraphs 

9 (18) and (19); 

10 (3) by striking the period at the end of para11 graph (20) and inserting ‘‘; and’’; and 

12 (4) by adding at the end the following: 

13 ‘‘(21) ‘other eligible provider’ means a physician 

14 assistant, nurse practitioner, clinical nurse specialist, 

15 certified nurse midwife, or certified registered nurse 

16 anesthetist, within the scope of their practice as de17 fined by State law, or as credentialed by the Federal 

18 government.’’. 

19 (b) CONFORMING AMENDMENTS.—Chapter 81 of 

20 title 5, United States Code, is amended— 

21 (1) in section 8103(a)— 

22 (A) in the matter preceding paragraph (1), 

23 by inserting ‘‘or other eligible provider’’ after 

24 ‘‘physician’’; 

25 (B) in paragraph (3), by inserting ‘‘or 

26 other eligible providers’’ after ‘‘physicians’’; and 


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1 (C) in the matter following paragraph (3), 

2 by inserting ‘‘or other eligible provider’’ after 

3 ‘‘physician’’; 

4 (2) in section 8121(6), by inserting ‘‘or other 

5 eligible provider’’ after ‘‘physician’’; and 

6 (3) in section 8123(a)— 

7 (A) in the second sentence, by inserting 

8 ‘‘or other eligible provider’’ after ‘‘physician’’; 

9 and 

10 (B) in the third sentence, by striking ‘‘of 

11 the employee’’ and inserting ‘‘or other eligible 

12 provider of the employee’’. 

13 SEC. 4. EFFECTIVE DATE. 

14 The amendments made by this section shall apply be15 ginning on the first day of the second Federal fiscal year 

16 quarter that begins on or after the date of the enactment 

17 of this Act. 

Æ 


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