I 

110TH CONGRESS 

1ST SESSION H. R. 1178 

To amend title XVIII of the Social Security Act to permit a physician 

assistant, when delegated by a physician, to order or provide post-hospital 

extended care services, home health services, and hospice care under 

the Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 16, 2007 

Mr. TOWNS (for himself and Mr. ENGLISH of Pennsylvania) 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 permit 

a physician assistant, when delegated by a physician, 

to order or provide post-hospital extended care services, 

home health services, and hospice care 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 ‘‘Physician Assistants 

5 Continuity of Care Act of 2007’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) In 2006, approximately 286 million pre4 scriptions were written by physician assistants and 

5 more than 230 million patient visits were made for 

6 physician assistant services. Such services are par7 ticularly needed in communities that experience 

8 health disparities, especially rural communities and 

9 communities with high minority populations. 

10 (2) Physician assistants furnish services in al11 most all health care settings and in every medical 

12 and surgical specialty, providing quality, cost-effec13 tive medical care. They deliver a broad range of 

14 medical and surgical services to diverse populations. 

15 (3) All 50 States, the District of Columbia, and 

16 Guam regulate physician assistant services so as to 

17 permit physician assistants to practice medicine sub18 ject to the oversight of physicians and to have the 

19 authority to write prescriptions subject to such over20 sight. 

21 (4) In 1997, the Balanced Budget Act of 1997 

22 amended the Medicare program to extend coverage 

23 for medical services provided by physician assistants, 

24 as permitted under applicable State law, thus pro25 viding for a uniform rate of reimbursement for cer26 tain services furnished by physician assistants who 


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1 work in health care practice settings subject to the 

2 oversight of a physician. 

3 (5) Physician assistants and physicians work 

4 together as a team. However, supervising physicians 

5 need not be physically present when physician assist6 ants provide medical care. In medically underserved 

7 communities, a physician assistant may be the only 

8 onsite health care professional accessible during the 

9 time when a patient needs immediate care. Health 

10 care furnished by physician assistants is therefore 

11 critical to providing medical care for the most vul12 nerable and at-risk populations in the United States. 

13 (6) In some rural areas, physician assistants 

14 are the only providers of care immediately available. 

15 However, Medicare beneficiaries have faced delays of 

16 weeks in receiving hospice care because care deliv17 ered by physician assistants may not be reimbursed 

18 under the Medicare program. 

19 (7) Some critical access hospitals have reported 

20 difficulty with discharge planning because the Medi21 care program does not provide reimbursement for 

22 services related to skilled nursing facility orders or 

23 home health orders that have been signed by a phy24 sician assistant. 


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1 (8) The continuity of care of a terminally ill 

2 Medicare beneficiary may be interrupted because a 

3 physician assistant may not be reimbursed under the 

4 Medicare program for furnishing such beneficiary 

5 with certain services, such as hospice care, even 

6 though a physician assistant may have been such 

7 beneficiary’s primary health care provider prior to 

8 the diagnosis of the terminal illness. Such break 

9 downs in the continuity of care of Medicare bene10 ficiaries may cause additional costs for the Medicare 

11 program. 

12 SEC. 3. PERMITTING PHYSICIAN ASSISTANTS WHEN DELE13 GATED BY A PHYSICIAN TO ORDER OR PRO14 VIDE POST-HOSPITAL EXTENDED CARE SERV15 ICES, HOME HEALTH SERVICES, AND HOS16 PICE CARE UNDER THE MEDICARE PRO17 GRAM. 

18 (a) POST-HOSPITAL EXTENDED CARE SERVICES.— 

19 Section 1814(a)(2) of the Social Security Act (42 U.S.C. 

20 1395f(a)(2)) is amended, in the matter before subpara21 graph (A)— 

22 (1) by inserting ‘‘or a physician assistant as 

23 delegated by a physician’’ after ‘‘a physician’’ the 

24 first place it appears; and 


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1 (2) by inserting ‘‘a physician assistant as dele2 gated by a physician,’’ after ‘‘a physician,’’ the sec3 ond place it appears. 

4 (b) HOME HEALTH SERVICES.— 

5 (1) UNDER PART A.—Section 1814(a)(2)(C) of 

6 such Act (42 U.S.C. 1395f(a)(2)(C)) is amended— 

7 (A) by inserting ‘‘by a physician or by a 

8 physician assistant as delegated by a physi9 cian,’’ after ‘‘established’’; and 

10 (B) by inserting ‘‘or a physician assistant 

11 as delegated by a physician’’ after ‘‘a physi12 cian’’ each place it appears. 

13 (2) UNDER PART B.—Section 1835(a)(2) of 

14 such Act (42 U.S.C. 1395n(a)(2)) is amended— 

15 (A) in the matter before subparagraph (A), 

16 by inserting ‘‘or a physician assistant as dele17 gated by a physician,’’ after ‘‘a physician’’; and 

18 (B) in each of clauses (ii) and (iii) of sub19 paragraph (A)(ii), by inserting ‘‘or a physician 

20 assistant as delegated by a physician’’ after ‘‘a 

21 physician’’. 

22 (c) HOSPICE CARE.— 

23 (1) CERTIFICATION OF TERMINAL ILLNESS.— 

24 Section 1814(a)(7)(A) of such Act is (42 U.S.C. 

25 1395f(a)(7)(A)) is amended— 


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1 (A) in clause (i)(I), by inserting ‘‘or a phy2 sician assistant as delegated by such attending 

3 physician’’ after ‘‘nurse practitioner)’’; and 

4 (B) in clause (ii), by inserting ‘‘or physi5 cian assistant’’ after ‘‘physician’’. 

6 (2) INCLUDING PROFESSIONAL SERVICES OF

7 PHYSICIAN ASSISTANT.—Section 1861(dd)(1)(F) of 

8 such Act (42 U.S.C. 1395x(dd)(1)(F)) is amended 

9 by inserting after ‘‘physicians’ services’’ the fol10 lowing: ‘‘and services which would be physicians’ 

11 services if furnished by a physician (as defined in 

12 subsection (r)(1)) and which are performed by a 

13 physician assistant under the supervision of a physi14 cian (as so defined) and which the physician assist15 ant is legally authorized to perform in the State in 

16 which the services are performed’’. 

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

18 this section shall apply to services furnished on or after 

19 January 1, 2007. 

Æ 


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