```

[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1178 Introduced in House (IH)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Physician Assistants Continuity of 
Care Act of 2007''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) In 2006, approximately 286 million prescriptions were 
        written by physician assistants and more than 230 million 
        patient visits were made for physician assistant services. Such 
        services are particularly needed in communities that experience 
        health disparities, especially rural communities and 
        communities with high minority populations.
            (2) Physician assistants furnish services in almost all 
        health care settings and in every medical and surgical 
        specialty, providing quality, cost-effective medical care. They 
        deliver a broad range of medical and surgical services to 
        diverse populations.
            (3) All 50 States, the District of Columbia, and Guam 
        regulate physician assistant services so as to permit physician 
        assistants to practice medicine subject to the oversight of 
        physicians and to have the authority to write prescriptions 
        subject to such oversight.
            (4) In 1997, the Balanced Budget Act of 1997 amended the 
        Medicare program to extend coverage for medical services 
        provided by physician assistants, as permitted under applicable 
        State law, thus providing for a uniform rate of reimbursement 
        for certain services furnished by physician assistants who work 
        in health care practice settings subject to the oversight of a 
        physician.
            (5) Physician assistants and physicians work together as a 
        team. However, supervising physicians need not be physically 
        present when physician assistants provide medical care. In 
        medically underserved communities, a physician assistant may be 
        the only onsite health care professional accessible during the 
        time when a patient needs immediate care. Health care furnished 
        by physician assistants is therefore critical to providing 
        medical care for the most vulnerable and at-risk populations in 
        the United States.
            (6) In some rural areas, physician assistants are the only 
        providers of care immediately available. However, Medicare 
        beneficiaries have faced delays of weeks in receiving hospice 
        care because care delivered by physician assistants may not be 
        reimbursed under the Medicare program.
            (7) Some critical access hospitals have reported difficulty 
        with discharge planning because the Medicare program does not 
        provide reimbursement for services related to skilled nursing 
        facility orders or home health orders that have been signed by 
        a physician assistant.
            (8) The continuity of care of a terminally ill Medicare 
        beneficiary may be interrupted because a physician assistant 
        may not be reimbursed under the Medicare program for furnishing 
        such beneficiary with certain services, such as hospice care, 
        even though a physician assistant may have been such 
        beneficiary's primary health care provider prior to the 
        diagnosis of the terminal illness. Such break downs in the 
        continuity of care of Medicare beneficiaries may cause 
        additional costs for the Medicare program.

SEC. 3. PERMITTING PHYSICIAN ASSISTANTS WHEN DELEGATED BY A PHYSICIAN 
              TO ORDER OR PROVIDE POST-HOSPITAL EXTENDED CARE SERVICES, 
              HOME HEALTH SERVICES, AND HOSPICE CARE UNDER THE MEDICARE 
              PROGRAM.

    (a) Post-Hospital Extended Care Services.--Section 1814(a)(2) of 
the Social Security Act (42 U.S.C. 1395f(a)(2)) is amended, in the 
matter before subparagraph (A)--
            (1) by inserting ``or a physician assistant as delegated by 
        a physician'' after ``a physician'' the first place it appears; 
        and
            (2) by inserting ``a physician assistant as delegated by a 
        physician,'' after ``a physician,'' the second place it 
        appears.
    (b) Home Health Services.--
            (1) Under part a.--Section 1814(a)(2)(C) of such Act (42 
        U.S.C. 1395f(a)(2)(C)) is amended--
                    (A) by inserting ``by a physician or by a physician 
                assistant as delegated by a physician,'' after 
                ``established''; and
                    (B) by inserting ``or a physician assistant as 
                delegated by a physician'' after ``a physician'' each 
                place it appears.
            (2) Under part b.--Section 1835(a)(2) of such Act (42 
        U.S.C. 1395n(a)(2)) is amended--
                    (A) in the matter before subparagraph (A), by 
                inserting ``or a physician assistant as delegated by a 
                physician,'' after ``a physician''; and
                    (B) in each of clauses (ii) and (iii) of 
                subparagraph (A)(ii), by inserting ``or a physician 
                assistant as delegated by a physician'' after ``a 
                physician''.
    (c) Hospice Care.--
            (1) Certification of terminal illness.--Section 
        1814(a)(7)(A) of such Act is (42 U.S.C. 1395f(a)(7)(A)) is 
        amended--
                    (A) in clause (i)(I), by inserting ``or a physician 
                assistant as delegated by such attending physician'' 
                after ``nurse practitioner)''; and
                    (B) in clause (ii), by inserting ``or physician 
                assistant'' after ``physician''.
            (2) Including professional services of physician 
        assistant.--Section 1861(dd)(1)(F) of such Act (42 U.S.C. 
        1395x(dd)(1)(F)) is amended by inserting after ``physicians' 
        services'' the following: ``and services which would be 
        physicians' services if furnished by a physician (as defined in 
        subsection (r)(1)) and which are performed by a physician 
        assistant under the supervision of a physician (as so defined) 
        and which the physician assistant is legally authorized to 
        perform in the State in which the services are performed''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2007.
                                 <all>
```