I 
110TH CONGRESS 
1ST SESSION H. R. 4651 
To amend the Federal Employees’ Compensation Act to cover services pro-
vided to injured Federal workers by physician assistants and nurse prac-
titioners, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 13, 2007 
Mr. HARE (for himself and Mr. SOUDER) introduced the following bill; which 
was referred to the Committee on Energy and Commerce 
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 pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Improving Access to 
Workers’ Compensation for Injured Federal Workers 
Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Medical services and supplies provided by 
physician assistants (PAs), nurse practitioners 
(NPs), clinical nurse specialists (CNSs), certified 
nurse midwives (CNMs), and certified registered 
nurse anesthetists (CRNAs), are not included in the 
definition of ‘‘medical, surgical, and hospital services 
and supplies’’ in the Federal Employees’ Compensa-
tion Act (5 U.S.C. 8101 et seq.). PAs, NPs, CNSs, 
CNMs, and CRNAs are not included in the defini-
tion of ‘‘physician’’ in such Act, and claims signed 
by PAs, NPs, CNSs, CNMs, and CRNAs have been 
denied by the Office of Workers’ Compensation Pro-
grams of the Department of Labor. 
(2) In some rural areas where many of these 
providers are the only full-time providers of care, in-
jured Federal workers may have to travel more than 
100 miles to receive care that is reimbursable. 
(3) In some cases, Federal workers have been 
advised to use hospital emergency rooms for non- 
emergency care, rather than receiving care after 
hours at local clinics where many of these providers 
are the only health care professionals on-site. 
(4) PAs, NPs, CNSs, and CNMs are covered 
providers within Medicare, Medicaid, Tri-Care, and 
most private insurance plans. 
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(5) PAs, NPs, and CNMs are legally regulated 
in all 50 States, the District of Columbia, and 
Guam. 
(6) All 50 States, the District of Columbia, and 
Guam authorize physicians to delegate prescriptive 
privileges to the PAs they supervise, authorize NPs 
to prescribe medications under their own signature, 
and 48 States, the District of Columbia, American 
Samoa, and Guam provide prescriptive authority to 
CNMs. 
(7) PAs and NPs work in virtually every area 
of medicine and surgery and are also employed by 
the Federal government to provide medical care, in-
cluding by the Department of Veterans Affairs, the 
Department of Defense, and the Public and Indian 
Health Services. 
(8) CNSs have clinical nursing expertise in di-
agnosis and provide direct care to prevent, reme-
diate, or alleviate illness and promote health. CNSs 
practice in hospitals, clinics, nursing homes, and 
other community-based settings. 
(9) CNMs provide vital care to pregnant Fed-
eral workers who are injured on the job. 
(10) CRNAs, the oldest of the advanced nurs-
ing specialties, administer more than 65 percent of 
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