I 
112TH CONGRESS 
1ST SESSION H. R. 2267 
To amend title XVIII of the Social Security Act to ensure more timely 
access to home health services for Medicare beneficiaries under the Medi-
care program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 21, 2011 
Mr. WALDEN (for himself, Ms. SCHWARTZ, Mr. JONES, Mr. ELLISON, Mr. 
LANCE, Ms. HANABUSA, Mr. WU, Mr. BARLETTA, Mr. GRIJALVA, Mr. 
COFFMAN of Colorado, Mr. LANGEVIN, Mr. BILBRAY, Mr. BLUMENAUER, 
Mr. LATHAM, Mr. SCHRADER, Mr. LATOURETTE, Mrs. CAPPS, Mr. 
HANNA, Mr. THOMPSON of California, Mr. TERRY, Mr. NEAL, Mr. BASS 
of New Hampshire, Mr. CHANDLER, Ms. LEE of California, Ms. SCHA-
KOWSKY, Mr. CICILLINE, Mr. BRADY of Pennsylvania, and Mr. BOS-
WELL) 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 juris-
diction 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Home Health Care 
Planning Improvement Act of 2011’’. 
SEC. 2. IMPROVING CARE PLANNING FOR MEDICARE HOME 
HEALTH SERVICES. 
(a) PART A PROVISIONS.—Section 1814(a) of the So-
cial Security Act (42 U.S.C. 1395f(a)) is amended— 
(1) in paragraph (2)— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘, a nurse practitioner or clin-
ical nurse specialist who is working in collabo-
ration with a physician in accordance with 
State law, a certified nurse-midwife (as defined 
in section 1861(gg)) as authorized by State law, 
or a physician assistant (as defined in section 
1861(aa)(5)) under the supervision of a physi-
cian’’ after ‘‘1866(j)’’; and 
(B) in subparagraph (C)— 
(i) by inserting ‘‘, a nurse practi-
tioner, a clinical nurse specialist, a cer-
tified nurse-midwife, or a physician assist-
ant (as the case may be)’’ after ‘‘physi-
cian’’ the first 2 times it appears; and 
(ii) by striking ‘‘, and, in the case of 
a certification made by a physician’’ and 
all that follows through ‘‘face-to-face en-
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counter’’ and inserting ‘‘, and, in the case 
of a certification made by a physician after 
January 1, 2010, or by a nurse practi-
tioner, clinical nurse specialist, certified 
nurse-midwife, or physician assistant (as 
the case may be) after January 1, 2012, 
prior to making such certification the phy-
sician, nurse practitioner, clinical nurse 
specialist, certified nurse-midwife, or physi-
cian assistant must document that the 
physician, nurse practitioner, clinical nurse 
specialist, certified nurse-midwife, or physi-
cian assistant has had a face-to-face en-
counter’’; 
(2) in the second sentence, by inserting ‘‘cer-
tified nurse-midwife,’’ after ‘‘clinical nurse spe-
cialist,’’; 
(3) in the third sentence— 
(A) by striking ‘‘physician certification’’ 
and inserting ‘‘certification’’; 
(B) by inserting ‘‘(or on January 1, 2012, 
in the case of regulations to implement the 
amendments made by section 2 of the Home 
Health Care Planning Improvement Act of 
2011)’’ after ‘‘1981’’; and 
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(C) by striking ‘‘a physician who’’ and in-
serting ‘‘a physician, nurse practitioner, clinical 
nurse specialist, certified nurse-midwife, or phy-
sician assistant who’’; and 
(4) in the fourth sentence, by inserting ‘‘, nurse 
practitioner, clinical nurse specialist, certified nurse- 
midwife, or physician assistant’’ after ‘‘physician’’. 
(b) PART B PROVISIONS.—Section 1835(a) of the So-
cial Security Act (42 U.S.C. 1395n(a)) is amended— 
(1) in paragraph (2)— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘, a nurse practitioner or clin-
ical nurse specialist (as those terms are defined 
in 1861(aa)(5)) who is working in collaboration 
with a physician in accordance with State law, 
a certified nurse-midwife (as defined in section 
1861(gg)) as authorized by State law, or a phy-
sician 
assistant 
(as 
defined 
in 
section 
1861(aa)(5)) under the supervision of a physi-
cian’’ after ‘‘1866(j)’’; 
(B) in subparagraph (A)— 
(i) in each of clauses (ii) and (iii) of 
subparagraph (A) by inserting ‘‘, a nurse 
practitioner, a clinical nurse specialist, a 
certified nurse-midwife, or a physician as-
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sistant (as the case may be)’’ after ‘‘physi-
cian’’; and 
(ii) in clause (iv), by striking ‘‘after 
January 1, 2010’’ and all that follows 
through ‘‘face-to-face encounter’’ and in-
serting ‘‘made by a physician after Janu-
ary 1, 2010, or by a nurse practitioner, 
clinical nurse specialist, certified nurse- 
midwife, or physician assistant (as the case 
may be) after January 1, 2012, prior to 
making such certification the physician, 
nurse practitioner, clinical nurse specialist, 
certified nurse-midwife, or physician assist-
ant must document that the physician, 
nurse practitioner, clinical nurse specialist, 
certified nurse-midwife, or physician assist-
ant has had a face-to-face encounter’’; 
(2) in the third sentence, by inserting ‘‘, nurse 
practitioner, clinical nurse specialist, certified nurse- 
midwife, or physician assistant (as the case may 
be)’’ after physician; 
(3) in the fourth sentence— 
(A) by striking ‘‘physician certification’’ 
and inserting ‘‘certification’’; 
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(B) by inserting ‘‘(or on January 1, 2012, 
in the case of regulations to implement the 
amendments made by section 2 of the Home 
Health Care Planning Improvement Act of 
2011)’’ after ‘‘1981’’; and 
(C) by striking ‘‘a physician who’’ and in-
serting ‘‘a physician, nurse practitioner, clinical 
nurse specialist, certified nurse-midwife, or phy-
sician assistant who’’; and 
(4) in the fifth sentence, by inserting ‘‘, nurse 
practitioner, clinical nurse specialist, certified nurse- 
midwife, or physician assistant’’ after ‘‘physician’’. 
(c) DEFINITION PROVISIONS.— 
(1) 
HOME
HEALTH
SERVICES.—Section 
1861(m) of the Social Security Act (42 U.S.C. 
1395x(m)) is amended— 
(A) in the matter preceding paragraph 
(1)— 
(i) by inserting ‘‘, a nurse practitioner 
or a clinical nurse specialist (as those 
terms are defined in subsection (aa)(5)), a 
certified nurse-midwife (as defined in sec-
tion 1861(gg)), or a physician assistant (as 
defined in subsection (aa)(5))’’ after ‘‘phy-
sician’’ the first place it appears; and 
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(ii) by inserting ‘‘, a nurse practi-
tioner, a clinical nurse specialist, a cer-
tified nurse-midwife, or a physician assist-
ant’’ after ‘‘physician’’ the second place it 
appears; and 
(B) in paragraph (3), by inserting ‘‘, a 
nurse practitioner, a clinical nurse specialist, a 
certified nurse-midwife, or a physician assist-
ant’’ after ‘‘physician’’. 
(2) 
HOME
HEALTH
AGENCY.—Section 
1861(o)(2) of the Social Security Act (42 U.S.C. 
1395x(o)(2)) is amended— 
(A) by inserting ‘‘, nurse practitioners or 
clinical nurse specialists (as those terms are de-
fined in subsection (aa)(5)), certified nurse-mid-
wives (as defined in section 1861(gg)), or physi-
cian assistants (as defined in subsection 
(aa)(5))’’ after ‘‘physicians’’; and 
(B) by inserting ‘‘, nurse practitioner, clin-
ical nurse specialist, certified nurse-midwife, 
physician assistant,’’ after ‘‘physician’’. 
(d) HOME HEALTH PROSPECTIVE PAYMENT SYSTEM 
PROVISIONS.—Section 1895 of the Social Security Act (42 
U.S.C. 1395fff) is amended— 
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(1) in subsection (c)(1), by inserting ‘‘, the 
nurse practitioner or clinical nurse specialist (as 
those terms are defined in section 1861(aa)(5)), the 
certified nurse-midwife (as defined in section 
1861(gg)), or the physician assistant (as defined in 
section 1861(aa)(5)),’’ after ‘‘physician’’; and 
(2) in subsection (e)— 
(A) in paragraph (1)(A), by inserting ‘‘, a 
nurse practitioner or clinical nurse specialist (as 
those terms are defined in section 1861(aa)(5)), 
a certified nurse-midwife (as defined in section 
1861(gg)), or a physician assistant (as defined 
in section 1861(aa)(5))’’ after ‘‘physician’’; and 
(B) in paragraph (2)— 
(i) in the heading, by striking ‘‘PHY-
SICIAN
CERTIFICATION’’ 
and 
inserting 
‘‘RULE OF CONSTRUCTION REGARDING RE-
QUIREMENT FOR CERTIFICATION’’; and 
(ii) by striking ‘‘physician’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2012. 
Æ 
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