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 consider-
ation 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 Medi-
care Program. 
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 ‘‘Physician Assistants 
Continuity of Care Act of 2007’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) In 2006, approximately 286 million pre-
scriptions were written by physician assistants and 
more than 230 million patient visits were made for 
physician assistant services. Such services are par-
ticularly needed in communities that experience 
health disparities, especially rural communities and 
communities with high minority populations. 
(2) Physician assistants furnish services in al-
most all health care settings and in every medical 
and surgical specialty, providing quality, cost-effec-
tive 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 sub-
ject to the oversight of physicians and to have the 
authority to write prescriptions subject to such over-
sight. 
(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 pro-
viding for a uniform rate of reimbursement for cer-
tain services furnished by physician assistants who 
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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 assist-
ants 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 vul-
nerable 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 deliv-
ered by physician assistants may not be reimbursed 
under the Medicare program. 
(7) Some critical access hospitals have reported 
difficulty with discharge planning because the Medi-
care program does not provide reimbursement for 
services related to skilled nursing facility orders or 
home health orders that have been signed by a phy-
sician assistant. 
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(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 bene-
ficiaries may cause additional costs for the Medicare 
program. 
SEC. 3. PERMITTING PHYSICIAN ASSISTANTS WHEN DELE-
GATED BY A PHYSICIAN TO ORDER OR PRO-
VIDE POST-HOSPITAL EXTENDED CARE SERV-
ICES, HOME HEALTH SERVICES, AND HOS-
PICE CARE UNDER THE MEDICARE PRO-
GRAM. 
(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 subpara-
graph (A)— 
(1) by inserting ‘‘or a physician assistant as 
delegated by a physician’’ after ‘‘a physician’’ the 
first place it appears; and 
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(2) by inserting ‘‘a physician assistant as dele-
gated by a physician,’’ after ‘‘a physician,’’ the sec-
ond 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 physi-
cian,’’ after ‘‘established’’; and 
(B) by inserting ‘‘or a physician assistant 
as delegated by a physician’’ after ‘‘a physi-
cian’’ 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 dele-
gated by a physician,’’ after ‘‘a physician’’; and 
(B) in each of clauses (ii) and (iii) of sub-
paragraph (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— 
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(A) in clause (i)(I), by inserting ‘‘or a phy-
sician assistant as delegated by such attending 
physician’’ after ‘‘nurse practitioner)’’; and 
(B) in clause (ii), by inserting ‘‘or physi-
cian 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 fol-
lowing: ‘‘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 physi-
cian (as so defined) and which the physician assist-
ant 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. 
Æ 
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