I 
111TH CONGRESS 
2D SESSION 
H. R. 4993 
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 
APRIL 13, 2010 
Ms. SCHWARTZ (for herself, Mrs. CAPPS, Mrs. MCCARTHY of New York, Ms. 
BALDWIN, Ms. SHEA-PORTER, Mr. BRALEY of Iowa, Mr. COURTNEY, Ms. 
HARMAN, Mr. FARR, Mr. BLUMENAUER, Mr. GARAMENDI, Ms. WATSON, 
Ms. SCHAKOWSKY, Ms. PINGREE of Maine, Mrs. DAHLKEMPER, Mr. 
GRIJALVA, Mr. PERLMUTTER, Ms. DELAURO, and Mr. DEFAZIO) intro-
duced 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 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, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Home Health Care 
Planning Improvement Act of 2010’’. 
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SEC. 2. IMPROVING CARE PLANNING FOR MEDICARE HOME 
HEALTH SERVICES. 
(a) IN GENERAL.—Section 1814(a)(2) of the Social 
Security Act (42 U.S.C. 1395f(a)(2)), in the matter pre-
ceding subparagraph (A), is amended— 
(1) by inserting ‘‘(as those terms are defined in 
section 1861(aa)(5))’’ after ‘‘clinical nurse spe-
cialist’’; and 
(2) by inserting ‘‘, or in the case of services de-
scribed in subparagraph (C), a physician, or a nurse 
practitioner or clinical nurse specialist who is work-
ing in collaboration with a physician in accordance 
with State law, or a certified nurse-midwife (as de-
fined 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 physician’’ 
after ‘‘collaboration with a physician’’. 
(b) 
CONFORMING
AMENDMENTS.—(1) 
Section 
1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) 
is amended— 
(A) in paragraph (2)(C), by inserting ‘‘, a nurse 
practitioner, a clinical nurse specialist, a certified 
nurse-midwife, or a physician assistant (as the case 
may be)’’ after ‘‘physician’’ each place it appears; 
(B) in the second sentence, by striking ‘‘or clin-
ical nurse specialist’’ and inserting ‘‘clinical nurse 
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specialist, certified nurse-midwife, or physician as-
sistant’’; 
(C) in the third sentence— 
(i) by striking ‘‘physician certification’’ 
and inserting ‘‘certification’’; 
(ii) by inserting ‘‘(or on January 1, 2011, 
in the case of regulations to implement the 
amendments made by section 2 of the Home 
Health Care Planning Improvement Act of 
2010)’’ after ‘‘1981’’; and 
(iii) by striking ‘‘a physician who’’ and in-
serting ‘‘a physician, nurse practitioner, clinical 
nurse specialist, certified nurse-midwife, or phy-
sician assistant who’’; and 
(D) in the fourth sentence, by inserting ‘‘, 
nurse practitioner, clinical nurse specialist, certified 
nurse-midwife, or physician assistant’’ after ‘‘physi-
cian’’. 
(2) Section 1835(a) of the Social Security Act (42 
U.S.C. 1395n(a)) is amended— 
(A) in paragraph (2)— 
(i) in the matter preceding subparagraph 
(A), by inserting ‘‘or, in the case of services de-
scribed in subparagraph (A), a physician, or a 
nurse practitioner or clinical nurse specialist (as 
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those terms are defined in 1861(aa)(5)) who is 
working in collaboration with a physician in ac-
cordance with State law, or a certified nurse- 
midwife (as defined in section 1861(gg)) as au-
thorized by State law, or a physician assistant 
(as defined in section 1861(aa)(5)) under the 
supervision of a physician’’ after ‘‘a physician’’; 
and 
(ii) in each of clauses (ii) and (iii) of sub-
paragraph (A) by inserting ‘‘, a nurse practi-
tioner, a clinical nurse specialist, a certified 
nurse-midwife, or a physician assistant (as the 
case may be)’’ after ‘‘physician’’; 
(B) in the third sentence, by inserting ‘‘, nurse 
practitioner, clinical nurse specialist, certified nurse- 
midwife, or physician assistant (as the case may 
be)’’ after physician; 
(C) in the fourth sentence— 
(i) by striking ‘‘physician certification’’ 
and inserting ‘‘certification’’; 
(ii) by inserting ‘‘(or on January 1, 2011, 
in the case of regulations to implement the 
amendments made by section 2 of the Home 
Health Care Planning Improvement Act of 
2010)’’ after ‘‘1981’’; and 
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(iii) by striking ‘‘a physician who’’ and in-
serting ‘‘a physician, nurse practitioner, clinical 
nurse specialist, certified nurse-midwife, or phy-
sician assistant who’’; and 
(D) in the fifth sentence, by inserting ‘‘, nurse 
practitioner, clinical nurse specialist, certified nurse- 
midwife, or physician assistant’’ after ‘‘physician’’. 
(3) Section 1861 of the Social Security Act (42 
U.S.C. 1395x) is amended— 
(A) in subsection (m)— 
(i) 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 
(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 
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(ii) in paragraph (3), by inserting ‘‘, a 
nurse practitioner, a clinical nurse specialist, a 
certified nurse-midwife, or a physician assist-
ant’’ after ‘‘physician’’; and 
(B) in subsection (o)(2)— 
(i) 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 
(ii) by inserting ‘‘, nurse practitioner, clin-
ical nurse specialist, certified nurse-midwife, 
physician assistant,’’ after ‘‘physician’’. 
(4) Section 1895 of the Social Security Act (42 
U.S.C. 1395fff) is amended— 
(A) 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 
(B) in subsection (e)— 
(i) in paragraph (1)(A), by inserting ‘‘, a 
nurse practitioner or clinical nurse specialist (as 
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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 
(ii) 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’’. 
(c) RULE
OF
CONSTRUCTION.—Nothing in the 
amendments made by this section shall be construed as 
affecting the scope of practice authorized under State law 
of a certified nurse-midwife (as defined in section 
1861(gg) of the Social Security Act) or a nurse practi-
tioner, clinical nurse specialist, or physician assistant (as 
such terms are defined in section 1861(aa)(5) of such 
Act). 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2011. 
Æ 
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