I 
113TH CONGRESS 
1ST SESSION H. R. 2504 
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 26, 2013 
Mr. WALDEN (for himself, Ms. SCHWARTZ, Mr. COBLE, Mr. COFFMAN, Mr. 
DENT, Mr. HANNA, Mr. HARPER, Mr. JONES, Mr. JOYCE, Mr. MCKIN-
LEY, Mr. MEEHAN, Mr. TIBERI, Ms. BONAMICI, Mrs. CAPPS, Mr. DEFA-
ZIO, Mr. ELLISON, Ms. LEE of California, Mr. BEN RAY LUJA´N of New 
Mexico, Ms. PINGREE of Maine, Mr. SCHRADER, Ms. TSONGAS, Mr. 
SIMPSON, and Mr. JOHNSON of Ohio) 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 provi-
sions 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 2013’’. 
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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-
counter’’ and inserting ‘‘, and, in the case 
of a certification made by a physician after 
January 1, 2010, or by a nurse practi-
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tioner, clinical nurse specialist, certified 
nurse-midwife, or physician assistant (as 
the case may be) after January 1, 2014, 
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, 2014, 
in the case of regulations to implement the 
amendments made by section 2 of the Home 
Health Care Planning Improvement Act of 
2013)’’ after ‘‘1981’’; and 
(C) by striking ‘‘a physician who’’ and in-
serting ‘‘a physician, nurse practitioner, clinical 
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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)’’; and 
(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-
sistant (as the case may be)’’ after ‘‘physi-
cian’’; and 
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(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, 2014, 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’’; 
(B) by inserting ‘‘(or on January 1, 2014, 
in the case of regulations to implement the 
amendments made by section 2 of the Home 
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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, 2014. 
Æ 
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