APRN Ability to Certify Home Health Plans of Care

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The Home Health Planning and Improvement Act (S.227), introduced by Senators Susan Collins (R-ME) and Kent Conrad (D-ND), would allow advanced practice registered nurses (APRNs) - nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs), physician assistants (PAs) - to order home health services under Medicare in accordance with state law. Medicare has recognized the independent practice of APRNs for nearly two decades, and these health care professionals now provide the majority of skilled care to home health patients. Unfortunately, a quirk in Medicare law has kept APRNs from signing home health plans of care and from certifying Medicare patients for the home health benefit. In areas where access to physicians is limited, this outdated prohibition has led to delays in health care delivery. Moreover, these delays in care inconvenience patients and their families. Additionally, delays can lead to increased cost to the Medicare system when patients are unnecessarily left in more expensive institutional settings.

  • Medicare has recognized the independent practice of APRNs for nearly two decades, and these health care professionals now provide the majority of skilled care to home health patients. As the demands for home care increases, the supply of qualified health care providers decreases. The inability of APRNs to certify home health plans of care often leads to delay in care for home health patients.
  • In order to meet our nation's healthcare needs, an integrated, national healthcare workforce that looks beyond physicians must be put into action. APRNs are playing an increasing role in American health care deliver; practicing independent of physicians in most states.
  • The ability of APRNs to provide high quality, cost-effective care has been widely recognized by patients and the health care community and is supported by significant peer-reviewed research and critical analysis.
  • APRNS are willing to provide services in areas where access to physicians is limited; including underserved urban and remote rural areas. At least sixty-six percent of NPs practice in primary care settings and twenty percent practice in remote rural or frontier settings.

ANA strongly supports the Home Health Planning and Improvement Act (S. 277) which would:

  • Allow nurse practitioners (NPs), clinical nurse specialists (CNSs) certified nurse midwives (CNMs) and physician assistants (PAs) to order home health services under Medicare in accordance with state law.
  • Ensure seniors and disabled citizens have timely access to home health services under Medicare.
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