Home Health, Hospice Bills Seek Larger Physician Assistant Role

Two federal bills recently have been proposed to expand the role of physician assistants (PAs) and other types of clinicians in home health and hospice.

Sens. Susan Collins (R-ME) and Ben Cardin (D-MD) last week introduced the Home Health Care Planning Improvement Act. If passed, the new law would enable physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives to order home health services for Medicare beneficiaries.

Currently, these practitioners can order nursing home care, but they cannot order “less costly and less expensive home health care services,” the National Association for Home Care & Hospice (NAHC) noted in a website post on the proposed legislation.


NAHC “strongly supports” the bill, as do other organizations such as the Visiting Nurse Associations of America (VNAA).

Similar legislation introduced in the previous Congress garnered majority support in the Senate, while a companion bill in the House had more than 200 co-sponsors, NAHC noted.

“Under current law, only physicians are allowed to certify or initiate home health care for Medicare patients, even though they may not be as familiar with the patient’s case as the non-physician provider,” Sen. Collins said in introducing the bill. “In fact, in many cases, the certifying physician may not even have a relationship with the patient and must rely upon the input of the nurse practitioner, physician assistant, clinical nurse specialist, or certified nurse midwife to order the medically necessary home health care.”


Meanwhile, two members of the House of Representatives—Reps. Lynn Jenkins (R-KS) and Mike Thompson (D-CA)—last week put forward a bill that would allow PAs to act as attending physicians for hospice care.

Especially in rural areas, a PA very often is a person’s primary caregiver; having to establish contact with another primary care provider before transitioning to hospice can be “terribly inconvenient and burdensome” to Medicare beneficiaries, NAHC stated on its website.

The association sent a letter to Reps. Jenkins and Thompson to register its support for the Medicare Patient Access to Hospice Act.

A similar bill also was put forward in the last Congress and had bipartisan support.

Written by Tim Mullaney

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