Newly Introduced House Legislation Would Relax Home Health Certification Requirements

Lawmakers are pushing yet another piece of new legislation that would make it easier for patients to gain access to home health care, specifically by widening the scope of who can certify the need for home health services under Medicare rules.

A bipartisan group of representatives introduced the Home Health Care Planning Improvement Act of 2019 (H.R. 2150) Wednesday. If passed, the legislation would allow physician assistants, nurse practitioners and other advanced practice nurses to certify home health care services, potentially cutting the need for a physician out of the equation.

Under current Medicare rules, only physicians can certify patients to receive home health services — a common point of contention within the home health care industry. Among other challenges, it’s not uncommon for home health providers to experience gaps in communication with patients’ doctors, as well as costly certification delays that leave individuals vulnerable to negative outcomes without timely care.


Representatives supporting H.R. 2150 include Jan Schakowsky (D-Ill.), Buddy Carter (R-Ga.), Ron Kind (D-Wis.), Mike Kelly (R-Pa.), Susan Wild (D-Pa.) and David Joyce (R-Ohio).

“Nurse practitioners, certified-nurse midwives, clinical nurse specialists, and physician assistants offer invaluable, personal, professional care to so many people around the country,” Schakowsky said in a press release announcing the news. “This legislation will make their cost-saving, high-quality services more directly accessible to Medicare patients in need, while greatly reducing the costs of these services. A win for patients, a win for providers and a win for Medicare’s bottom line.”

The bill comes after counterpart legislation (S. 296) was introduced in the Senate earlier this year by Senators Susan Collins (R-Maine) and Ben Cardin (D-Md.). S. 296 — read twice after its introduction and referred to the Senate Committee on Finance — is also bipartisan.


Home health providers argue that the Medicare physician-certification policy is outdated, as many patients receive primary care from non-physician clinicians, such as nurse practitioners or physician assistants. This is especially true in rural and underserved communities, critics point out.

In general, when a Medicare beneficiary under the care of a nurse practitioner needs home health, a physician — who may not serve as the patient’s primary care practitioner — has to be called to certify the need for home health services.

That process often results in disjointed care and the insertion of a practitioner who may not be knowledgeable about the patient’s individual care needs, according to Washington, D.C.-based Partnership for Quality Home Healthcare, an industry advocacy organization whose members include LHC Group (Nasdaq: LHCG), VNA Health Group, Kindred at Home, Encompass Health’ Home Health & Hospice (NYSE: EHC) and other providers.

In a statement shared with Home Health Care News, PQHH Chairman Keith Myers further applauded the bipartisan legislation as a way to improve access to home health services for Medicare’s homebound seniors.

“This is a practical and pragmatic approach to improving access to home health services for seniors who need them most, including those who receive primary care through non-physician clinicians,” Myers, who is also chairman and CEO of LHC Group, said.

LHC Group offers home health, hospice, personal care and facility-based services to patients in at least 36 states.

Meanwhile, executives at Addison, Texas-based Elara Caring share a similar view. Elara Caring was formed in 2018 after Great Lakes Caring, Jordan Health Services and National Home Health Care merged.

“We support the legislation because it would increase access and improve outcomes — which our team at Elara Caring strives to do each and every day,” an Elara Caring spokesperson told HHCN.

Elara Caring serves more than 65,000 patients daily throughout 16 states.

The National Association for Home Care & Hospice (NAHC), the American Association of Nurse Practitioners, the American Academy of PAs, the American College of Nurse-Midwives and the American Nurses Association are also among the bill’s supporters.

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