February 25, 2015

The Honorable Susan Collins
United State Senate
Washington, D.C.  20510

The Honorable Chuck Schumer
United States Senate
Washington, D.C.  20510

Dear Senator Collins and Senator Schumer:

Thank you for introducing the bipartisan Home Health Care Planning Improvement Act of 2015.  We, the undersigned groups, pledge our continued support of your efforts to obtain passage of this important legislation in the 114th Congress.  As you know, the bill authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can certify patient eligibility for home health care services under Medicare.  This critical change would improve access to important home health care services, and potentially prevent additional hospital, sub-acute care facility and nursing home admissions—all of which are costly to the consumer, the taxpayer and Medicare.

The undersigned organizations are committed to ensuring that consumers have access to health care providers who are qualified, educated, and certified to provide high quality primary care, chronic care management, and other services that keep them living a high quality life, with dignity, in locations of their choice.

Although current law has long recognized advanced practice registered nurses and physician assistants as authorized Medicare providers, and allows these clinicians to certify eligibility for nursing home care for their patients, it precludes these same practitioners from certifying patient eligibility for home health care services.  This is an unnecessary barrier to care and adds at least one more step in the process of accessing home health care services by requiring the provider to find a physician to certify eligibility.  In addition, time delays to locate a physician to certify eligibility, particularly in rural and underserved areas, can result in an extended hospital stay or nursing home admission because the beneficiary could not be moved back to or remain at home without home health care services.

There are decades of data supporting the ability of these providers to deliver high quality care to people of all ages, including Medicare recipients with multiple chronic conditions.  Advanced practice registered nurses are often the only care providers available in health professional shortage areas such as urban, rural, and frontier regions.  Given the existing and future projected primary care physician shortages, and the coming of increased numbers of Medicare eligible patients, the need will be even greater for all qualified providers to be allowed to certify home health care eligibility.

The Home Health Care Planning Improvement Act would help to ensure that Medicare beneficiaries in need of home health care services whose providers are nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants would be able to directly access home health care by referral from their providers.  This bill would provide beneficiaries continued access to care and increase the likelihood that they would experience better health and a higher quality of life.  Additionally, outside experts assessed the impact of the bill earlier last year and projected a Medicare savings of $7.1 million in 2015 and up to a ten-year savings of $252.6 million.[1]  This analysis also notes the potential to reduce beneficiary admissions to and lengths of stay in institutional settings under the policy change.

We appreciate your continued leadership and are committed to working with you to ensure that this bipartisan legislation is passed and placed on the President’s desk for signature at the first opportunity.  The time is now to ensure that patients have timely access to the quality, cost effective care they need.  For any questions, please contact [email protected] or 703-740-2529.

Thank you for your help.



AFT Nurses and Health Professionals

AMDA- The Society for Post-Acute and Long-Term Care Medicine

Alzheimer’s Foundation of America

American Academy of Nursing

American Academy of Physician Assistants

American Association of Colleges of Nursing

American Association of Heart Failure Nurses

American Association of Nurse Practitioners

American Association of Occupational Health Nurses 

American College of Nurse-Midwives

American Geriatrics Society 

American Nephrology Nurses’ Association

American Nurses Association

American Organization of Nurse Executives

American Pediatric Surgical Nurses Association

American Psychiatric Nurses Association

Association of Community Health Nursing Educators

Association of Public Health Nurses 

Association of Rehabilitation Nurses 

Center for Medicare Advocacy

Gerontological Advance Practice Nurses Association 

International Society of Psychiatric-Mental Health Nurses 

The Jewish Federations of North America

Justice in Aging 

Leading Age

Medicare Rights Center

National Academy of Elder Law Attorneys 

National Association for Home Care & Hospice

National Association of Clinical Nurse Specialists 

National Association of Neonatal Nurses

National Association of Neonatal Nurse Practitioners

National Association of Pediatric Nurse Practitioners

National Association of Professional Geriatric Care Managers

National Black Nurses Association

National Committee to Preserve Social Security and Medicare 

National Consumer Voice for Quality Long-Term Care

National Council on Aging

National Organization of Nurse Practitioner Faculties

Organization for Associate Degree Nursing 

OWL– The Voice of Women 40+

Public Health Nursing Section, American Public Health Association

VNAA – The Visiting Nurse Associations of America

Women’s Institute for a Secure Retirement


cc:  The Honorable Harry Reid

       The Honorable Richard Durbin

       The Honorable Mitch McConnell

       The Honorable John Cornyn

       The Honorable John Thune

       Senate Finance Committee members

[1] Dobson DaVanzo & Associates, LLC, “Updated Report: Impact of The Home Health Care Planning Improvement Act (H.R. 2504;

S. 1332) on Medicare Expenditures,” March 25, 2014.