,,ii #aaeth ,,congress #ast ,session ,s4 #dde ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #bg1 #bjag,ms4 ,collins 7for herself and ,mr4 ,cardin7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 program4 #a4 ,short title ,this ,act may be cited as the ,home ,health ,care ,planning ,improvement ,act of #bjag4 #b4 ,improving care planning for ,medicare home health services 7a7 ,part ,a provisions ,section #ahad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in the matter preceding subparagraph 7,a71 by inserting 1 a nurse practitioner or clinical nurse specialist who is working in collaboration with a physician in accordance with ,state law1 a certified nurse-midwife 7as defined in section #ahfa7;gg77 as authorized by ,state law1 or a physician assistant 7as defined in section #ahfa7;aa77#e77 under the supervision of a physician after #ahff7;j72 and 7,b7 in subparagraph 7,c7-- 7i7 by inserting 1 a nurse practitioner1 a clinical nurse specialist1 a certified nurse-midwife1 or a physician assistant 7as the case may be7 after physician the first #b times it appears2 and 7ii7 by striking 1 and1 in the case of a certification made by a physician and all that follows through face-to-face encounter and inserting 1 and1 in the case of a certification made by a physician after ,january #a1 #bjaj1 or by a nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant 7as the case may be7 after ,january #a1 #bjah1 prior to making such certification the physician1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant must document that the physician1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant has had a face-to-face encounter2 7#b7 in the second sentence1 by inserting certified nurse-midwife1 after clinical nurse specialist12 7#c7 in the third sentence-- 7,a7 by striking physician certification and inserting certification2 7,b7 by inserting 7or on ,january #a1 #bjah1 in the case of regulations to implement the amendments made by section #b of the ,home ,health ,care ,planning ,improvement ,act of #bjag7 after #aiha2 and 7,c7 by striking a physician who and inserting a physician1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant who2 and 7#d7 in the fourth sentence1 by inserting 1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant after physician4 7b7 ,part ,b provisions ,section #ahce7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acien7a77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in the matter preceding subparagraph 7,a71 by inserting 1 a nurse practitioner or clinical nurse specialist 7as those terms are defined in #ahfa7;aa77#e77 who is working in collaboration with a physician in accordance with ,state law1 a certified nurse-midwife 7as defined in section #ahfa7;gg77 as authorized by ,state law1 or a physician assistant 7as defined in section #ahfa7;aa77#e77 under the supervision of a physician after #ahff7;j72 7,b7 in subparagraph 7,a7-- 7i7 in each of clauses 7ii7 and 7iii7 of subparagraph 7,a7 by inserting 1 a nurse practitioner1 a clinical nurse specialist1 a certified nurse-midwife1 or a physician assistant 7as the case may be7 after physician2 and 7ii7 in clause 7iv71 by striking after ,january #a1 #bjaj and all that follows through face-to-face encounter and inserting made by a physician after ,january #a1 #bjaj1 or by a nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant 7as the case may be7 after ,january #a1 #bjah1 prior to making such certification the physician1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant must document that the physician1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant has had a face-to-face encounter2 7#b7 in the third sentence1 by inserting 1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant 7as the case may be7 after physician2 7#c7 in the fourth sentence-- 7,a7 by striking physician certification and inserting certification2 7,b7 by inserting 7or on ,january #a1 #bjah1 in the case of regulations to implement the amendments made by section #b of the ,home ,health ,care ,planning ,improvement ,act of #bjag7 after #aiha2 and 7,c7 by striking a physician who and inserting a physician1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant who2 and 7#d7 in the fifth sentence1 by inserting 1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 or physician assistant after physician4 7c7 ,definition provisions 7#a7 ,home health services ,section #ahfa7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7m77 is amended-- 7,a7 in the matter preceding paragraph 7#a7-- 7i7 by inserting 1 a nurse practitioner or a clinical nurse specialist 7as those terms are defined in subsection 7aa77#e771 a certified nurse-midwife 7as defined in section #ahfa7;gg771 or a physician assistant 7as defined in subsection 7aa77#e77 after physician the first place it appears2 and 7ii7 by inserting 1 a nurse practitioner1 a clinical nurse specialist1 a certified nurse-midwife1 or a physician assistant after physician the second place it appears2 and 7,b7 in paragraph 7#c71 by inserting 1 a nurse practitioner1 a clinical nurse specialist1 a certified nurse-midwife1 or a physician assistant after physician4 7#b7 ,home health agency ,section #ahfa7o77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7o77#b77 is amended-- 7,a7 by inserting 1 nurse practitioners or clinical nurse specialists 7as those terms are defined in subsection 7aa77#e771 certified nurse-midwives 7as defined in section #ahfa7;gg771 or physician assistants 7as defined in subsection 7aa77#e77 after physicians2 and 7,b7 by inserting 1 nurse practitioner1 clinical nurse specialist1 certified nurse-midwife1 physician assistant1 after physician4 7d7 ,home health prospective payment system provisions ,section #ahie of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7 is amended-- 7#a7 in subsection 7c77#a71 by inserting 1 the nurse practitioner or clinical nurse specialist 7as those terms are defined in section #ahfa7;aa77#e771 the certified nurse-midwife 7as defined in section #ahfa7;gg771 or the physician assistant 7as defined in section #ahfa7;aa77#e771 after physician2 and 7#b7 in subsection 7e7-- 7,a7 in paragraph 7#a77;,a71 by inserting 1 a nurse practitioner or clinical nurse specialist 7as those terms are defined in section #ahfa7;aa77#e771 a certified nurse-midwife 7as defined in section #ahfa7;gg771 or a physician assistant 7as defined in section #ahfa7;aa77#e77 after physician2 and 7,b7 in paragraph 7#b7-- 7i7 in the heading1 by striking ,physician certification and inserting ,rule of construction regarding requirement for certification2 and 7ii7 by striking physician4 7e7 ,effective ,date ,the amendments made by this section shall apply to items and services furnished on or after ,january #a1 #bjah4