,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #bif  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,janu>y #ca1 #bjai,ms4 
,coll9s 7= h]self & ,mr4 ,c>d97         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
ensure m timely access to home heal?    
s]vices = ,m$ic>e b5efici>ies "u !      
,m$ic>e program4  #a4 ,%ort title ,?is  
,act may be cit$ z ! ,home ,heal? ,c>e  
,plann+ ,improvem5t ,act ( #bjai4  #b4  
,improv+ c>e plann+ = ,m$ic>e home heal?
 s]vices  7a7 ,"p ,a provisions ,section
 #ahad7;a7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #acie;f7a77 is am5d$--   
7#a7 9 p>agraph 7#b7--  7,a7 9 ! matt]  
prec$+ subp>agraph 7,a71 by ins]t+ 1 a  
nurse practition] or cl9ical nurse      
speciali/ :o is work+ 9 collaboration ) 
a physician 9 accordance ) ,/ate law1 a 
c]tifi$ nurse-midwife 7z def9$ 9 section
 #ahfa7;gg77 z au?oriz$ by ,/ate law1 or
 a physician assi/ant 7z def9$ 9 section

 #ahfa7;aa77#e77 "u ! sup]vision ( a    
physician aft] #ahff7;j72 &  7,b7 9     
subp>agraph 7,c7-- 7i7 by ins]t+ 1 a    
nurse practition]1 a cl9ical nurse      
speciali/1 a c]tifi$ nurse-midwife1 or a
 physician assi/ant 7z ! case may be7   
aft] physician ! fir/ #b times x appe>s2
 &  7ii7 by /rik+ 1 &1 9 ! case ( a     
c]tification made by a physician & all t
 foll[s ?r\gh face-to-face enc\nt] &    
ins]t+ 1 &1 9 ! case ( a c]tification   
made by a physician aft] ,janu>y #a1    
#bjaj1 or by a nurse practition]1       
cl9ical nurse speciali/1 c]tifi$        
nurse-midwife1 or physician assi/ant 7z 
! case may be7 aft] ,janu>y #a1 #bjbj1  
prior to mak+ su* c]tification !        
physician1 nurse practition]1 cl9ical   
nurse speciali/1 c]tifi$ nurse-midwife1 
or physician assi/ant mu/ docum5t t !   
physician1 nurse practition]1 cl9ical   
nurse speciali/1 c]tifi$ nurse-midwife1 
or physician assi/ant has _h a          
face-to-face enc\nt]2  7#b7 9 ! second  
s5t5ce1 by ins]t+ c]tifi$ nurse-midwife1

 aft] cl9ical nurse speciali/12  7#c7 9 
! ?ird s5t5ce-- 7,a7 by /rik+ physician 
c]tification & ins]t+ c]tification2     
7,b7 by ins]t+ 7or on ,janu>y #a1 #bjbj1
 9 ! case ( regulations to implem5t !   
am5dm5ts made by section #b ( ! ,home   
,heal? ,c>e ,plann+ ,improvem5t ,act (  
#bjai7 aft] #aiha2 &  7,c7 by /rik+ a   
physician :o & ins]t+ a physician1 nurse
 practition]1 cl9ical nurse speciali/1  
c]tifi$ nurse-midwife1 or physician     
assi/ant :o2 &  7#d7 9 ! f\r? s5t5ce1 by
 ins]t+ 1 nurse practition]1 cl9ical    
nurse speciali/1 c]tifi$ nurse-midwife1 
or physician assi/ant aft] physician4   
7b7 ,"p ,b provisions ,section #ahce7;a7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acien7a77 is am5d$--  7#a7 9 
p>agraph 7#b7--  7,a7 9 ! matt] prec$+  
subp>agraph 7,a71 by ins]t+ 1 a nurse   
practition] or cl9ical nurse speciali/  
7z ^? t]ms are def9$ 9 #ahfa7;aa77#e77  
:o is work+ 9 collaboration ) a         
physician 9 accordance ) ,/ate law1 a   
c]tifi$ nurse-midwife 7z def9$ 9 section

 #ahfa7;gg77 z au?oriz$ by ,/ate law1 or
 a physician assi/ant 7z def9$ 9 section
 #ahfa7;aa77#e77 "u ! sup]vision ( a    
physician aft] #ahff7;j72 &  7,b7 9     
subp>agraph 7,a7--  7i7 9 ea* ( clauses 
7ii7 & 7iii7 ( subp>agraph 7,a7 by      
ins]t+ 1 a nurse practition]1 a cl9ical 
nurse speciali/1 a c]tifi$              
nurse-midwife1 or a physician assi/ant  
7z ! case may be7 aft] physician2 &     
7ii7 9 clause 7iv71 by /rik+ aft]       
,janu>y #a1 #bjaj & all t foll[s ?r\gh  
face-to-face enc\nt] & ins]t+ made by a 
physician aft] ,janu>y #a1 #bjaj1 or by 
a nurse practition]1 cl9ical nurse      
speciali/1 c]tifi$ nurse-midwife1 or    
physician assi/ant 7z ! case may be7    
aft] ,janu>y #a1 #bjbj1 prior to mak+   
su* c]tification ! physician1 nurse     
practition]1 cl9ical nurse speciali/1   
c]tifi$ nurse-midwife1 or physician     
assi/ant mu/ docum5t t ! physician1     
nurse practition]1 cl9ical nurse        
speciali/1 c]tifi$ nurse-midwife1 or    
physician assi/ant has _h a face-to-face

 enc\nt]2  7#b7 9 ! ?ird s5t5ce1 by     
ins]t+ 1 nurse practition]1 cl9ical     
nurse speciali/1 c]tifi$ nurse-midwife1 
or physician assi/ant 7z ! case may be7 
aft] physician2  7#c7 9 ! f\r? s5t5ce-- 
7,a7 by /rik+ physician c]tification &  
ins]t+ c]tification2  7,b7 by ins]t+ 7or
 on ,janu>y #a1 #bjbj1 9 ! case (       
regulations to implem5t ! am5dm5ts made 
by section #b ( ! ,home ,heal? ,c>e     
,plann+ ,improvem5t ,act ( #bjai7 aft]  
#aiha2 &  7,c7 by /rik+ a physician :o &
 ins]t+ a physician1 nurse practition]1 
cl9ical nurse speciali/1 c]tifi$        
nurse-midwife1 or physician assi/ant :o2
 &  7#d7 9 ! fif? s5t5ce1 by ins]t+ 1   
nurse practition]1 cl9ical nurse        
speciali/1 c]tifi$ nurse-midwife1 or    
physician assi/ant aft] physician4  7c7 
,def9ition provisions  7#a7 ,home heal? 
s]vices ,section #ahfa7m7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #aciex7m77
 is am5d$--  7,a7 9 ! matt] prec$+      
p>agraph 7#a7--  7i7 by ins]t+ 1 a nurse
 practition] or a cl9ical nurse         

speciali/ 7z ^? t]ms are def9$ 9        
subsection 7aa77#e771 a c]tifi$         
nurse-midwife 7z def9$ 9 section        
#ahfa7;gg771 or a physician assi/ant 7z 
def9$ 9 subsection 7aa77#e77 aft]       
physician ! fir/ place x appe>s2 &  7ii7
 by ins]t+ 1 a nurse practition]1 a     
cl9ical nurse speciali/1 a c]tifi$      
nurse-midwife1 or a physician assi/ant  
aft] physician ! second place x appe>s2 
&  7,b7 9 p>agraph 7#c71 by ins]t+ 1 a  
nurse practition]1 a cl9ical nurse      
speciali/1 a c]tifi$ nurse-midwife1 or a
 physician assi/ant aft] physician4     
7#b7 ,home heal? ag5cy ,section         
#ahfa7o77#b7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciex7o77#b77 is am5d$--
  7,a7 by ins]t+ 1 nurse practition]s or
 cl9ical nurse speciali/s 7z ^? t]ms are
 def9$ 9 subsection 7aa77#e771 c]tifi$  
nurse-midwives 7z def9$ 9 section       
#ahfa7;gg771 or physician assi/ants 7z  
def9$ 9 subsection 7aa77#e77 aft]       
physicians2 &  7,b7 by ins]t+ 1 nurse   
practition]1 cl9ical nurse speciali/1   

c]tifi$ nurse-midwife1 physician        
assi/ant1 aft] physician4  7d7 ,home    
heal? prospective paym5t sy/em          
provisions ,section #ahie ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acie;fff7
 is am5d$--  7#a7 9 subsection 7c77#a71 
by ins]t+ 1 ! nurse practition] or      
cl9ical nurse speciali/ 7z ^? t]ms are  
def9$ 9 section #ahfa7;aa77#e771 !      
c]tifi$ nurse-midwife 7z def9$ 9 section
 #ahfa7;gg771 or ! physician assi/ant 7z
 def9$ 9 section #ahfa7;aa77#e771 aft]  
physician2 &  7#b7 9 subsection 7e7--   
7,a7 9 p>agraph 7#a77;,a71 by ins]t+ 1 a
 nurse practition] or cl9ical nurse     
speciali/ 7z ^? t]ms are def9$ 9 section
 #ahfa7;aa77#e771 a c]tifi$             
nurse-midwife 7z def9$ 9 section        
#ahfa7;gg771 or a physician assi/ant 7z 
def9$ 9 section #ahfa7;aa77#e77 aft]    
physician2 &  7,b7 9 p>agraph 7#b7-- 7i7
 9 ! head+1 by /rik+ ,physician         
c]tification & ins]t+ ,rule (           
con/ruction reg>d+ requirem5t =         
c]tification2 &  7ii7 by /rik+          

physician4  7e7 ,effective ,date ,!     
am5dm5ts made by ?is section %all apply 
to items & s]vices furni%$ on or aft]   
,janu>y #a1 #bjbj4