Nurses should be proud that their hard work during the healthcare reform debate has paid off with passage of the Patient Protection and Affordable Care Act. In addition to monitoring the implementation phase of the new healthcare reform law, ANA is working on Capitol Hill to advance pieces of legislation that were not included in the final package. One such bill is the Home Health Care Planning Improvement Act (H.R. 4993/S. 2814). Introduced by Congresswoman Allyson Schwartz (D-PA) and Senators Susan Collins (R-ME) and Kent Conrad (D-ND), this bill would allow physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives to order home health services under Medicare in accordance with state law.

Medicare has recognized the independent practice of advanced practice registered nurses (APRNs) for nearly two decades, and these healthcare professionals now provide the majority of skilled care to home health patients. Unfortunately, a quirk in Medicare law has kept APRNs from signing home health plans of care and from certifying Medicare patients for the home health benefit. In areas where access to physicians is limited, this outdated prohibition has led to delays in healthcare delivery. These delays inconvenience patients and their families and can result in increased cost to the Medi­care system when patients are left unnecessarily in more expensive institutional settings.

ANA continues to garner support for the Home Health Care Planning Improvement Act—but urges nurses to get involved on a personal level as well. While outreach via the Internet or telephone is important, it is essential that nurses attend in-district meetings when their representative or senators are in their district office. The best way to make an impact on nursing issues is to schedule meetings with congressional representatives in their home district. Elected officials will be back in their districts for more than a month during the August recess. ANA suggests nurses take the following steps to ensure an effective meeting:

• Send a letter or an e-mail requesting a meeting. Most members of Congress can be reached in their district offices over the congressional recess and many are available on Fridays.
• Promptly follow up the letter or e-mail with a telephone call to the member’s district office. Ask to speak with the scheduler who handles the member’s district office appointments. You may be referred to the member’s Washington, D.C. office; if so, be aware that the main number for the Capitol Hill switchboard is (202) 224-3121. The switchboard can transfer you to any House or Senate office.
• Invite colleagues, friends, and family members to attend the meeting. The biggest impact occurs when a member hears the same message from the nursing community both individually and collectively.
• The group should meet in advance to plan the discussion strategy. Also, it should designate a leader to deliver the key message.
• The discussion with the member should be organized and focused on the Home Health Care Planning Improvement Act. Ask directly for the member’s help in supporting this bill, and get a clear sense of where the member stands on the legislation. Sample talking points for the meeting with the member of Congress include the following:
  • Medicare has recognized the independent practice of APRNs for nearly two decades, and these healthcare professionals now provide the majority of skilled care to home health patients.
  • Unfortunately, a quirk in Medicare law has kept APRNs from signing home health plans of care and from certifying Medicare patients for the home health benefit. In areas where access to physicians is limited, this outdated prohibition has led to delays in healthcare delivery.
  • The Home Health Care Planning Improvement Act would address these problems by specifically allowing nurse practitioners, clinical nurse specialists, and certified nurse midwives to certify home health services.
• Every meeting participant should immediately write an individual thank-you note to the member of Congress and any staff members present during the meeting.
• E-mail gova@ana.org to make ANA aware of your efforts.

Rachel Conant is an associate director in ANA’s Department of Government Affairs.