Home Health Care Planning Improvement Act of 2009

Mr. President, I rise today on behalf of myself and Senator Conrad to introduce legislation to ensure that our seniors and disabled citizens have timely access to home health services under the Medicare program.

Nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists are all playing increasingly important roles in the delivery of health care services, particularly in rural and medically underserved areas of our country where physicians may be in scarce supply. In recognition of their growing role, Congress, in 1997, authorized Medicare to begin paying for physician services provided by these health professionals as long as those services are within their scope of practice under state law.

Despite their expanded role, these advanced practice registered nurses and physician assistants are currently unable to order home health services for their Medicare patients. Under current law, only physicians are allowed to certify or initiate home health care for Medicare patients, even though they may not be as familiar with the patient's case as the non-physician provider. In fact, in many cases, the certifying physician may not even have a relationship with the patient and must rely upon the input of the nurse practitioner, physician assistant, clinical nurse specialist or certified nurse midwife to order the medically necessary home health care. At best, this requirement adds more paperwork and a number of unnecessary steps to the process before home health care can be provided. At worst, it can lead to needless delays in getting Medicare patients the home health care they need simply because a physician is not readily available to sign the form.

The inability of advanced practice registered nurses and physician assistants to order home health care is particularly burdensome for Medicare beneficiaries in medically underserved areas, where these providers may be the only health care professionals available. For example, needed home health care was delayed by more than a week for a Medicare patient in Nevada because the physician assistant was the only health care professional serving the patient's small town, and the supervising physician was located 60 miles away.

A nurse practitioner told me about another case in which her collaborating physician had just lost her father and was not available. As a consequence, the patient experienced a two-day delay in getting needed care while they waited to get the paperwork signed by another physician. Another nurse practitioner pointed out that it is ridiculous that she can order physical and occupational therapy in a subacute facility but cannot order home health care. One of her patients had to wait 11 days after being discharged before his physical and occupational therapy could continue simply because the home health agency had difficulty finding a physician to certify the continuation of the same therapy that the nurse practitioner had been able to authorize when the patient was in the facility.

The Home Health Care Planning Improvement Act will help to ensure that our Medicare beneficiaries get the home health care that they need when they need it by allowing physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives to order home health services. Our legislation is supported by the National Association for Home Care and Hospice, the American Nurses Association, the American Academy of Physician Assistants, the American College of Nurse Practitioners, the American College of Nurse Midwives, the American Academy of Nurse Practitioners, and the Visiting Nurse Associations of America. I urge all of my colleagues to join us as cosponsors of this important legislation.

Mr. President, I rise today on behalf of myself and Senator Conrad to introduce legislation to ensure that our seniors and disabled citizens have timely access to home health services under the Medicare program.

Nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists are all playing increasingly important roles in the delivery of health care services, particularly in rural and medically underserved areas of our country where physicians may be in scarce supply. In recognition of their growing role, Congress, in 1997, authorized Medicare to begin paying for physician services provided by these health professionals as long as those services are within their scope of practice under state law.

Despite their expanded role, these advanced practice registered nurses and physician assistants are currently unable to order home health services for their Medicare patients. Under current law, only physicians are allowed to certify or initiate home health care for Medicare patients, even though they may not be as familiar with the patient's case as the non-physician provider. In fact, in many cases, the certifying physician may not even have a relationship with the patient and must rely upon the input of the nurse practitioner, physician assistant, clinical nurse specialist or certified nurse midwife to order the medically necessary home health care. At best, this requirement adds more paperwork and a number of unnecessary steps to the process before home health care can be provided. At worst, it can lead to needless delays in getting Medicare patients the home health care they need simply because a physician is not readily available to sign the form.

The inability of advanced practice registered nurses and physician assistants to order home health care is particularly burdensome for Medicare beneficiaries in medically underserved areas, where these providers may be the only health care professionals available. For example, needed home health care was delayed by more than a week for a Medicare patient in Nevada because the physician assistant was the only health care professional serving the patient's small town, and the supervising physician was located 60 miles away.

A nurse practitioner told me about another case in which her collaborating physician had just lost her father and was not available. As a consequence, the patient experienced a two-day delay in getting needed care while they waited to get the paperwork signed by another physician. Another nurse practitioner pointed out that it is ridiculous that she can order physical and occupational therapy in a subacute facility but cannot order home health care. One of her patients had to wait 11 days after being discharged before his physical and occupational therapy could continue simply because the home health agency had difficulty finding a physician to certify the continuation of the same therapy that the nurse practitioner had been able to authorize when the patient was in the facility.

The Home Health Care Planning Improvement Act will help to ensure that our Medicare beneficiaries get the home health care that they need when they need it by allowing physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives to order home health services. Our legislation is supported by the National Association for Home Care and Hospice, the American Nurses Association, the American Academy of Physician Assistants, the American College of Nurse Practitioners, the American College of Nurse Midwives, the American Academy of Nurse Practitioners, and the Visiting Nurse Associations of America. I urge all of my colleagues to join us as cosponsors of this important legislation.

Mr. President, I rise today to introduce the Nuclear Power 2021 Act, which is cosponsored by Senator Murkowski and Senator Udall from Colorado.

This bill, along with Senator Udall's bill S. 2052 are designed to give the Department of Energy a set of specific programmatic authorities to help address ways to lower the up-front capital cost of nuclear reactors. The National Academies of Science in their recent America's Energy Future study determined that by 2030 we will need essentially to double the existing base load power provided by nuclear energy or about another 100 gigawatts.

But before we can make such a large and dramatic increase in nuclear energy, I believe we must demonstrate the ability to construct ``first- mover'' reactors in the U.S. that are on cost and schedule. The National Academies likewise confirmed this as one of two principal demonstrations that must be carried out during the next decade to more fully understand the range of available options for controlling carbon emissions from energy production. The other challenge of commensurate importance that they identified is the demonstration of carbon capture and sequestration on a large scale for fossil-fuel based energy production.

In that regard, the bill I am introducing today addresses the topic of small modular reactors, which are typically rated with a capacity of less than 300 electrical megawatts; and that can be constructed and operated in combination with similar reactors at a single site. These reactors can be less capital intensive than the larger 1,000 megawatt reactors currently being licensed at the Nuclear Regulatory Commission; they have the potential to be built in a modular fashion much like our current fleet of nuclear submarines.

This bill is similar to the Department of Energy's Nuclear Power 2010 program; it concentrates not so much on the research and development of these reactors but demonstrating the ability to license them. Senator Udall's bill authorizes the Department to conduct research on these reactors with the goal of reducing cost while operating them in a safe and secure fashion.

More specifically, this bill authorizes the Secretary of Energy to work in a public private partnership to develop a standard design for two modular reactors, one of which will not be more than 50 megawatts; obtain a design certification from the Nuclear Regulatory Commission for each design by 2018; and obtain a combined operating license from the Commission by 2021.

All of this effort would be cost shared by non-federal funds and selected under competitive merit review process while emphasizing efficiency, cost, safety and proliferation resistance.

The climate change issue we face today is too large to exclude any one

technology that can produce energy without emitting carbon dioxide. The National Academies report acknowledges the important role nuclear energy has and must play in a carbon constrained energy world; this bill I hope is another step to address some of the recommendations of this report. I hope my colleagues join me as cosponsors of this legislation.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, today I have introduced a bill to extend deadlines by one year for three provisions in the Heartland Disaster Tax Relief Act of 2008.

The Heartland Disaster Tax Relief Act has been critical in rebuilding the lives and communities of those affected by the terrible floods and tornadoes from last year.

Because of delays in Federal funding and tighter credit conditions, many homeowners affected by the 2008 floods and storms will be unable to meet the deadline for the tax relief intended to help with recovery.

It is only fair to extend the deadline and give these homeowners the chance to recover and rebuild. A lot of people are still trying to fix their ruined homes or move on to new housing. A house is ruined in a few minutes, but banks and governments take what seems like an eternity.

The first provision is a one-year extension of the provision allowing disaster victims with damage to their primary residence to use their own assets

to buy a new home or repair an existing home by withdrawing money from their retirement plans without tax penalties.

The second provision is a one-year extension of a provision allowing disaster victims that have borrowed from their retirement account for disaster recovery to repay their own account without penalty.

The final provision is a 1-year extension of a provision allowing disaster victims whose banks cancel mortgage debt to not have the cancelled debt counted as taxable income. I urge my colleagues to help me in getting this important legislation enacted into law as soon as possible.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.