Improving Access to Workers’ Compensation for Injured Federal Workers Act of 2022

Madam Speaker, I move to suspend the rules and pass the bill (H.R. 6087) to amend chapter 81 of title 5, United States Code, to cover, for purposes of workers' compensation under such chapter, services by physician assistants and nurse practitioners provided to injured Federal workers, and for other purposes, as amended.

Madam Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and insert extraneous material on H.R. 6087, the Improving Access to Workers' Compensation for Injured Federal Workers Act

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, today, we are considering a straightforward bipartisan bill that will alleviate some of the barriers Federal workers face seeking treatment and care after they have been injured on the job.

Right now, whether we represent urban districts or rural districts, we are all hearing about the very real shortage of physicians, whether it is in general practice or specialty practices. That is why it is important for Congress to surgically and intelligently reform outdated, antiquated policies in place that prevent qualified providers from treating patients who need their care.

This bill achieves that goal for Federal employees who need treatment for workplace injuries or illness and will allow qualified, licensed nurse practitioners and physician assistants to treat these patients safely and competently and be reimbursed under the Federal Employees' Compensation Act.

The bill explicitly states, in section 2, that such treatment must adhere to the scope of practice for nurse practitioners and physician assistants, as defined by State law. I repeat: The bill was carefully crafted so that it does not encroach on the authority of State health licensing boards to determine the scope of practice. That is one of the reasons why the Committee on Education and Labor came together on a bipartisan basis to unanimously endorse passage of this bill.

Right now, injured Federal workers who serve our Nation at agencies such as the Department of Homeland Security, the Postal Service, and our National Parks, to name a few, can only receive the care they are entitled to under the Federal workers' compensation law if it is provided by a physician, and only a physician can certify a claim regardless of whether the State the worker resides in allows nurse practitioners and PAs to practice independently.

As any healthcare patient in America knows, nurse practitioners and physician assistants are a growing portion of primary care and healthcare workforce nationwide, especially in rural areas. Patients are ably and safely treated by NPs and PAs in these settings every day and having the capability to be treated by a nurse practitioner or a physician assistant increases access to more timely treatment, particularly in parts of the country experiencing physician shortages.

The benefit of increased access was confirmed by the Congressional Budget Office in their analysis of this bill, which found that it would have no impact on direct spending by the government.

Given the challenges some Federal workers have in accessing their Federal workers' comp benefits, allowing these providers to be reimbursed for the care they provide within the scope of their practice is an extremely commonsense improvement. CBO has even stated that this legislation would help injured Federal workers return to the job faster. In this labor market, anything we can do to improve workers' healthy recovery and job retention is worthwhile.

This bill has been endorsed by the National Rural Health Association, the American Nursing Association, the American Association of Nurse Practitioners, the American Academy of Physician Assistants, as well as a diverse coalition of unions representing Federal employees, such as the National Treasury Employees Union and the National Postal Mail Handlers Union.

Further, the Department of Labor's Office of the Workers' Compensation Programs which administers the Federal Employees' Compensation Act for Federal workers in agencies as diverse as the Pentagon, Department of Homeland Security, Interior, and Veterans Affairs, has confirmed this legislation will help alleviate barriers that create delays for FECA claimants and would expand injured workers access to medical treatment.

Madam Speaker, I have the honor to represent the largest military installation in New England, Naval Submarine Base New London, which employs over 1,000 civilian Federal workers who perform outstanding work to support 16 attack submarines that deploy from that base.

Some of that work is physically demanding, such as firefighters, police, and crane operators, and injuries do happen. This bill will create healthcare parity for those patriots by ensuring that they will have their claims handled and treated the same as any other workers who reside in Connecticut and Rhode Island. This is an overdue and important, but commonsense, way to bring this program in line with the reality of 21st century healthcare delivery.

Madam Speaker, I thank my Republican counterpart, Mr. Walberg, for his great support and work to bring this issue forward. I also thank Chairman Scott and Ranking Member Foxx for their bipartisan work supporting this bill and getting it through committee.

Madam Speaker, I strongly urge a ``yes'' vote on this bipartisan and commonsense measure, and I reserve the balance of my time.

Madam Speaker, I again applaud Mr. Walberg for his leadership on this legislation.

Madam Speaker, I yield 3 minutes to the gentleman from the great Commonwealth of Virginia (Mr. Scott), chairman of the Committee on Education and Labor.

Madam Speaker, I yield myself such time as I may consume.

Just briefly, I agree with the gentleman from Maryland that the goal here should be what is best for Federal employees, who do critical work for our country, but I think also what we want is what is best for people who are protected by Social Security Disability Insurance, by the Federal Employees Health Benefits Program, which are programs in which independent practice of nurse practitioners and physician assistants has been well established and, again, subject to scope of practice in the State where the patient resides.

Again, this is just simply conforming Federal workers' compensation law with existing practice and a whole host of other Federal programs involving really important populations that all of us have a duty to protect.

Madam Speaker, I yield 2 minutes to the gentlewoman from North Carolina (Ms. Adams), a member of the Education and Labor Committee who does outstanding work on the Workforce Protections Subcommittee as its chair.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I yield myself such time as I may consume.

Just briefly, again, I thank the ranking member, Congresswoman Foxx, for her remarks and Mr. Walberg, who I think very effectively and specifically addressed some of the issues that we have heard in this brief debate regarding whether or not this is opening the door to practitioners who really aren't qualified to engage in the handling of workers' compensation claims.

Right now, today, there are 27 States that actually allow nurse practitioners and physician assistants to handle workers' compensation claims under State law, including, by the way, North Carolina and Maryland. Just going down the list, it is from all different regions of the country, and, again, I think it has demonstrated that the system functions smoothly. As the Congressional Budget Office indicated, it allows for quicker care because you have more access when you have a broader, larger pool of qualified practitioners.

That is really what this bill is aimed at. It is just to make sure that Federal workers will have that same opportunity to access care, particularly when they are in underserved parts of the country.

To sort of frame it, I mentioned earlier the New London sub base where they have a really sizable firefighters contingent there. Again, fires on submarines and Navy ships is a demanding, highly specialized area of practice. If they get injured on the job, they do not have the same rights as a firefighter who works for the city of New London who gets injured on the job, in terms of having access to a nurse practitioner or a physician assistant to handle that individual's treatment and care and their disability claim.

That is really what this bill is doing. It is just simply establishing parity for Federal workers who reside in those 28 States that recognize independent practice by physician assistants and nurse practitioners.

I have some letters of support, Madam Speaker, which I include in the Record: one from the National Postal Mail Handlers Union, one from the National Treasury Employees Union, one from the National Rural Health Association, one from the American Association of Nurse Practitioners, and one from the American Association of Physician Assistants.

National Postal Mail

Handlers Union,

Washington, DC.

Hon. Joe Courtney,

House of Representatives,

Washington, DC.

Dear Congressman Courtney: On behalf of the National Postal

Mail Handlers Union, which represents over 50,000 mail

handlers across the country, I write in support of H.R. 6087,

the Improving Access to Workers' Compensation for injured

Federal Workers Act.

Your legislation is a commonsense solution to amend the

Federal Employees' Compensation Act to grant injured postal

and federal workers wider access medical care from eligible

providers. This will ensure they are able to claim workers'

compensation and receive necessary care in a timely manner.

As it can be difficult to expeditiously schedule

appointments with physicians for work-related injuries, H.R.

6087 extends eligible providers to include physician

assistants and nurse practitioners. It is an unfortunate fact

that postal employees are the largest group of beneficiaries

under current FECA regulations. Your legislation will ensure

those injured on the job will have access to medical care and

can see their preferred primary care provider.

I look forward to seeing H.R. 6087 gain support within the

House Education and Labor Committee, and its advancement

through the House.

In solidarity,

Paul V. Hogrogian,

National President,

National Postal Mail Handlers Union.

Madam Speaker, I include in the Record a letter from the Nursing Community Coalition, which represents 63 national nursing organizations all across America.

Nursing Community Coalition,

June 7, 2022.

Hon. Joe Courtney,

Washington, DC.

Hon. Tim Walberg,

Washington, DC.

Dear Representatives Courtney and Walberg: On behalf of the

Steering Committee of the Nursing Community Coalition (NCC),

which represents 63 national nursing organizations, we are

pleased to support H.R. 6087, the Improving Access to

Workers' Compensation for Injured Federal Workers Act, which

would retire outdated barriers in the Federal Employees'

Compensation Act (FECA) that limit the ability of Nurse

Practitioners (NPs) to provide care and treatment for injured

or ill federal employees. The NCC is a cross section of

education, practice, research, and regulation within the

nursing profession representing Registered Nurses (RNs),

Advanced Practice Registered Nurses (APRNs), nurse leaders,

students, faculty, and researchers. We appreciate your

continued efforts to improve the health care system for our

nation's federal employees and strongly support passage of

Madam Speaker, I am prepared to close and I reserve the balance of my time.

Madam Speaker, I yield myself the balance of my time. Mr. Walberg's eloquence, and comprehensive closing statement I think really said it all. I tip my hat to him, Ranking Member Foxx, Mr. Davis from the minority side of the aisle, and the speakers on this side that really represent a bipartisan message that we are prepared to get our Federal Employee Workers' Compensation Act modernized so that the hard work of nurse practitioners and physician assistants and the work that they do every single day around the country is now extended to a critical part of our healthcare system and also our Federal disability benefits system.

This is really about giving patients a choice. There is nothing in this bill that mandates that they can't go to a physician or that they don't have that option. In some areas people just don't have that choice. If you are in a place where the only real access is to a physician assistant or a nurse practitioner, sometimes for even a life- threatening injury, we need to open the door to give people that opportunity. That is precisely what this bill does.

It came out of committee with a unanimous vote. I strongly urge all of my colleagues from both sides of the aisle to follow the lead of the Education and Labor Committee and pass this bill with an overwhelming majority.

Madam Speaker, I yield back the balance of my time.

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, H.R. 6087, the Improving Access to Workers' Compensation for Injured Federal Workers Act,

is a commonsense bill to improve access to care for workers under the Federal Employees' Compensation, or FECA, program.

I rise in support of this bill that I have co-led with my friend and colleague, Representative Courtney, and thank him, his staff, my staff, the staff of the Committee on Education and Labor for their diligent work on this legislation.

The bill simply allows nurse practitioners or physician assistants to care for Federal employees under the Federal workers' compensation program so long--and I make this clear--so long as that care is within their scope of practice under State law.

Under current Federal law, only a physician can diagnose, certify, and oversee the treatment of an injured Federal worker receiving compensation benefits. This requirement places an additional burden on Federal employees who may have to drive great distances to receive care from an approved provider.

Additionally, it limits the injured individual's choice, depriving them from receiving healthcare from the provider with whom they are most comfortable. A majority of States already allow NPs and PAs to diagnose, certify an injury, and oversee the patient's treatment and care for their State workers' compensation programs. So it is time that the Federal Government do the same under the Federal disability program. Furthermore, our bill will align the FECA program with other Federal programs.

Currently, the Federal Government allows care provided or overseen by PAs and NPs in Medicare, Medicaid, the Federal Employee Health Benefits Program, and TRICARE. Additionally, since 2017, the Social Security Administration has considered PAs and NPs, along with physicians, as acceptable sources of information for documenting the existence of an impairment for purposes of determining a disability.

Madam Speaker, across the country, nurse practitioners and physician assistants provide critical care, especially in rural communities where there may not be a physician within a reasonable distance. In Michigan, there are 5,300 practicing physician assistants and nearly 9,000 nurse practitioners. They are an important part of our primary care workforce in our State.

Our bill updates Federal law to grant Federal employees more choice in selecting their healthcare provider, improve access to care, and enable better continuity of care. Again, I sincerely thank my colleague, Representative Courtney, and his staff for their great work on this bipartisan, commonsense bill.

Madam Speaker, I urge all Members to support it, and I reserve the balance of my time.

Madam Speaker, I yield 2 minutes to the gentleman from Maryland (Mr. Harris), my friend, the MD.

Madam Speaker, I yield an additional 30 seconds to the gentleman.

Madam Speaker, I yield myself such time as I may consume.

I add to the comments about concerns about the care that is being provided. Repeated studies over the decades have shown that NPs and PAs provide outstanding quality of care, improve health outcomes, and increase cost-effectiveness.

Additionally, these healthcare professionals have advanced degrees from nationally accredited programs that include both classroom and clinical rotations and must demonstrate clinical competency.

Once more, if there were legitimate concerns about the quality of care, whether it is a Federal program or State program, provided by NPs and PAs to injured workers, then States would not license them to treat or diagnose these workers under State workers' compensation programs. However, the vast majority of States do recognize nurse practitioners and physician assistants as eligible providers for diagnosing and treating disability claims.

Madam Speaker, I yield 1 minute to the gentleman from North Carolina (Mr. Murphy), my good friend.

Madam Speaker, I yield such time as she may consume to the gentlewoman from North Carolina (Ms. Foxx), the ranking member of the Education and Labor Committee and my good friend and colleague.

Madam Speaker, I yield myself such time as I may consume.

I appreciate that information being shared, but I would like to address some of the concerns that my good friends from the Doc Caucus have presented.

We have discussed this in committee representing districts that are rural, urban, and suburban, and the challenges that are there. Again, the issue of States' rights and the ability of States to make decisions, there is a primacy that is there that we ought to consider very strongly.

A majority of States already allow nurse practitioners and PAs to diagnose, certify an injury, and oversee patients' treatment. Furthermore, if we are talking about precedent, our bill will align the FECA program with other Federal programs currently in place. Currently, the Federal Government allows care provided or overseen by PAs and NPs in, I state it again, Medicare, Medicaid, the Federal Employees Health Benefits Program, and TRICARE.

That is significant. Those are textbook studies on how it is working already. Adding to this just seems like it is justified and very important to do.

Going back to the States' concerns, as well, if diagnosing or treating a particular workplace injury is outside of the scope of practice for a nurse practitioner or a physician assistant under their State's law, then they would not be covered under this bill, plain and simple. The bill preserves States' rights to make those determinations.

H.R. 6087 is simply expanding choice, important at this time, especially with inflation and the cost that is going on in coming out of a pandemic and getting in endemic situations.

The Congressional Budget Office, I repeat, noted that the bill would not affect direct spending. In fact, CBO noted in its score that the bill may result in injured workers receiving treatment faster and, as my colleague Representative Courtney said, thereby returning them to work and productivity more quickly and reducing the actual cost for some FECA costs in the process.

Getting workers healthy and back to work is not only good for the individual but also good for our economy as we look to get through these worrisome economic times.

I accept the concerns of the medical doctors. I understand that they have committed themselves to significant training and significant time in the classroom and in the hospital itself, but we also know that we have come of an age where doctors very regularly use the services and need the services of nurse practitioners and physician assistants.

There are communities in my district, in rural areas, where the doctor is a physician assistant. The people appreciate them and receive good care as well.

Madam Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. Rodney Davis).

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, we have all heard of the physician shortage in America. Nurse practitioners and physician assistants are a critical component in fulfilling the provider gap. There are 355,000 nurse practitioners and more than 150,000 physician assistants across the country.

These healthcare professionals have advanced degrees from nationally accredited programs and include both classroom and clinical rotations and must demonstrate clinical competency.

Allowing nurse practitioners and physician assistants to diagnose, certify, and treat injured Federal workers to the full extent of their State license is not only common sense but is smart economic policy to ensure workers get back to work more quickly and off government supported programs.

The bill will not remove physicians from providing care to an injured worker if that is who the patient chooses. The bill is simply giving injured workers more choice to get the timely care they need.

The CBO scored the bill as having insignificant impact on direct spending and noted, may result, in fact, in injured workers receiving treatment faster, thereby returning to work more quickly and reducing costs for the FECA program.

Lastly, the FECA program is virtually the last remaining Federal health program that does not recognize the role that PAs and NPs play in modern healthcare delivery. They can already provide and oversee care in Medicare, Medicaid, the Federal Employee Health Benefits program, the VA, DOD, Indian Health Service, and the Bureau of Prisons, and are recognized by the Social Security Administration.

Furthermore, the bill aligns with the majority of States which already authorize NPs and PAs to certify and oversee healthcare for patients in their State workers' compensation programs.

This is a commonsense, bipartisan bill that will make the Federal workers' compensation program more efficient and ensure workers have access to a health provider of their choice.

Madam Speaker, I thank Chairman Scott, Ranking Member Foxx, and Mr. Courtney for their support of this bill, and I urge the rest of my colleagues to support this bill. I yield back the balance of my time.

Madam Speaker, I thank the gentleman for yielding the time.

Madam Speaker, I rise with concern about H.R. 6087, Improving Access to Workers' Compensation for Injured Federal Workers Act. It was mentioned that it is fine if healthcare practitioners are qualified to deliver workmen's comp. Certainly, in some States, nurse practitioners and physician assistants--nurse practitioners, specifically, can practice without a physician oversight, but the question is whether that is appropriate for workmen's compensation.

Remember, workmen's compensation includes people who have been injured or claimed to have been injured on the job. These employees deserve the highest level of care, the highest level of evaluation, of diagnosis, certification, and treatment. And what this bill does is turns over the qualifications for who is going to treat those injured Federal workers to the State to make the decision. Because it says, Well, if in a State they decide that a physician assistant practicing independently is just fine, well, that Federal worker is not going to have the benefit of having a physician involved in that care.

Madam Speaker, this is a serious policy debate. This debate should be taking place, I believe, not on a suspension calendar but actually come under a regular rule and be debated for whether or not this is the way we want to treat Federal employees, that we want to subject them to a State level of care as opposed to a level of care that we think is appropriate, again, for an injured Federal worker.

So, Madam Speaker, I include in the Record a letter from the American Medical Association strongly opposing H.R. 6087.

American Medical Association,

June 5, 2022.

Hon. Nancy Pelosi,

U.S. House of Representatives,

Washington, DC.

Hon. Kevin McCarthy,

U.S. House of Representatives,

Washington, DC.

Dear Speaker Pelosi and Minority Leader McCarthy: On behalf

of the physician and medical student members of the American

Medical Association (AMA), I am writing in strong opposition

to H.R. 6087, the ``Improving Access to Workers' Compensation

for Injured Federal Workers Act.'' This legislation would

allow nurse practitioners (NPs) and physician assistants

(PAs) to diagnose, prescribe, treat, and certify an injury

and extent of disability for purposes of compensating federal

workers under the Federal Employees' Compensation Act (FECA).

Current law prohibits non-physician health professionals

from making these determinations and reserves this function

to physicians who have the education, training, and expertise

to make these evaluations. The AMA remains steadfast in its

commitment to patients who have said repeatedly that they

want and expect physicians leading their health care team. In

a recent survey of U.S. voters, 68 percent say it is very

important for a physician to be involved in their

diagnosis and treatment decisions. However, H.R. 6087

effectively removes physicians from the care team and sets up

our federal workers for suboptimal health outcomes and

increased costs, without improving access to care. At a time

when inflation is at an all-time high and our economy is

still struggling to recover from the costs associated with

the COVID-19 pandemic, now is especially not the time for

Congress to enact this type of policy change.

Madam Speaker, they give reasons. They say, look, education matters. Patients want physicians involved in their diagnosis and treatment decisions. I think that is true.

They say that increasing the scope of practice of nurse practitioners or physician assistants can lead to increased healthcare costs, specifically mentioning the fact that there are studies now that show that when a nurse practitioner is involved or a physician assistant----

Madam Speaker, they mention that, for instance, opioid overprescribing occurs four times as much when a nurse practitioner is involved. Obviously, in a workers' comp case where injury may be determined, this could be significant. This is something we should deal with.

Finally, even the AMA recognized that they are concerned that we are attempting to pass this under suspension of the rules usually, typically, reserved for noncontroversial bills.

Madam Speaker, I thank the gentleman for yielding me time.

Madam Speaker, I thank the gentleman from Connecticut for yielding.

Madam Speaker, more than 2 million Federal employees provide key services to the public. In fact, during the height of the pandemic, Federal workers were critical in delivering vaccines, personal protective equipment, and other COVID relief to the American people. So it stands to reason that when a Federal worker gets sick or injured on the job, we are obligated to provide them and their families with the resources and medical care that they need.

Today, we can improve that effort by providing expanded healthcare access for injured Federal workers who are seeking healthcare covered by Federal workers' compensation. We live in a country where people are increasingly turning to nurse practitioners and physician assistants as their primary healthcare provider. This is particularly true in rural America where they are disproportionately impacted by physician shortages.

Unfortunately, Federal law now limits what can be reimbursed under Federal workers' compensation, forcing injured workers to see only a physician to certify the injury and disability as work-related and to deliver services. It is time to correct this lag in access to healthcare. After all, core Federal healthcare programs, including Medicare and the Veterans Affairs' system, already recognize services delivered by nurse practitioners and physician assistants if provided within the scope of practice allowed by State law.

This bill would allow nurse practitioners and physician assistants to receive reimbursement for healthcare services they are providing to injured Federal workers if, and only if, those services are already permissible under their State laws.

Madam Speaker, a ``yes'' vote on this bill is a step to expand the group of available healthcare providers consistent with existing State law so that we can ensure injured Federal workers and their families get the support and care they deserve.

I thank the gentleman from Connecticut (Mr. Courtney) for his leadership on the bill, along with the distinguished member of the Committee on Education and Labor, the gentleman from Michigan (Mr. Walberg), and the committee's ranking member, Dr. Foxx, for their support of this legislation.

Madam Speaker, I urge my colleagues to support the Improving Access to Workers' Compensation for Injured Federal Workers Act.

Madam Speaker, I thank my colleague from Michigan for yielding.

I rise in support of this bipartisan legislation to allow nurse practitioners and physician assistants to act as eligible providers under the Federal Employees' Compensation Act program

within the scope of their practice under State law.

Under current law, nurse practitioners and physician assistants are unable to treat Federal workers covered by FECA, even though most State workers' compensation programs authorize them to provide this care for private-sector employees.

To be clear, H.R. 6087 defers to State law and does not expand the scope of practice. This legislation aligns FECA with other Federal programs that already include care provided by nurse practitioners and physician assistants, such as Medicare and the Veterans Health Administration program.

H.R. 6087 would increase healthcare access and choice for Federal employees when many areas of our country are grappling with provider shortages, especially in rural areas.

According to the National Rural Health Association, nurse practitioners and physician assistants account for a third of all primary care clinicians treating Medicare beneficiaries nationwide, and they are closer to half of the primary care clinicians in rural areas.

Improving healthcare access for FECA beneficiaries would allow injured Federal employees to return to the workforce more quickly, benefiting both employees and taxpayers.

I urge my colleagues to support this commonsense, bipartisan improvement to our Federal workers' compensation program. I thank my committee colleagues, Representatives Walberg and Courtney, and Chairman Scott for advancing this important legislation.