Improving Access to Workers' Compensation for Injured Federal Workers Act of 2022
Floor Speech
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Mr. COURTNEY. 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.
The Clerk read the title of the bill.
The text of the bill is as follows: H.R. 6087
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improving Access to Workers' Compensation for Injured Federal Workers Act of 2022''. SEC. 2. INCLUSION OF PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS IN FEDERAL EMPLOYEES' COMPENSATION ACT.
(a) Inclusion.--Section 8101 of title 5, United States Code, is amended--
(1) in paragraph (3), by inserting ``, other eligible providers,'' after ``osteopathic practitioners'';
(2) by striking ``and'' at the end of paragraphs (18) and (19);
(3) by striking the period at the end of paragraph (20) and inserting ``; and''; and
(4) by adding at the end the following:
``(21) `other eligible provider' means a nurse practitioner or physician assistant within the scope of their practice as defined by State law.''.
(b) Conforming Amendments.--Chapter 81 of title 5, United States Code, is amended--
(1) in section 8103(a)--
(A) by inserting ``or other eligible provider'' after ``physician'' in each instance; and
(B) in paragraph (3), by inserting ``or other eligible providers'' after ``physicians'';
(2) in section 8121(6), by inserting ``or other eligible provider'' after ``physician''; and
(3) in section 8123(a)--
(A) by inserting ``or other eligible provider'' after ``The employee may have a physician''; and
(B) by inserting ``or other eligible provider'' after ``United States and the physician''.
(c) Regulations.--Not later than 6 months after the date of enactment of this Act, the Secretary shall finalize rules to carry out the amendments made by this Act. SEC. 3. DETERMINATION OF BUDGETARY EFFECTS.
The budgetary effects of this Act, for the purpose of complying with the Statutory Pay-As-You-Go Act of 2010, shall be determined by reference to the latest statement titled ``Budgetary Effects of PAYGO Legislation'' for this Act, submitted for printing in the Congressional Record by the Chairman of the House Budget Committee, provided that such statement has been submitted prior to the vote on passage.
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Mr. COURTNEY. 6087, the Improving Access to Workers' Compensation for Injured Federal Workers Act
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Mr. COURTNEY. 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.
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Mr. COURTNEY. 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.
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Mr. COURTNEY. 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.
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Mr. COURTNEY. 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. ____ The National Treasury Employees Union, June 6, 2022.
Dear Representative: This week, the House of Representatives is expected to vote on suspension on the Improving Access to Workers' Compensation for Injured Federal Workers Act of 2022 (HR 6087). The National Treasury Employees Union (NTEU) strongly supports this legislation and urges you to vote YES.
This bill would improve access to benefits under the Federal Employees' Compensation Act (FECA), which serves as the workers' compensation program for federal employees. It does so by allowing workers to have their medical care provided by a Nurse Practitioner (NP) or Physician Assistant (PA), as well as have NPs and PAs provide certification of injury. This bipartisan bill was introduced by Rep. Joseph Courtney (CT) and Rep. Timothy Walberg (MI) and passed out of the Education & Labor Committee on a bipartisan basis.
Thank you for your consideration of our views. Please feel free to contact Kurt Vorndran of the NTEU Department of Legislation if you have any questions. Sincerely, Anthony M. Reardon, National President. ____ National Rural Health Association, Washington, DC, June 6, 2022. Re H.R. 6087, the Improving Access to Workers' Compensation for Injured Federal Workers Act, under suspension in the House of Representatives. Hon. Nancy Pelosi, Speaker, House of Representatives. Hon. Kevin McCarthy, Minority Leader, House of Representatives.
Dear Speaker Pelosi and Minority Leader McCarthy: The National Rural Health Association (NRHA) writes in support of House passage for H.R. 6087, the Improving Access to Workers' Compensation for Injured Federal Workers Act, which is scheduled to be considered by the House of Representatives this week. This legislation would allow nurse practitioners (NP) and physician assistants (PA) to diagnose, treat, and provide care for federal employees who are injured at work, consistent with state scope of practice. In fact, most states already authorize NPs to provide this care for non-federal employees.
NRHA is a non-profit membership organization with more than 21,000 members nationwide that provides leadership on rural health issues. Our membership includes every component of rural America's health care, including rural community hospitals, critical access hospitals, doctors, nurses, and patients. We provide leadership on rural health issues through advocacy, communications, education, and research.
NRHA is supportive of this legislation as NPs and PAs are common primary care providers in rural communities. According to MedPAC, in 2018 advanced practice registered nurses (APRN) and PAs accounted for a third of all primary care clinicians treating Medicare beneficiaries nationwide. In rural communities, their presence is closer to half of the primary care clinicians. Because of the significant presence of NPs and PAs, and the quality of care they provide, NRHA urges swift passage of this legislation. This commonsense bill will ensure increased access to needed services in our rural areas.
Thank you for your consideration of this important legislation. If you have questions, please contact Josh Jorgensen. Sincerely, Alan Morgan, Chief Executive Officer, National Rural Health Association. ____ American Association of Nurse Practitioners, March 4, 2022. Hon. Joe Courtney, Washington, DC. Hon. Tim Walberg, Washington, DC.
Dear Representatives Courtney and Walberg: The American Association of Nurse Practitioners (AANP), representing more than 325,000 nurse practitioners (NPs) in the United States, is pleased to support H.R. 6087, the Improving Access to Workers' Compensation for injured Federal Workers Act. This legislation would retire outdated barriers in the Federal Employees' Compensation Act (FECA) that limit the ability of NPs to provide care and treatment for injured or ill federal employees. AANP thanks you for you continued efforts to improve the health care system for our nation's federal employees.
Currently, federal employees can select an NP as their health care provider under the Federal Employees Health Benefits Program (FEHPB), and the majority of states authorize NPs to provide the diagnosis and treatment for a workplace related injury. However, contrary to the workers' compensation process in most states, FECA requires that only a physician can make the diagnosis, certify the injury and extent of the disability, and oversee the patient's treatment and care. This barrier places an additional burden on the over two million federal employees, depriving them from receiving health care from their provider of choice, as well as hindering timely access to care and continuity of care.
As you know, H.R. 6087 would update the federal workers' compensation program and authorize NPs to certify disabilities and oversee treatment for injured or ill federal employees under FECA. This would improve access to health care for injured or ill federal employees, particularly in rural and underserved communities, and better align the federal workers' compensation program with the majority of states and FEHBP. By updating FECA to authorize federal employees to select their health care provider of choice when they are injured or become ill in the course of their federal employment, greater access, overall efficiency and better continuity of care can be achieved. We thank you for this impactful legislation and look forward to continuing to work with you to ensure H.R. 6087 becomes law.
Thank you again for your tireless efforts on behalf of federal employees. Should you have comments or questions, please direct them to MaryAnne Sapio, V.P. Federal Government Affairs. Sincerely, Jon Fanning, MS, CAE, CNED, Chief Executive Officer, American Association of Nurse Practioners. ____ AAPA, Alexandria, VA, March 15, 2022. Hon. Joe Courtney, Washington, DC. Hon. Tim Walberg, Washington, DC.
Dear Representatives Courtney and Walberg: On behalf of the more than 151,000 PAs (physician assistants) throughout the United States, the American Academy of PAs (AAPA) lends strong support to H.R. 6087, the Improving Access to Worker's Compensation for Injured Federal Workers Act. AAPA thanks you for your continued support of the federal workforce and unwavering commitment to ensuring that all Americans have access to high-quality healthcare.
As you know, U.S. federal and postal employees receive workers compensation coverage through the Federal Employee's Compensation Act (FECA) for employment-related injuries and occupational disease. However, as currently written, FECA does not cover medical care provided by PAs within the definition of ``medical, surgical, and hospital services . . .'' and FECA claims signed by PAs are routinely denied. This undue restriction negatively impacts federal employees, especially those in rural and underserved areas, who receive primary care from PAs.
PAs practice in all medical and surgical specialties in all 50 states, the District of Columbia, U.S. territories, and the uniformed services. PAs provide high-quality, cost- effective medical care in every specialty and setting, undertake rigorous education and clinical training, and are well established as medical professionals. PAs are recognized as qualified healthcare providers under Medicare, Medicaid, and almost every state and federal healthcare program, including state workers' compensation programs. PAs are also included in the definition of an ``acceptable medical source'' by the Social Security Administration for the purposes of certifying that an individual has a medically determinable impairment. Further, thousands of PAs are employed by the federal government as healthcare providers and work within the Department of Veterans Affairs, the Department of Defense, the Public Health Service, and Indian Health Services. However, PAs are not considered healthcare providers within FECA, an oversight that does not align with state or other federal programs.
H.R. 6087 would ensure that federal employees can access high-quality healthcare from the provider of their choice, as well as further align FECA with state workers compensation programs which recognize PAs as covered providers. It is well within the education and training of PAs to provide treatment to federal employees who are injured in the course of their work for the government, and it is time to remove this outdated and unnecessary restriction.
AAPA appreciates your work and dedication to the federal workforce and our nation's healthcare system. If we can be of assistance to you on this or any issue, please do not hesitate to contact Tate Heuer, AAPA Vice President, Federal Advocacy. Sincerely Lisa M. Gables, CPA, Chief Executive Officer.
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Mr. COURTNEY. 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 H.R. 6087.
Currently, federal employees can select an NP as their health care provider under the Federal Employees Health Benefits Program (FEHPB), and the majority of states authorize NPs to provide the diagnosis and treatment for a workplace related injury. However, contrary to the workers' compensation process in most states, FECA requires that only a physician can make the diagnosis, certify the injury and extent of the disability, and oversee the patient's treatment and care. This barrier places an additional burden on the over two million federal employees, depriving them from receiving health care from their provider of choice, as well as hindering timely access to care and continuity of care.
H.R. 6087 would update the federal workers' compensation program and authorize NPs to certify disabilities and oversee treatment for injured or ill federal employees under FECA. This would improve access to health care for injured or ill federal employees, particularly in rural and underserved communities, and better align the federal workers' compensation program with the majority of states and FEHBP. By updating FECA to authorize federal employees to select their health care provider of choice when they are injured or become ill in the course of their federal employment, greater access, overall efficiency and better continuity of care can be achieved.
We appreciate this important legislation and strongly support passage of H.R. 6087, the Improving Access to Workers' Compensation for Injured Federal Workers Act. Should you have any questions or if the Nursing Community Coalition can be of any additional assistance please contact the coalition's Executive Director, Rachel Stevenson. Sincerely,
American Association of Colleges of Nursing, American Association of Nurse Anesthesiology, American Association of Nurse Practitioners, American Nurses Association, Association of Women's Health, Obstetric and Neonatal Nurses, National Association of Pediatric Nurse Practitioners, National Council of State Boards of Nursing, National League for Nursing, Oncology Nursing Society.
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Mr. COURTNEY. Madam Speaker, I am prepared to close and I reserve the balance of my time.
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Mr. COURTNEY. 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.
Ms. JACKSON LEE. Madam Speaker, as a steadfast ally of the men and women serving in the federal government, I rise in support of H.R. 6087, the ``Improving Access to Workers' Compensation for Injured Federal Workers Act.''
This bill allows for injured federal workers to consult with nurse practitioners or physician assistants for the diagnosis and treatment of injuries covered by workers' compensation.
H.R. 6087 will make a needed correction to the Federal Employees Compensation Act, increasing the accessibility of healthcare for nearly three million federal employees.
Nurse practitioners and physician assistants represent a growing portion of American primary care providers, especially for medically underserved communities.
We must prioritize the needs of our invaluable federal workers. Lowering the bureaucratic obstacles blocking federal workers' access to benefits is a necessary measure to protect them.
When Congress has an opportunity to remedy real-world issues with bipartisan action, especially when it improves the lives of government employees, it is our responsibility to act.
H.R. 6087 is especially critical in the face of the increasing workplace risks associated with COVID-19, in which situation an expanded list of approved medical providers can help fill the coverage gap.
The pandemic has already stressed the health and wellbeing of federal workers. Amending the Federal Employees Compensation Act is imperative to lessen that burden.
According to the Office of Personnel Management, Texas has 143,087 federal workers. I will always fight for these workers by standing up for their access to healthcare.
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