Primary Care Health Practitioner Incentive Act of 1995

Summary: Primary Care Health Practitioner Incentive Act of 1995 - Amends title XVIII (Medicare) of the Social Security Act, with respect to payments for medical and other health services, to cover services which would be physicians' services if furnished by a physician but: (1) which are performed by a clinical nurse specialist working in collaboration with a physician; and (2) which the clinical nurse specialist is legally authorized to perform by the State.  Eliminates the requirement, with respect to such services performed by a nurse practitioner, that they be performed in a skilled nursing facility or other specified nursing facility.  Covers, in addition, other services and supplies incidental to such services. 
Revises the formula for payment from the Federal Supplementary Medical Insurance Trust Fund for such services (thereby increasing such payment). 
Repeals the rural area restriction on services performed by nurse practitioners or clinical nurse specialists for which direct payment may be made. 
Requires a ten percent bonus payment from the Fund for services of a nurse practitioner or clinical nurse specialist furnished in a health professional shortage area.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Primary Care Health Practitioner 
Incentive Act of 1995''.

SEC. 2. INCREASED MEDICARE REIMBURSEMENT FOR NURSE PRACTITIONERS AND 
              CLINICAL NURSE SPECIALISTS.

    (a) Removal of Restrictions on Settings.--
            (1) In general.--Section 1861(s)(2)(K)(ii) of the Social 
        Security Act (42 U.S.C. 1395x(s)(2)(K)(ii)) is amended to read 
        as follows:
            ``(ii) services which would be physicians' services if 
        furnished by a physician (as defined in subsection (r)(1)) and 
        which are performed by a nurse practitioner or clinical nurse 
        specialist (as defined in subsection (aa)(5)) working in 
        collaboration (as defined in subsection (aa)(6)) with a 
        physician (as so defined) which the nurse practitioner or 
        clinical nurse specialist is legally authorized to perform by 
        the State in which the services are performed, and such 
        services and supplies furnished as an incident to such services 
        as would be covered under subparagraph (A) if furnished 
        incident to a physician's professional service;''.
            (2) Conforming amendments.--
                    (A) Section 1861(s)(2)(K) of such Act (42 U.S.C. 
                1395x(s)(2)(K)), as amended by paragraph (1), is 
                amended--
                            (i) in clause (i), by inserting ``and such 
                        services and supplies furnished as incident to 
                        such services as would be covered under 
                        subparagraph (A) if furnished as an incident to 
                        a physician's professional service.'' after 
                        ``are performed, and''; and
                            (ii) by striking clauses (iii) and (iv).
                    (B) Section 1861(b)(4) of such Act (42 U.S.C. 
                1395x(b)(4)) is amended by striking ``clauses (i) or 
                (iii) of subsection (s)(2)(K)'' and inserting 
                ``subsection (s)(2)(K)''.
                            (C) Section 1862(a)(14) of such Act (42 
                        U.S.C. 1395y(a)(14)) is amended by striking 
                        ``section 1861(s)(2)(K)(i) or 
                        1861(s)(2)(K)(iii)'' and inserting ``section 
                        1861(s)(2)(K)''.
                            (D) Section 1866(a)(1)(H) of such Act (42 
                        U.S.C. 1395cc(a)(1)(H)) is amended by striking 
                        ``section 1861(s)(2)(K)(i) or 
                        1861(s)(2)(K)(iii)'' and inserting ``section 
                        1861(s)(2)(K)''.
    (b) Increased Payment.--
            (1) Fee schedule amount.--Section 1833(a)(1)(O) of the 
        Social Security Act (42 U.S.C. 1395l(a)(1)(O)) is amended to 
        read as follows: ``(O) with respect to services described in 
        section 1861(s)(2)(K)(ii) (relating to nurse practitioner or 
        clinical nurse specialist services), the amounts paid shall be 
        equal to 80 percent of (i) the lesser of the actual charge or 
        85 percent of the fee schedule amount provided under section 
        1848 for the same service provided by a physician who is not a 
        specialist; or (ii) in the case of services as an assistant at 
        surgery, the lesser of the actual charge or 85 percent of the 
        amount that would otherwise be recognized if performed by a 
        physician who is serving as an assistant at surgery, and''.
            (2) Conforming amendments.--
                    (A) Section 1833(r) of such Act (42 U.S.C. 
                1395l(r)) is amended--
                            (i) in paragraph (1), by striking ``section 
                        1861(s)(2)(K)(iii) (relating to nurse 
                        practitioner or clinical nurse specialist 
                        services provided in a rural area),'' and 
                        inserting ``section 1861(s)(2)(K)(ii) (relating 
                        to nurse practitioner or clinical nurse 
                        specialist services),'';
                            (ii) by striking paragraph (2);
                            (iii) in paragraph (3), by striking 
                        ``section 1861(s)(2)(K)(iii)'' and inserting 
                        ``section 1861(s)(2)(K)(ii)''; and
                            (iv) by redesignating paragraph (3) as 
                        paragraph (2).
                    (B) Section 1842(b)(12)(A) of such Act (42 U.S.C. 
                1395u(b)(12)(A)) is amended in the matter preceding 
                clause (i), by striking ``clauses (i), (ii), or (iv) of 
                section 1861(s)(2)(K) (relating to a physician 
                assistants and nurse practitioners)'' and inserting 
                ``section 1861(s)(2)(K)(i) (relating to physician 
                assistants)''.
    (c) Direct Payment for Nurse Practitioners and Clinical Nurse 
Specialists.--
            (1) In general.--Section 1832(a)(2)(B)(iv) of the Social 
        Security Act (42 U.S.C. 1395k(a)(2)(B)(iv)) is amended by 
        striking ``provided in a rural area (as defined in section 
        1886(d)(2)(D))''.
            (2) Conforming amendment.--Section 1842(b)(6)(C) of such 
        Act (42 U.S.C. 1395u(b)(6)(C)) is amended--
                    (A) by striking ``clauses (i), (ii), or (iv)'' and 
                inserting ``clause (i)''; and
                    (B) by striking ``or nurse practitioner''.
    (d) Bonus Payment for Services Provided in Health Professional 
Shortage Areas.--Section 1833(m) of such Act (42 U.S.C. 1395l(m)) is 
amended--
            (1) by inserting ``(1)'' after ``(m)''; and
            (2) by adding at the end the following new paragraph:
    ``(2) In the case of services of a nurse practitioner or clinical 
nurse specialist furnished to an individual, described in paragraph 
(1), in an area that is a health professional shortage area as 
described in such paragraph, in addition to the amount otherwise paid 
under this part, there shall also be paid to such service provider (on 
a monthly or quarterly basis) from the Federal Supplementary Medical 
Insurance Trust Fund an amount equal to 10 percent of the payment 
amount for the service under this part.''.
    (e) Definition of Clinical Nurse Specialist Clarified.--Section 
1861(aa)(5) of such Act (42 U.S.C. 1395x(aa)(5)) is amended--
            (1) by inserting ``(A)'' after ``(5)'';
            (2) by striking ``The term ```physician assistant''' and 
        all that follows through ``who performs'' and inserting ``The 
        term `physician assistant' and the term `nurse practitioner' 
        mean, for purposes of this title, a physician assistant or 
        nurse practitioner who performs''; and
            (3) by adding at the end the following new subparagraph:
            ``(B) The term `clinical nurse specialist' means, for 
        purposes of this title, an individual who--
                    ``(i) is a registered nurse and is licensed to 
                practice nursing in the State in which the clinical 
                nurse specialist services are performed; and
                    ``(ii) holds a master's degree in a defined 
                clinical area of nursing from an accredited educational 
                institution.''.
    (f) Effective Date.--The amendments made by this section shall 
apply with respect to services furnished and supplies provided on and 
after July 1, 1995.