Rural Physicians' Incentives Act of 1993

Summary: Rural Physicians' Incentives Act of 1993 - Amends the Internal Revenue Code to allow a deduction on medical education loan interest of a physician which accrues while the physician is living in and providing primary care to residents of a medically underserved rural area. 
Amends title XVIII (Medicare) of the Social Security Act to exempt services furnished in a rural area from a special fee schedule applicable to new physicians. 
Amends the Higher Education Act of 1965 to extend beyond the normal two-year limit, for borrowers serving an internship or residency program in preparation for practice in an area of primary care, the deferral of payments on:  (1) insured student loans (Stafford Loans), including those eligible for interest subsidies; and (2) low-interest student loans (Perkins Loans). 
Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to modify provisions setting forth requirements concerning billing by one physician for services rendered by another physician in specified circumstances.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Physicians' Incentives Act of 
1993''.

SEC. 2. DEDUCTION FOR MEDICAL SCHOOL EDUCATION LOAN INTEREST INCURRED 
              BY DOCTORS SERVING IN MEDICALLY UNDERSERVED RURAL AREAS.

    (a) In General.--Paragraph (1) of section 163(h) of the Internal 
Revenue Code of 1986 (relating to disallowance of deduction for 
personal interest) is amended by striking ``and'' at the end of 
subparagraph (D), by redesignating subparagraph (E) as subparagraph 
(F), and by inserting after subparagraph (D) the following new 
subparagraph:
                    ``(E) any qualified medical education loan interest 
                (within the meaning of paragraph (5)), and''.
    (b) Qualified Medical Education Loan Interest Defined.--Subsection 
(h) of section 163 of such Code is amended by redesignating paragraph 
(5) as paragraph (6) and by inserting after paragraph (4) the following 
new paragraph:
            ``(5) Qualified medical education loan interest.--
                    ``(A) In general.--The term `qualified medical 
                education loan interest' means interest--
                            ``(i) which is on a medical education loan 
                        of a physician,
                            ``(ii) which is paid or accrued by such 
                        physician, and
                            ``(iii) which accrues during the period--
                                    ``(I) such physician is providing 
                                primary care (including internal 
                                medicine, pediatrics, obstetrics/
                                gynecology, family medicine, and 
                                osteopathy) to residents of a medically 
                                underserved rural area, and
                                    ``(II) such physician's principal 
                                place of abode is in such area.
                    ``(B) Medical education loan.--The term `medical 
                education loan' means indebtedness incurred to pay the 
                individual's--
                            ``(i) qualified tuition and related 
                        expenses (as defined in section 117(b)) 
                        incurred for the medical education of such 
                        individual, or
                            ``(ii) reasonable living expenses while 
                        away from home in order to attend an 
                        educational institution described in section 
                        170(b)(1)(A)(ii) for the medical education of 
                        such individual.
                    ``(C) Physician.--For purposes of subparagraph (A), 
                the term `physician' has the meaning given such term by 
                section 1861(r)(1) of the Social Security Act.
                    ``(D) Medically underserved rural area.--The term 
                `medically underserved rural area' means any rural area 
                which is a medically underserved area (as defined in 
                section 330(b) or 1302(7) of the Public Health Service 
                Act).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years ending after the date of the enactment of this 
Act.

SEC. 3. ELIMINATION OF MEDICARE PAYMENT REDUCTIONS FOR NEW DOCTORS FOR 
              SERVICES FURNISHED IN ANY RURAL AREA.

    (a) In General.--Section 1848(a)(4) of the Social Security Act (42 
U.S.C. 1395w-4(a)(4)) is amended--
            (1) by striking ``or services'' and inserting ``, 
        services'', and
            (2) by inserting before the period at the end the 
        following: ``, or services furnished in a rural area (as so 
        defined) by (or under the supervision, or incidental to 
        services, of) a physician described in section 1861(r)(1)''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to services furnished after 1993.

SEC. 4. EXTENSION OF DEFERMENTS.

    (a) Stafford Loans.--
            (1) GSL loans.--Section 428(b)(1)(M) of the Higher 
        Education Act of 1965 (20 U.S.C. 1078(b)(1)(M)) is amended--
                    (A) by striking ``or'' at the end of clause (ii);
                    (B) by inserting ``or'' after the semicolon at the 
                end of clause (iii); and
                    (C) by adding at the end thereof the following new 
                clause:
                            ``(iv) during which the borrower is serving 
                        in an internship or residency program in 
                        preparation for practice in an area of primary 
                        care (including internal medicine, pediatrics, 
                        obstetrics/gynecology, family medicine, and 
                        osteopathy);''.
            (2) FISL loans.--Section 427(a)(2)(C) of such Act (20 
        U.S.C. 1077(a)(2)(C)) is amended--
                    (A) by striking ``or'' at the end of clause (ii);
                    (B) by inserting ``or'' after the semicolon at the 
                end of clause (iii); and
                    (C) by adding at the end thereof the following new 
                clause:
                            ``(iv) during which the borrower is serving 
                        in an internship or residency program in 
                        preparation for practice in an area of primary 
                        care (including internal medicine, pediatrics, 
                        obstetrics/gynecology, family medicine, and 
                        osteopathy);''.
    (b) Perkins Loans.--Section 464(c)(2)(A) of such Act (20 U.S.C. 
1087dd(c)(2)(A)) is amended--
            (1) by striking ``or'' at the end of clause (iii);
            (2) by inserting ``or'' after the semicolon at the end of 
        clause (iv); and
            (3) by adding at the end thereof the following new clause:
                            ``(v) during which the borrower is serving 
                        in an internship or residency program in 
                        preparation for practice in an area of primary 
                        care (including internal medicine, pediatrics, 
                        obstetrics/gynecology, family medicine, and 
                        osteopathy);''.
    (c) Effective Date.--The amendments made by this section shall 
apply to on and after the date of the enactment of this Act with 
respect to loans made under the Higher Education Act of 1965 before, 
on, or after that date.

SEC. 5. CLARIFICATION OF PERMISSIBLE SUBSTITUTE BILLING ARRANGEMENTS 
              FOR PHYSICIANS' SERVICES UNDER THE MEDICARE AND MEDICAID 
              PROGRAMS.

    (a) Medicare Program.--
            (1) In general.--Clause (D) of section 1842(b)(6) of the 
        Social Security Act (42 U.S.C. 1395u(b)(6)) is amended to read 
        as follows: ``(D)(i) payment may be made to a physician for 
        physicians' services (and services incident to such services) 
        to be provided by a second physician on a reciprocal basis to 
        individuals who are patients of the first physician if (I) the 
        first physician is unavailable to provide the services, (II) 
        the services are not provided by the second physician over a 
        continuous period of longer than 60 days, and (III) the claim 
        form submitted to the carrier includes the second physician's 
        unique identifier (provided under the system established under 
        subsection (r)) and indicates that the claim meets the 
        requirements of this clause for payment to the first physician; 
        and (ii) payment may be made to a physician for physicians' 
        services (and services incident to such services) which that 
        physician pays a second physician on a per diem or other fee-
        for-time basis to provide to individuals who are patients of 
        the first physician if (I) the first physician is unavailable 
        to provide the services, (II) the services are not provided by 
        the second physician over a continuous period of longer than 90 
        days (or such longer period as the Secretary may provide), and 
        (III) the claim form submitted to the carrier includes the 
        second physician's unique identifier (provided under the system 
        established under subsection (r)) and indicates that the claim 
        meets the requirements of this clause for payment to the first 
        physician''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to services furnished on or after the first day of 
        the first month beginning more than 60 days after the date of 
        the enactment of this Act.
    (b) Medicaid Program.--
            (1) In general.--Section 1902(a)(32)(C) of the Social 
        Security Act (42 U.S.C. 1396a(a)(32)(C)) is amended to read as 
        follows:
                    ``(C) payment may be made to a physician for 
                services furnished by a substitute physician under the 
                circumstances described in subparagraph (D) of section 
                1842(b)(6), except that, for purposes of this 
                subparagraph, any reference in such subparagraph to `a 
                carrier' or `the system established under subsection 
                (r)' is deemed a reference to the State (or other 
                fiscal agent under the State plan) and to the system 
                established under subsection (x) of this section, 
                respectively.''.
            (2) Effective date.--(A) The amendment made by paragraph 
        (1) shall apply to services furnished on or after the date of 
        the enactment of this Act.
            (B) Until the first day of the first calendar quarter 
        beginning more than 60 days after the date the Secretary of 
        Health and Human Services establishes the physician identifier 
        system under section 1902(x) of the Social Security Act, the 
        requirement under section 1902(a)(32)(C) of such Act that a 
        claim form submitted must include the second physician's unique 
        identifier is deemed to be satisfied if the claim form 
        identifies (in a manner specified by the Secretary of Health 
        and Human Services) the second physician.