SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Certified Registered Nurse 
First Assistant Direct Reimbursement Act of 2000''.

SEC. 2. MEDICARE COVERAGE OF SURGICAL FIRST ASSISTING SERVICES OF 
              CERTIFIED REGISTERED NURSE FIRST ASSISTANTS.

    (a) Services Covered.--Section 1861(s)(2) of the Social Security 
Act (42 U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (S);
            (2) by striking the period at the end of (T) and inserting 
        ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(U) surgical first assisting services (as defined in 
        subsection (uu)(1)) furnished by a certified registered nurse 
        first assistant (as defined in subsection (uu)(2)).''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended by adding at the end the following new 
subsection:

 ``Surgical First Assisting Services; Certified Registered Nurse First 
                               Assistant

    ``(uu)(1) The term `surgical first assisting services' means 
services consisting of first assisting a physician with surgery and 
related preoperative, intraoperative, and postoperative care (as 
determined by the Secretary) furnished by a certified registered nurse 
first assistant (as defined in paragraph (2)) which the certified 
registered nurse first assistant is legally authorized to perform by 
the State in which the services are performed.
    ``(2) The term `certified registered nurse first assistant' means 
an individual who--
            ``(A) is a registered nurse and is licensed to practice 
        nursing in the State in which the surgical first assisting 
        services are performed;
            ``(B) has completed a minimum of 2,000 hours of first 
        assisting a physician with surgery and related preoperative, 
        intraoperative, and postoperative care; and
            ``(C) is certified as a registered nurse first assistant by 
        an organization recognized by the Secretary.''.
    (c) Payment Amount.--Section 1833(a)(1) of the Social Security Act 
(42 U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and'' before ``(S)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (T) with respect to surgical first assisting 
        services (as defined in section 1861(uu)(1)) furnished by a 
        certified registered nurse first assistant (as defined in 
        section 1861(uu)(2)), the amount paid shall be 80 percent of 
        the lesser of the actual charge for the services or 85 percent 
        of the amount determined under the fee schedule established 
        under section 1848(b) for the same services if furnished by a 
        physician''.
    (d) Payments to Employers.--
            (1) In general.--Section 1833(r) of the Social Security Act 
        (42 U.S.C. 1395l(r)) is amended--
                    (A) in paragraph (1), by inserting ``or section 
                1861(s)(2)(U) (relating to surgical first assisting 
                services)'' after ``clinical nurse specialist 
                services)''; and
                    (B) in paragraph (2), by striking 
                ``1861(s)(2)(K)(ii)'' and inserting ``1861(s)(2)(K)(ii) 
                or 1861(s)(2)(U)''.
            (2) Application of mandatory assignment rules.--Section 
        1842(b)(18)(C)(i) of such Act (42 U.S.C. 1395u(b)(18)(C)(i)) is 
        amended by striking ``physician assistant, nurse practitioner, 
        clinical nurse specialist'' and inserting ``physician 
        assistant, nurse practitioner, clinical nurse specialist, or 
        certified registered nurse first assistant''.
            (3) Exclusion from bundled payments for covered skilled 
        nursing facility services.--Section 1888(e)(2)(A)(ii) of such 
        Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 
        ``surgical first assisting services of a certified registered 
        nurse first assistant,'' after ``services of a certified 
        registered nurse anesthetist,''.
    (e) Reduction in Payments To Avoid Duplicate Payment.--
Notwithstanding any other provision of law, the Secretary of Health and 
Human Services may reduce the amount of payments otherwise made to 
hospitals under title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.) to eliminate estimated duplicate payments for historical or 
current costs attributable to surgical first assisting services 
furnished by certified registered nurse first assistants as described 
in section 1861(uu) of such Act (as added by subsection (a)).
    (f) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the date of the enactment of 
this Act.

SEC. 3. STUDY OF PAYMENT RATES.

    Not later than 180 days after the date of the enactment of this 
Act, the Secretary of Health and Human Services shall submit to 
Congress a report containing recommendations for adjustments to the 
payment amounts established under part B of title XVIII of the Social 
Security Act for surgical first assisting services furnished by 
certified registered nurse first assistants (as described in section 
1861(uu) of such Act (as added by section 1(a)) to ensure that the 
payment amounts reflect the approximate costs of furnishing such 
services, taking into account the costs of compensation, overhead, and 
supervision attributable to certified registered nurse first 
assistants.
Provides for payment of such nurses on an assignment-related basis.
Excludes services of such nurses from the definition of "covered skilled nursing facility services" for purposes of applying a prospective payment formula for such services.
Directs the Secretary of Health and Human Services to reduce the amount of Medicare payments otherwise made to hospitals to eliminate estimated duplicate payments for historical or current costs attributable to surgical first assisting services furnished by certified registered nurse first assistants.
Requires the Secretary to report to Congress on recommendations for adjustments to the payment amounts established under part B (Supplementary Medical Insurance) of Medicare for surgical first assisting services furnished by such nurses to ensure that the payment amounts reflect the approximate costs of furnishing such services, taking into account the costs of compensation, overhead, and supervision attributable to such nurses.
Medicare Certified Registered Nurse First Assistant Direct Reimbursement Act of 2000