I 

108TH CONGRESS 

1ST SESSION H. R. 1388

To amend title XVIII of the Social Security Act to provide for coverage 

under the Medicare Program for surgical first assisting services of certified registered nurse first assistants. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 20, 2003

Mr. COLLINS introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL

To amend title XVIII of the Social Security Act to provide 

for coverage under the Medicare Program for surgical 

first assisting services of certified registered nurse first 

assistants.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Certified 

5 Registered Nurse First Assistant Direct Reimbursement 

6 Act of 2003’’. 
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1 SEC. 2. MEDICARE COVERAGE OF SURGICAL FIRST ASSIST2 ING SERVICES OF CERTIFIED REGISTERED 

3 NURSE FIRST ASSISTANTS. 

4 (a) SERVICES COVERED.—Section 1861(s)(2) of the 

5 Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—

6 (1) by striking ‘‘and’’ at the end of subpara7 graph (U); 

8 (2) by inserting ‘‘and’’ at the end of subpara9 graph (V); and 

10 (3) by adding at the end the following new sub11 paragraph: 

12 ‘‘(W) surgical first assisting services (as defined 

13 in subsection (ww)(1)) furnished by a certified reg14 istered nurse first assistant (as defined in subsection 

15 (ww)(2));’’. 

16 (b) SERVICES DESCRIBED.—Section 1861 of the So17 cial Security Act (42 U.S.C. 1395x) is amended by adding 

18 at the end the following new subsection: 

19 ‘‘Surgical First Assisting Services; Certified Registered 

20 Nurse First Assistant 

21 ‘‘(ww)(1) The term ‘surgical first assisting services’ 

22 means services consisting of first assisting a physician 

23 with surgery and related preoperative, intraoperative, and 

24 postoperative care (as determined by the Secretary) fur25 nished by a certified registered nurse first assistant (as 

26 defined in paragraph (2)) which the certified registered 
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1 nurse first assistant is legally authorized to perform by 

2 the State in which the services are performed. 

3 ‘‘(2) The term ‘certified registered nurse first assist4 ant’ means an individual who—

5 ‘‘(A) is a registered nurse and is licensed to 

6 practice nursing in the State in which the surgical 

7 first assisting services are performed; 

8 ‘‘(B) has completed a minimum of 2,000 hours 

9 of first assisting a physician with surgery and re10 lated preoperative, intraoperative, and postoperative 

11 care; and 

12 ‘‘(C) is certified as a registered nurse first as13 sistant by an organization recognized by the Sec14 retary.’’. 

15 (c) PAYMENT AMOUNT.—Section 1833(a)(1) of the 

16 Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—

17 (1) by striking ‘‘and’’ before ‘‘(U)’’; and 

18 (2) by inserting before the semicolon at the end 

19 the following: ‘‘, and (V) with respect to surgical 

20 first assisting services (as defined in section 

21 1861(ww)(1)) furnished by a certified registered 

22 nurse first assistant (as defined in section 

23 1861(ww)(2)), the amount paid shall be 80 percent 

24 of the lesser of the actual charge for the services or 

25 85 percent of the amount determined under the fee 
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1 schedule established under section 1848(b) for the 

2 same services if furnished by a physician’’. 

3 (d) PAYMENTS TO EMPLOYERS.—

4 (1) IN GENERAL.—Section 1833(r) of the So5 cial Security Act (42 U.S.C. 1395l(r)) is amended—

6 (A) in paragraph (1), by inserting ‘‘or sec7 tion 1861(s)(2)(W) (relating to surgical first 

8 assisting services)’’ after ‘‘clinical nurse spe9 cialist services)’’; and 

10 (B) in paragraph (2), by striking 

11 ‘‘1861(s)(2)(K)(ii)’’ and inserting 

12 ‘‘1861(s)(2)(K)(ii) or 1861(s)(2)(W)’’. 

13 (2) APPLICATION OF MANDATORY ASSIGNMENT

14 RULES.—Section 1842(b)(18)(C)(i) of such Act (42 

15 U.S.C. 1395u(b)(18)(C)(i)) is amended by striking 

16 ‘‘physician assistant, nurse practitioner, clinical 

17 nurse specialist’’ and inserting ‘‘physician assistant, 

18 nurse practitioner, clinical nurse specialist, or cer19 tified registered nurse first assistant’’. 

20 (3) EXCLUSION FROM BUNDLED PAYMENTS

21 FOR COVERED SKILLED NURSING FACILITY SERV22 ICES.—Section 1888(e)(2)(A)(ii) of such Act (42 

23 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 

24 ‘‘surgical first assisting services of a certified reg-
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1 istered nurse first assistant,’’ after ‘‘services of a 

2 certified registered nurse anesthetist,’’. 

3 (e) REDUCTION IN PAYMENTS TO AVOID DUPLICATE

4 PAYMENT.—Notwithstanding any other provision of law, 

5 the Secretary of Health and Human Services may reduce 

6 the amount of payments otherwise made to hospitals 

7 under title XVIII of the Social Security Act (42 U.S.C. 

8 1395 et seq.) to eliminate estimated duplicate payments 

9 for historical or current costs attributable to surgical first 

10 assisting services furnished by certified registered nurse 

11 first assistants as described in section 1861(ww) of such 

12 Act (as added by subsection (a)). 

13 (f) EFFECTIVE DATE.—The amendments made by 

14 this section shall apply to services furnished on or after 

15 the date of the enactment of this Act. 

16 SEC. 3. STUDY OF PAYMENT RATES. 

17 Not later than 180 days after the date of the enact18 ment of this Act, the Secretary of Health and Human 

19 Services shall submit to Congress a report containing rec20 ommendations for adjustments to the payment amounts 

21 established under part B of title XVIII of the Social Secu22 rity Act for surgical first assisting services furnished by 

23 certified registered nurse first assistants (as described in 

24 section 1861(ww) of such Act (as added by section 1(a)) 

25 to ensure that the payment amounts reflect the approxi-
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1 mate costs of furnishing such services, taking into account 

2 the costs of compensation, overhead, and supervision at3 tributable to certified registered nurse first assistants.

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