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104TH CONGRESS

1ST SESSION H. R. 1750

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

medicare reimbursement for nurse practitioners and clinical nurse specialists to increase the delivery of health services in health professional

shortage areas, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JUNE 6, 1995

Mr. TOWNS (for himself and Mrs. JOHNSON of Connecticut) introduced the

following bill; which was referred to the Committee on 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 increased medicare reimbursement for nurse practitioners and clinical nurse specialists to increase the delivery of health services in health professional shortage

areas, and for other purposes.

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 ‘‘Primary Care Health

5 Practitioner Incentive Act of 1995’’.
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1 SEC. 2. INCREASED MEDICARE REIMBURSEMENT FOR

2 NURSE PRACTITIONERS AND CLINICAL

3 NURSE SPECIALISTS.

4 (a) REMOVAL OF RESTRICTIONS ON SETTINGS.—

5 (1) IN GENERAL.—Section 1861(s)(2)(K)(ii) of

6 the Social Security Act (42 U.S.C.

7 1395x(s)(2)(K)(ii)) is amended to read as follows:

8 ‘‘(ii) services which would be physicians’ serv9 ices if furnished by a physician (as defined in sub10 section (r)(1)) and which are performed by a nurse

11 practitioner or clinical nurse specialist (as defined in

12 subsection (aa)(5)) working in collaboration (as de13 fined in subsection (aa)(6)) with a physician (as so

14 defined) which the nurse practitioner or clinical

15 nurse specialist is legally authorized to perform by

16 the State in which the services are performed, and

17 such services and supplies furnished as an incident

18 to such services as would be covered under subpara19 graph (A) if furnished incident to a physician’s pro20 fessional service;’’.

21 (2) CONFORMING AMENDMENTS.—

22 (A) Section 1861(s)(2)(K) of such Act (42

23 U.S.C. 1395x(s)(2)(K)), as amended by para24 graph (1), is amended—

25 (i) in clause (i), by inserting ‘‘and

26 such services and supplies furnished as in-
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1 cident to such services as would be covered

2 under subparagraph (A) if furnished as an

3 incident to a physician’s professional serv4 ice.’’ after ‘‘are performed, and’’; and

5 (ii) by striking clauses (iii) and (iv).

6 (B) Section 1861(b)(4) of such Act (42

7 U.S.C. 1395x(b)(4)) is amended by striking

8 ‘‘clauses (i) or (iii) of subsection (s)(2)(K)’’ and

9 inserting ‘‘subsection (s)(2)(K)’’.

10 (C) Section 1862(a)(14) of such Act

11 (42 U.S.C. 1395y(a)(14)) is amended by

12 striking ‘‘section 1861(s)(2)(K)(i) or

13 1861(s)(2)(K)(iii)’’ and inserting ‘‘section

14 1861(s)(2)(K)’’.

15 (D) Section 1866(a)(1)(H) of such

16 Act (42 U.S.C. 1395cc(a)(1)(H)) is

17 amended by striking ‘‘section

18 1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)’’

19 and inserting ‘‘section 1861(s)(2)(K)’’.

20 (b) INCREASED PAYMENT.—

21 (1) FEE SCHEDULE AMOUNT.—Section

22 1833(a)(1)(O) of the Social Security Act (42 U.S.C.

23 1395l(a)(1)(O)) is amended to read as follows: ‘‘(O)

24 with respect to services described in section

25 1861(s)(2)(K)(ii) (relating to nurse practitioner or
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1 clinical nurse specialist services), the amounts paid

2 shall be equal to 80 percent of (i) the lesser of the

3 actual charge or 85 percent of the fee schedule

4 amount provided under section 1848 for the same

5 service provided by a physician who is not a special6 ist; or (ii) in the case of services as an assistant at

7 surgery, the lesser of the actual charge or 85 per8 cent of the amount that would otherwise be recog9 nized if performed by a physician who is serving as

10 an assistant at surgery, and’’.

11 (2) CONFORMING AMENDMENTS.—

12 (A) Section 1833(r) of such Act (42

13 U.S.C. 1395l(r)) is amended—

14 (i) in paragraph (1), by striking ‘‘sec15 tion 1861(s)(2)(K)(iii) (relating to nurse

16 practitioner or clinical nurse specialist

17 services provided in a rural area),’’ and in18 serting ‘‘section 1861(s)(2)(K)(ii) (relating

19 to nurse practitioner or clinical nurse spe20 cialist services),’’;

21 (ii) by striking paragraph (2);

22 (iii) in paragraph (3), by striking

23 ‘‘section 1861(s)(2)(K)(iii)’’ and inserting

24 ‘‘section 1861(s)(2)(K)(ii)’’; and
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1 (iv) by redesignating paragraph (3) as

2 paragraph (2).

3 (B) Section 1842(b)(12)(A) of such Act

4 (42 U.S.C. 1395u(b)(12)(A)) is amended in the

5 matter preceding clause (i), by striking ‘‘clauses

6 (i), (ii), or (iv) of section 1861(s)(2)(K) (relat7 ing to a physician assistants and nurse practi8 tioners)’’ and inserting ‘‘section

9 1861(s)(2)(K)(i) (relating to physician assist10 ants)’’.

11 (c) DIRECT PAYMENT FOR NURSE PRACTITIONERS

12 AND CLINICAL NURSE SPECIALISTS.—

13 (1) IN GENERAL.—Section 1832(a)(2)(B)(iv) of

14 the Social Security Act (42 U.S.C.

15 1395k(a)(2)(B)(iv)) is amended by striking ‘‘pro16 vided in a rural area (as defined in section

17 1886(d)(2)(D))’’.

18 (2) CONFORMING AMENDMENT.—Section

19 1842(b)(6)(C) of such Act (42 U.S.C.

20 1395u(b)(6)(C)) is amended—

21 (A) by striking ‘‘clauses (i), (ii), or (iv)’’

22 and inserting ‘‘clause (i)’’; and

23 (B) by striking ‘‘or nurse practitioner’’.
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1 (d) BONUS PAYMENT FOR SERVICES PROVIDED IN

2 HEALTH PROFESSIONAL SHORTAGE AREAS.—Section

3 1833(m) of such Act (42 U.S.C. 1395l(m)) is amended—

4 (1) by inserting ‘‘(1)’’ after ‘‘(m)’’; and

5 (2) by adding at the end the following new

6 paragraph:

7 ‘‘(2) In the case of services of a nurse practitioner

8 or clinical nurse specialist furnished to an individual, de9 scribed in paragraph (1), in an area that is a health pro10 fessional shortage area as described in such paragraph,

11 in addition to the amount otherwise paid under this part,

12 there shall also be paid to such service provider (on a

13 monthly or quarterly basis) from the Federal Supple14 mentary Medical Insurance Trust Fund an amount equal

15 to 10 percent of the payment amount for the service under

16 this part.’’.

17 (e) DEFINITION OF CLINICAL NURSE SPECIALIST

18 CLARIFIED.—Section 1861(aa)(5) of such Act (42 U.S.C.

19 1395x(aa)(5)) is amended—

20 (1) by inserting ‘‘(A)’’ after ‘‘(5)’’;

21 (2) by striking ‘‘The term ‘‘ ‘physician assist22 ant’ ’’ and all that follows through ‘‘who performs’’

23 and inserting ‘‘The term ‘physician assistant’ and

24 the term ‘nurse practitioner’ mean, for purposes of
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1 this title, a physician assistant or nurse practitioner

2 who performs’’; and

3 (3) by adding at the end the following new sub4 paragraph:

5 ‘‘(B) The term ‘clinical nurse specialist’ means,

6 for purposes of this title, an individual who—

7 ‘‘(i) is a registered nurse and is licensed to

8 practice nursing in the State in which the clini9 cal nurse specialist services are performed; and

10 ‘‘(ii) holds a master’s degree in a defined

11 clinical area of nursing from an accredited edu12 cational institution.’’.

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

14 this section shall apply with respect to services furnished

15 and supplies provided on and after July 1, 1995.

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