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104TH CONGRESS

1ST SESSION H. R. 188

To amend title XVIII of the Social Security Act to permit direct payment

under the medicare program for services of registered nurses as assistants at surgery.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 4, 1995

Mrs. COLLINS of Illinois 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 permit

direct payment under the medicare program for services

of registered nurses as assistants at surgery.

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

3 SECTION 1. DIRECT PAYMENT FOR SERVICES OF REG4 ISTERED NURSES AS ASSISTANTS AT SUR5 GERY.

6 (a) SERVICES COVERED.—Section 1861(s)(2)(K) of

7 the Social Security Act (42 U.S.C 1395x(s)(2)(K)) is

8 amended—
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1 (1) in clause (iii), by striking ‘‘and’’ at the end;

2 (2) in clause (iv), by striking ‘‘clause (i) or (ii)’’

3 and inserting ‘‘clause (i), (ii), or (iv)’’;

4 (3) by redesignating clause (iv) as clause (v);

5 and

6 (4) by inserting after clause (iii) the following

7 new clause:

8 ‘‘(iv) 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 reg11 istered nurse under the supervision of a physician

12 (as so defined) as an assistant at surgery and which

13 the registered nurse is legally authorized to perform

14 by the State in which the services are performed,

15 and’’.

16 (b) PAYMENT AMOUNT.—Section 1842(b)(12)(A) of

17 such Act (42 U.S.C. 1395u(b)(12)) is amended—

18 (1) by striking ‘‘clauses (i), (ii), or (iv)’’ and in19 serting ‘‘clauses (i), (ii), (iv), or (v)’’; and

20 (2) by striking ‘‘a physician assistants and

21 nurse practitioners’’ and inserting ‘‘physician assist22 ants, nurse practitioners, and registered nurses’’.

23 (c) PAYMENTS TO EMPLOYERS.—Section

24 1842(b)(6)(C) of such Act (42 U.S.C. 1395u(b)(6)(C)) is

25 amended—
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1 (1) by striking ‘‘clauses (i), (ii), or (iv)’’ and in2 serting ‘‘clauses (i), (ii), (iv), or (v)’’; and

3 (2) by striking ‘‘physician assistant or nurse

4 practitioner’’ and inserting ‘‘physician assistant,

5 nurse practitioner, or registered nurse’’.

6 (d) APPLICATION OF MANDATORY ASSIGNMENT

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

8 U.S.C. 1395u(b)(18)(C)(i)), as added by section 123(b)(1)

9 of the Social Security Act Amendments of 1994, is amend10 ed by striking ‘‘A physician’’ and inserting ‘‘A registered

11 nurse, physician’’.

12 (e) REDUCTION IN PAYMENTS TO AVOID DUPLICATE

13 PAYMENT.—Notwithstanding any other provision of law,

14 the Secretary of Health and Human Services may reduce

15 the amount of payments otherwise made to hospitals

16 under title XVIII of the Social Security Act to eliminate

17 estimated duplicate payments for historical or current

18 costs attributable to services described in section

19 1861(s)(2)(K)(iv) of such Act (as amended by subsection

20 (a)).

21 (e) EFFECTIVE DATE.—The amendments made by

22 this section shall apply to services furnished on or after

23 January 1, 1996.
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1 SEC. 2. STUDY OF PAYMENT RATES.

2 Not later than April 1, 1996, the Secretary of Health

3 and Human Services shall submit a report to Congress

4 containing recommendations for adjustments to the pay5 ment amounts established under part B of title XVIII of

6 the Social Security Act for services described in section

7 1861(s)(2)(K)(iv) of such Act (as amended by section

8 1(a)) to ensure that the payment amounts reflect the ap9 proximate costs of furnishing the services, taking into ac10 count the costs of compensation, overhead, and super11 vision attributable to registered nurses.

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