II 

109TH CONGRESS 

1ST SESSION S. 1515 

To amend title XIX of the Social Security Act to improve access to advanced 

practice nurses and physician assistants under the Medicaid Program. 

IN THE SENATE OF THE UNITED STATES 

JULY 27, 2005 

Mr. INOUYE introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL

To amend title XIX of the Social Security Act to improve 

access to advanced practice nurses and physician assistants under the Medicaid Program.

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 ‘‘Medicaid Advanced 

5 Practice Nurses and Physician Assistants Access Act of 

6 2005’’. 
2

•S 1515 IS

1 SEC. 2. IMPROVED ACCESS TO SERVICES OF ADVANCED 

2 PRACTICE NURSES AND PHYSICIAN ASSIST3 ANTS UNDER STATE MEDICAID PROGRAMS. 

4 (a) PRIMARY CARE CASE MANAGEMENT.—Section 

5 1905(t)(2) of the Social Security Act (42 U.S.C. 

6 1396d(t)(2)) is amended by striking subparagraph (B) 

7 and inserting the following: 

8 ‘‘(B) A nurse practitioner (as defined in section 

9 1861(aa)(5)(A)). 

10 ‘‘(C) A certified nurse-midwife (as defined in 

11 section 1861(gg)). 

12 ‘‘(D) A physician assistant (as defined in sec13 tion 1861(aa)(5)(A)).’’. 

14 (b) FEE-FOR-SERVICE PROGRAM.—Section 

15 1905(a)(21) of such Act (42 U.S.C. 1396d(a)(21)) is 

16 amended— 

17 (1) by inserting ‘‘(A)’’ after ‘‘(21)’’; 

18 (2) by striking ‘‘services furnished by a certified 

19 pediatric nurse practitioner or certified family nurse 

20 practitioner (as defined by the Secretary) which the 

21 certified pediatric nurse practitioner or certified 

22 family nurse practitioner’’ and inserting ‘‘services 

23 furnished by a nurse practitioner (as defined in sec24 tion 1861(aa)(5)(A)) or by a clinical nurse specialist 

25 (as defined in section 1861(aa)(5)(B)) which the 

26 nurse practitioner or clinical nurse specialist’’; 
3

•S 1515 IS

1 (3) by striking ‘‘the certified pediatric nurse 

2 practitioner or certified family nurse practitioner’’ 

3 and inserting ‘‘the nurse practitioner or clinical 

4 nurse specialist’’; and 

5 (4) by inserting before the semicolon at the end 

6 the following: ‘‘and (B) services furnished by a phy7 sician assistant (as defined in section 1861(aa)(5)) 

8 with the supervision of a physician which the physi9 cian assistant is legally authorized to perform under 

10 State law’’. 

11 (c) INCLUDING IN MIX OF SERVICE PROVIDERS

12 UNDER MEDICAID MANAGED CARE ORGANIZATIONS.—

13 Section 1932(b)(5)(B) of such Act (42 U.S.C. 1396u–

14 2(b)(5)(B)) is amended by inserting ‘‘, with such mix in15 cluding nurse practitioners, clinical nurse specialists, phy16 sician assistants, certified nurse midwives, and certified 

17 registered nurse anesthetists (as defined in section 

18 1861(bb)(2))’’ after ‘‘services’’. 

19 (d) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply to items and services furnished in 

21 calendar quarters beginning on or after 90 days after the 

22 date of the enactment of this Act, without regard to 

23 whether or not final regulations to carry out such amend24 ments have been promulgated by such date.

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