January 6, 2009 CONGRESSIONAL RECORD — SENATE S59 

center or a Native Hawaiian health 

care system; to the Committee on Finance. 

Mr. INOUYE. Mr. President, today I 

am reintroducing the Native Hawaiian 

Medicaid Coverage Act. This legislation would authorize a Federal Medicaid Assistance Percent, FMAP, of 100 

percent for the payment of health care 

costs of Native Hawaiians who receive 

health care from Federally Qualified 

Health Centers or the Native Hawaiian 

Health Care System. 

This bill is modeled on the Native 

Alaskan Health Care Act, which provides for a Federal Medicaid Assistance 

Percent of 100 percent for payment of 

health care costs for Native Alaskans 

by the Indian Health Service, an Indian 

tribe, or a tribal organization. 

Community health centers serve as 

the ‘‘safety net’’ for uninsured and 

medically underserved Native Hawaiians and other United States citizens, 

providing comprehensive primary and 

preventive health services to the entire 

community. Outpatient services offered to the entire family include comprehensive primary care, preventive 

health maintenance, and education 

outreach in the local community. Community health centers, with their multidisciplinary approach, offer cost effective integration of health promotion 

and wellness with chronic disease management and primary care focused on 

serving vulnerable populations. 

Mr. President, I ask unanimous consent that the text of the bill be printed 

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 52 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Native Hawaiian Medicaid Coverage Act of 2009’’. 

SEC. 2. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED TO A NATIVE HAWAIIAN THROUGH A FEDERALLYQUALIFIED HEALTH CENTER OR A 

NATIVE HAWAIIAN HEALTH CARE 

SYSTEM UNDER THE MEDICAID PROGRAM. 

(a) MEDICAID.—The third sentence of section 1905(b) of the Social Security Act (42 

U.S.C. 1396d(b)) is amended by inserting ‘‘, 

and with respect to medical assistance provided to a Native Hawaiian (as defined in 

section 12 of the Native Hawaiian Health 

Care Improvement Act) through a Federallyqualified health center or a Native Hawaiian 

health care system (as so defined) whether 

directly, by referral, or under contract or 

other arrangement between a Federallyqualified health center or a Native Hawaiian 

health care system and another health care 

provider’’ before the period. 

(b) EFFECTIVE DATE.—The amendment 

made by this section applies to medical assistance provided on or after the date of enactment of this Act. 

By Mr. INOUYE: 

S. 53. A bill to amend title XIX of the 

Social Security Act to provide for coverage of services provided by nursing 

school clinics under State Medicaid 

programs; to the Committee on Finance. 

Mr. INOUYE. Mr. President, today I 

am, again, introducing the Nursing 

School Clinics Act. This measure 

builds on our concerted efforts to provide access to quality health care for 

all Americans by offering grants and 

incentives for nursing schools to establish primary care clinics in underserved areas where additional medical 

services are most needed. In addition, 

this measure provides the opportunity 

for nursing schools to enhance the 

scope of student training and education 

by providing firsthand clinical experience in primary care facilities. 

Primary care clinics administered by 

nursing schools are university of nonprofit primary care centers developed 

mainly in collaboration with university schools of nursing and the communities they serve. These centers are 

staffed by faculty and staff who are 

nurse practitioners and public health 

nurses. Students supplement patient 

care while receiving preceptorships 

provided by college of nursing faculty 

and primary care physicians, often associated with academic institutions, 

who serve as collaborators with nurse 

practitioners. To date, the comprehensive models of care provided by nursing 

clinics have yielded excellent results, 

including significantly fewer emergency room visits, fewer hospital inpatient days, and less use of specialists, 

as compared to conventional primary 

health care. 

The bill reinforces the principle of 

combining health care delivery in underserved areas with the education of 

advanced practice nurses. To accomplish these objectives, Title XIX of the 

Social Security Act would be amended 

to designate that the services provided 

in these nursing school clinics are reimbursable under Medicaid. The combination of grants and the provision of 

Medicaid reimbursement furnishes the 

financial incentives for clinic operators 

to establish the clinics. 

In order to meet the increasing challenges of bringing cost-effective and 

quality health care to all Americans, 

we must consider a wide range of proposals, both large and small. Most importantly, we must approach the issue 

of health care with creativity and determination, ensuring that all reasonable avenues are pursued. Nurses have 

always been an integral part of health 

care delivery. The Nursing School Clinics Act recognizes the central role 

nurses can perform as care givers to 

the medically underserved. 

Mr. President, I ask unanimous consent that the text of the bill be printed 

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 53 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Nursing 

School Clinics Act of 2009’’. 

SEC. 2. MEDICAID COVERAGE OF SERVICES PROVIDED BY NURSING SCHOOL CLINICS. 

(a) IN GENERAL.—Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is 

amended— 

(1) in paragraph (27), by striking ‘‘and’’ at 

the end; 

(2) by redesignating paragraph (28) as paragraph (29); and 

(3) by inserting after paragraph (27), the 

following new paragraph: 

‘‘(28) nursing school clinic services (as defined in subsection (y)) furnished by or under 

the supervision of a nurse practitioner or a 

clinical nurse specialist (as defined in section 1861(aa)(5)), whether or not the nurse 

practitioner or clinical nurse specialist is 

under the supervision of, or associated with, 

a physician or other health care provider; 

and’’. 

(b) NURSING SCHOOL CLINIC SERVICES DEFINED.—Section 1905 of the Social Security 

Act (42 U.S.C. 1396d) is amended by adding at 

the end the following new subsection: 

‘‘(y) The term ‘nursing school clinic services’ means services provided by a health 

care facility operated by an accredited 

school of nursing which provides primary 

care, long-term care, mental health counseling, home health counseling, home health 

care, or other health care services which are 

within the scope of practice of a registered 

nurse.’’. 

(c) CONFORMING AMENDMENT.—Section 

1902(a)(10)(C)(iv) of the Social Security Act 

(42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by 

inserting ‘‘and (28)’’ after ‘‘(24)’’. 

(d) EFFECTIVE DATE.—The amendments 

made by this section shall be effective with 

respect to payments made under a State plan 

under title XIX of the Social Security Act 

(42 U.S.C. 1396 et seq.) for calendar quarters 

commencing with the first calendar quarter 

beginning after the date of enactment of this 

Act. 

By Mr. INOUYE: 

S. 54. A bill to amend title XVIII of 

the Social Security Act to provide for 

patient protection by establishing minimum nurse staffing ratios at certain 

Medicare providers, and for other purposes; to the Committee on Finance. 

Mr. INOUYE. Mr. President, today I 

am, again, reintroducing the Registered Nurse Safe Staffing Act. For 

over four decades I have been a committed supporter of nurses and the delivery of safe patient care. While enforceable regulations will help to ensure patient safety, the complexity and 

variability of today’s hospitals require 

that staffing patters be determined at 

the hospital and unit level, with the 

professional input of registered nurses. 

More than a decade of research demonstrates that nurse staff levels and 

the skill mix of nursing staff directly 

affect the clinical outcomes of hospitalized patients. Studies show that 

when there are more registered nurses, 

there are lower mortality rates, shorter lengths of stay, reduced costs, and 

fewer complications. 

A study published in the Journal of 

the American Medical Association 

found that the risks of patient mortality rose by 7 percent for every additional patient added to the average 

nurse’s workload. In the midst of a 

nursing shortage and increasing financial pressures, hospitals often find it 

difficult to maintain adequate staffing. 


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S60 CONGRESSIONAL RECORD — SENATE January 6, 2009 

While nursing research indicates that 

adequate registered nurse staffing is 

vital to the health and safety of patients, there is no standardized public 

reporting mechanism, nor enforcement 

of adequate staffing plans. The only 

regulations addressing nursing staff exists vaguely in Medicare Conditions of 

Participation which states: ‘‘The nursing service must have an adequate 

number of licensed registered nurses, 

licensed practice, vocational, nurses, 

and other personnel to provide nursing 

care to all patients as needed’’. 

This bill will require Medicare Participating Hospitals to develop and 

maintain reliable and valid systems to 

determine sufficient registered nurse 

staffing. Given the demands that the 

healthcare industry faces today, it is 

our responsibility to ensure that patients have access to adequate nursing 

care. However, we must ensure that the 

decisions by which care is provided are 

made by the clinical experts, the registered nurses caring for these patients. Support of this bill supports our 

Nation’s nurses during a critical shortage, but more importantly, works to 

ensure the safety of their patients. 

Mr. President. I ask unanimous consent that the text of the bill be printed 

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 54 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Registered 

Nurse Safe Staffing Act of 2009’’. 

SEC. 2. FINDINGS. 

Congress makes the following findings: 

(1) There are hospitals throughout the 

United States that have inadequate staffing 

of registered nurses to protect the well-being 

and health of the patients. 

(2) Studies show that the health of patients 

in hospitals is directly proportionate to the 

number of registered nurses working in the 

hospital. 

(3) There is a critical shortage of registered 

nurses in the United States. 

(4) The effect of that shortage is revealed 

in unsafe staffing levels in hospitals. 

(5) Patient safety is adversely affected by 

these unsafe staffing levels, creating a public 

health crisis. 

(6) Registered nurses are being required to 

perform professional services under conditions that do not support quality health care 

or a healthful work environment for registered nurses. 

(7) As a payer for inpatient and outpatient 

hospital services for individuals entitled to 

benefits under the Medicare program established under title XVIII of the Social Security Act, the Federal Government has a compelling interest in promoting the safety of 

such individuals by requiring any hospital 

participating in such program to establish 

minimum safe staffing levels for registered 

nurses. 

SEC. 3. ESTABLISHMENT OF MINIMUM STAFFING 

RATIOS BY MEDICARE PARTICIPATING HOSPITALS. 

(a) REQUIREMENT OF MEDICARE PROVIDER

AGREEMENT.—Section 1866(a)(1) of the Social 

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

amended— 

(1) in subparagraph (U), by striking ‘‘and’’ 

at the end; 

(2) in subparagraph (V), by striking the period at the end and inserting ‘‘, and’’; and 

(3) by inserting after subparagraph (V) the 

following new subparagraph: 

‘‘(W) in the case of a hospital, to meet the 

requirements of section 1899.’’. 

(b) REQUIREMENTS.—Title XVIII of the Social Security Act is amended by inserting 

after section 1889 the following new section: 

‘‘STAFFING REQUIREMENTS FOR MEDICARE

PARTICIPATING HOSPITALS

‘‘SEC. 1899. (a) ESTABLISHMENT OF STAFFING

SYSTEM.— 

‘‘(1) IN GENERAL.—Each participating hospital shall adopt and implement a staffing 

system that ensures a number of registered 

nurses on each shift and in each unit of the 

hospital to ensure appropriate staffing levels 

for patient care. 

‘‘(2) STAFFING SYSTEM REQUIREMENTS.— 

Subject to paragraph (3), a staffing system 

adopted and implemented under this section 

shall— 

‘‘(A) be based upon input from the direct 

care-giving registered nurse staff or their exclusive representatives, as well as the chief 

nurse executive; 

‘‘(B) be based upon the number of patients 

and the level and variability of intensity of 

care to be provided, with appropriate consideration given to admissions, discharges, and 

transfers during each shift; 

‘‘(C) account for contextual issues affecting staffing and the delivery of care, including architecture and geography of the environment and available technology; 

‘‘(D) reflect the level of preparation and 

experience of those providing care; 

‘‘(E) account for staffing level effectiveness 

or deficiencies in related health care classifications, including but not limited to, certified nurse assistants, licensed vocational 

nurses, licensed psychiatric technicians, 

nursing assistants, aides, and orderlies; 

‘‘(F) reflect staffing levels recommended 

by specialty nursing organizations; 

‘‘(G) establish upwardly adjustable registered nurse-to-patient ratios based upon 

registered nurses’ assessment of patient acuity and existing conditions; 

‘‘(H) provide that a registered nurse shall 

not be assigned to work in a particular unit 

without first having established the ability 

to provide professional care in such unit; and 

‘‘(I) be based on methods that assure validity and reliability. 

‘‘(3) LIMITATION.—A staffing system adopted and implemented under paragraph (1) may 

not— 

‘‘(A) set registered-nurse levels below those 

required by any Federal or State law or regulation; or 

‘‘(B) utilize any minimum registered 

nurse-to-patient ratio established pursuant 

to paragraph (2)(G) as an upper limit on the 

staffing of the hospital to which such ratio 

applies. 

‘‘(b) REPORTING, AND RELEASE TO PUBLIC, 

OF CERTAIN STAFFING INFORMATION.— 

‘‘(1) REQUIREMENTS FOR HOSPITALS.—Each 

participating hospital shall— 

‘‘(A) post daily for each shift, in a clearly 

visible place, a document that specifies in a 

uniform manner (as prescribed by the Secretary) the current number of licensed and 

unlicensed nursing staff directly responsible 

for patient care in each unit of the hospital, 

identifying specifically the number of registered nurses; 

‘‘(B) upon request, make available to the 

public— 

‘‘(i) the nursing staff information described 

in subparagraph (A); and 

‘‘(ii) a detailed written description of the 

staffing system established by the hospital 

pursuant to subsection (a); and 

‘‘(C) submit to the Secretary in a uniform 

manner (as prescribed by the Secretary) the 

nursing staff information described in subparagraph (A) through electronic data submission not less frequently than quarterly. 

‘‘(2) SECRETARIAL RESPONSIBILITIES.—The 

Secretary shall— 

‘‘(A) make the information submitted pursuant to paragraph (1)(C) publicly available, 

including by publication of such information 

on the Internet website of the Department of 

Health and Human Services; and 

‘‘(B) provide for the auditing of such information for accuracy as a part of the process 

of determining whether an institution is a 

hospital for purposes of this title. 

‘‘(c) RECORDKEEPING; DATA COLLECTION; 

EVALUATION.— 

‘‘(1) RECORDKEEPING.—Each participating 

hospital shall maintain for a period of at 

least 3 years (or, if longer, until the conclusion of pending enforcement activities) such 

records as the Secretary deems necessary to 

determine whether the hospital has adopted 

and implemented a staffing system pursuant 

to subsection (a). 

‘‘(2) DATA COLLECTION ON CERTAIN OUTCOMES.—The Secretary shall require the collection, maintenance, and submission of data 

by each participating hospital sufficient to 

establish the link between the staffing system established pursuant to subsection (a) 

and— 

‘‘(A) patient acuity from maintenance of 

acuity data through entries on patients’ 

charts; 

‘‘(B) patient outcomes that are nursing 

sensitive, such as patient falls, adverse drug 

events, injuries to patients, skin breakdown, 

pneumonia, infection rates, upper gastrointestinal bleeding, shock, cardiac arrest, 

length of stay, and patient readmissions; 

‘‘(C) operational outcomes, such as workrelated injury or illness, vacancy and turnover rates, nursing care hours per patient 

day, on-call use, overtime rates, and needlestick injuries; and 

‘‘(D) patient complaints related to staffing 

levels. 

‘‘(3) EVALUATION.—Each participating hospital shall annually evaluate its staffing system and establish minimum registered nurse 

staffing ratios to assure ongoing reliability 

and validity of the system and ratios. The 

evaluation shall be conducted by a joint 

management-staff committee comprised of 

at least 50 percent of registered nurses who 

provide direct patient care. 

‘‘(d) ENFORCEMENT.— 

‘‘(1) RESPONSIBILITY.—The Secretary shall 

enforce the requirements and prohibitions of 

this section in accordance with the succeeding provisions of this subsection. 

‘‘(2) PROCEDURES FOR RECEIVING AND INVESTIGATING COMPLAINTS.—The Secretary shall 

establish procedures under which— 

‘‘(A) any person may file a complaint that 

a participating hospital has violated a requirement or a prohibition of this section; 

and 

‘‘(B) such complaints are investigated by 

the Secretary. 

‘‘(3) REMEDIES.—If the Secretary determines that a participating hospital has violated a requirement of this section, the Secretary— 

‘‘(A) shall require the facility to establish 

a corrective action plan to prevent the recurrence of such violation; and 

‘‘(B) may impose civil money penalties 

under paragraph (4). 

‘‘(4) CIVIL MONEY PENALTIES.— 

‘‘(A) IN GENERAL.—In addition to any other 

penalties prescribed by law, the Secretary 

may impose a civil money penalty of not 

more than $10,000 for each knowing violation 

of a requirement of this section, except that 

the Secretary shall impose a civil money 


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January 6, 2009 CONGRESSIONAL RECORD — SENATE S61 

penalty of more than $10,000 for each such 

violation in the case of a participating hospital that the Secretary determines has a 

pattern or practice of such violations (with 

the amount of such additional penalties 

being determined in accordance with a 

schedule or methodology specified in regulations). 

‘‘(B) PROCEDURES.—The provisions of section 1128A (other than subsections (a) and 

(b)) shall apply to a civil money penalty 

under this paragraph in the same manner as 

such provisions apply to a penalty or proceeding under section 1128A. 

‘‘(C) PUBLIC NOTICE OF VIOLATIONS.— 

‘‘(i) INTERNET WEBSITE.—The Secretary 

shall publish on the Internet website of the 

Department of Health and Human Services 

the names of participating hospitals on 

which civil money penalties have been imposed under this section, the violation for 

which the penalty was imposed, and such additional information as the Secretary determines appropriate. 

‘‘(ii) CHANGE OF OWNERSHIP.—With respect 

to a participating hospital that had a change 

in ownership, as determined by the Secretary, penalties imposed on the hospital 

while under previous ownership shall no 

longer be published by the Secretary of such 

Internet website after the 1-year period beginning on the date of change in ownership. 

‘‘(e) WHISTLEBLOWER PROTECTIONS.— 

‘‘(1) PROHIBITION OF DISCRIMINATION AND RETALIATION.—A participating hospital shall 

not discriminate or retaliate in any manner 

against any patient or employee of the hospital because that patient or employee, or 

any other person, has presented a grievance 

or complaint, or has initiated or cooperated 

in any investigation or proceeding of any 

kind, relating to the staffing system or other 

requirements and prohibitions of this section. 

‘‘(2) RELIEF FOR PREVAILING EMPLOYEES.— 

An employee of a participating hospital who 

has been discriminated or retaliated against 

in employment in violation of this subsection may initiate judicial action in a 

United States district court and shall be entitled to reinstatement, reimbursement for 

lost wages, and work benefits caused by the 

unlawful acts of the employing hospital. Prevailing employees are entitled to reasonable 

attorney’s fees and costs associated with 

pursuing the case. 

‘‘(3) RELIEF FOR PREVAILING PATIENTS.—A 

patient who has been discriminated or retaliated against in violation of this subsection 

may initiate judicial action in a United 

States district court. A prevailing patient 

shall be entitled to liquidated damages of 

$5,000 for a violation of this statute in addition to any other damages under other applicable statutes, regulations, or common law. 

Prevailing patients are entitled to reasonable attorney’s fees and costs associated 

with pursuing the case. 

‘‘(4) LIMITATION ON ACTIONS.—No action 

may be brought under paragraph (2) or (3) 

more than 2 years after the discrimination 

or retaliation with respect to which the action is brought. 

‘‘(5) TREATMENT OF ADVERSE EMPLOYMENT

ACTIONS.—For purposes of this subsection— 

‘‘(A) an adverse employment action shall 

be treated as retaliation or discrimination; 

and 

‘‘(B) the term ‘adverse employment action’ 

includes— 

‘‘(i) the failure to promote an individual or 

provide any other employment-related benefit for which the individual would otherwise 

be eligible; 

‘‘(ii) an adverse evaluation or decision 

made in relation to accreditation, certification, credentialing, or licensing of the individual; and 

‘‘(iii) a personnel action that is adverse to 

the individual concerned. 

‘‘(f) RELATIONSHIP TO STATE LAWS.—Nothing in this section shall be construed as exempting or relieving any person from any liability, duty, penalty, or punishment provided by any present or future law of any 

State or political subdivision of a State, 

other than any such law which purports to 

require or permit the doing of any act which 

would be an unlawful practice under this 

title. 

‘‘(g) RELATIONSHIP TO CONDUCT PROHIBITED

UNDER THE NATIONAL LABOR RELATIONS ACT

OR OTHER COLLECTIVE BARGAINING LAWS.— 

Nothing in this section shall be construed as 

permitting conduct prohibited under the National Labor Relations Act or under any 

other Federal, State, or local collective bargaining law. 

‘‘(h) REGULATIONS.—The Secretary shall 

promulgate such regulations as are appropriate and necessary to implement this section. 

‘‘(i) DEFINITIONS.—In this section: 

‘‘(1) PARTICIPATING HOSPITAL.—The term 

‘participating hospital’ means a hospital 

that has entered into a provider agreement 

under section 1866. 

‘‘(2) REGISTERED NURSE.—The term ‘registered nurse’ means an individual who has 

been granted a license to practice as a registered nurse in at least 1 State. 

‘‘(3) UNIT.—The term ‘unit’ of a hospital is 

an organizational department or separate geographic area of a hospital, such as a burn 

unit, a labor and delivery room, a post-anesthesia service area, an emergency department, an operating room, a pediatric unit, a 

stepdown or intermediate care unit, a specialty care unit, a telemetry unit, a general 

medical care unit, a subacute care unit, and 

a transitional inpatient care unit. 

‘‘(4) SHIFT.—The term ‘shift’ means a 

scheduled set of hours or duty period to be 

worked at a participating hospital. 

‘‘(5) PERSON.—The term ‘person’ means 1 or 

more individuals, associations, corporations, 

unincorporated organizations, or labor 

unions.’’. 

(c) EFFECTIVE DATE.—The amendments 

made by this section shall take effect on 

January 1, 2010. 

By Mr. INOUYE: 

S. 55. A bill to amend the XVIII of 

the Social Security Act to provide improved reimbursement for clinical social worker services under the Medicare program; to the Committee on Finance. 

Mr. INOUYE. Mr. President, today I 

am, again, introducing legislation to 

amend title XVIII of the Social Security Act to correct discrepancies in the 

reimbursement of clinical social workers covered through Medicare, Part B. 

These three proposed changes contained in this legislation clarify the 

current payment process for clinical 

social workers and establish a reimbursement methodology for the profession that is similar to other health 

care professionals reimbursed through 

the Medicare program. 

First, this legislation sets payment 

for clinical social worker services according to a fee schedule established by 

the Secretary. Second, it explicitly 

states that services and supplies furnished by a clinical social worker are a 

covered Medicare expense, just as these 

services are covered for other mental 

health professionals in Medicare. 

Third, the bill allows clinical social 

workers to be reimbursed for services 

provided to a client who is hospitalized. 

Clinical social workers are valued 

members of our health care provider 

network. They are legally regulated in 

every state of the nation and are recognized as independent providers of mental health care throughout the health 

care system. It is time to correct the 

disparate reimbursement treatment of 

this profession under Medicare. 

Mr. President, I ask unanimous consent that the text of the bill be printed 

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 55 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Equity for 

Clinical Social Workers Act of 2009’’. 

SEC. 2. IMPROVED REIMBURSEMENT FOR CLINICAL SOCIAL WORKER SERVICES 

UNDER MEDICARE. 

(a) IN GENERAL.—Section 1833(a)(1)(F)(ii) of 

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

1395l(a)(1)(F)(ii)) is amended to read as follows: ‘‘(ii) the amount determined by a fee 

schedule established by the Secretary,’’. 

(b) DEFINITION OF CLINICAL SOCIAL WORKER

SERVICES EXPANDED.—Section 1861(hh)(2) of 

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

1395x(hh)(2)) is amended by striking ‘‘services performed by a clinical social worker (as 

defined in paragraph (1))’’ and inserting 

‘‘such services and such services and supplies 

furnished as an incident to such services performed by a clinical social worker (as defined in paragraph (1))’’. 

(c) CLINICAL SOCIAL WORKER SERVICES NOT

TO BE INCLUDED IN INPATIENT HOSPITAL

SERVICES.—Section 1861(b)(4) of the Social 

Security Act (42 U.S.C. 1395x(b)(4)) is amended by striking ‘‘and services’’ and inserting 

‘‘clinical social worker services, and services’’. 

(d) TREATMENT OF SERVICES FURNISHED IN

INPATIENT SETTING.—Section 1832(a)(2)(B)(iii) 

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

1395k(a)(2)(B)(iii)) is amended— 

(1) by striking ‘‘and services’’ and inserting 

‘‘clinical social worker services, and services’’; and 

(2) by adding ‘‘and’’ at the end. 

(e) EFFECTIVE DATE.—The amendments 

made by this section shall apply to payments 

made for clinical social worker services furnished on or after January 1, 2010. 

By Mr. INOUYE: 

S. 56. A bill to amend the XVIII of 

the Social Security Act to remove the 

restriction that a clinical psychologist 

or clinical social worker provide services in a comprehensive outpatient rehabilitation facility to a patient only 

under the care of a physician; to the 

Committee on Finance. 

Mr. INOUYE. Mr. President, today I 

again introduce legislation to authorize the autonomous functioning of clinical psychologists and clinical social 

workers within the Medicare comprehensive outpatient rehabilitation 

facility program. 

In my judgment, it is unfortunate 

that Medicare requires clinical supervision of the services provided by certain health professionals and does not 


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