II

104TH CONGRESS

1ST SESSION S. 863

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

medicare reimbursement for physician assistants, to increase the delivery

of health services in health professional shortage areas, and for other

purposes.

IN THE SENATE OF THE UNITED STATES

MAY 25 (legislative day, MAY 15), 1995

Mr. GRASSLEY (for himself and Mr. CONRAD) introduced the following bill;

which was read twice and referred to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to provide

for increased medicare reimbursement for physician assistants, 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 ‘‘Physician Assistant

5 Incentive Act of 1995’’.
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1 SEC. 2. INCREASED MEDICARE REIMBURSEMENT FOR PHY2 SICIAN ASSISTANTS.

3 (a) REMOVAL OF RESTRICTION ON SETTINGS.—Sec4 tion 1861(s)(2)(K)(i) of the Social Security Act (42

5 U.S.C. 1395x(s)(2)(K)(i)) is amended by striking ‘‘(I) in

6 a hospital’’ and all that follows through ‘‘shortage area,’’.

7 (b) INCREASED PAYMENT.—

8 (1) IN GENERAL.—Section 1842(b)(12) of such

9 Act (42 U.S.C. 1395u(b)(12)) is amended by adding

10 at the end the following new subparagraph:

11 ‘‘(C) With respect to services described in clause (i)

12 and (iv) of section 1861(s)(2)(K) (relating to physician as13 sistants)—

14 ‘‘(i) payment under this part may only be made

15 on an assignment-related basis; and

16 ‘‘(ii) the amounts paid under this part shall be

17 equal to 80 percent of (I) the lesser of the actual

18 charge or 85 percent of the fee schedule amount

19 provided under section 1848 for the same service

20 provided by a physician who is not a specialist; or

21 (II) in the case of services as an assistant at sur22 gery, the lesser of the actual charge or 85 percent

23 of the amount that would otherwise be recognized if

24 performed by a physician who is serving as an as25 sistant at surgery.’’.
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1 (2) CONFORMING AMENDMENT.—Section

2 1842(b)(12)(A) of such Act (42 U.S.C.

3 1395u(b)(12)(A)) is amended in the matter preced4 ing clause (i) by striking ‘‘(i), (ii),’’ and inserting

5 ‘‘(ii)’’.

6 (3) TECHNICAL AMENDMENT.—Section

7 1842(b)(12)(A) of such Act (42 U.S.C.

8 1395u(b)(12)(A)) is amended in the matter preced9 ing clause (i) by striking ‘‘a physician assistants’’

10 and inserting ‘‘physician assistants’’.

11 (c) BONUS PAYMENT FOR SERVICES PROVIDED IN

12 HEALTH PROFESSIONAL SHORTAGE AREAS.—Section

13 1833(m) of such Act (42 U.S.C. 1395l(m)) is amended—

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

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

16 paragraph:

17 ‘‘(2) In the case of services of a physician assistant

18 furnished to an individual, described in paragraph (1), in

19 an area that is a health professional shortage area as de20 scribed in such paragraph, in addition to the amount oth21 erwise paid under this part, there shall also be paid to

22 such physician assistant (or to an employer in the cases

23 described in subparagraph (C) of section 1842(b)(6)) (on

24 a monthly or quarterly basis) from the Federal Supple25 mentary Medical Insurance Trust Fund an amount equal
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1 to 10 percent of the payment amount for the service under

2 this part.’’.

3 (d) REMOVAL OF RESTRICTION ON EMPLOYMENT

4 RELATIONSHIP.—Section 1842(b)(6) of such Act (42

5 U.S.C. 1395u(b)(6)) is amended by adding at the end the

6 following new sentence: ‘‘For purposes of subparagraph

7 (C), an employment relationship may include any inde8 pendent contractor arrangement, and employer status

9 shall be determined in accordance with the law of the

10 State in which the services described in such subparagraph

11 are performed.’’.

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

13 this section shall apply with respect to services furnished

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

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