II

104TH CONGRESS

1ST SESSION S. 864

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 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 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)

6 of 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 (42

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

12 ‘‘section 1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)’’

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

14 (D) Section 1866(a)(1)(H) of such Act (42

15 U.S.C. 1395cc(a)(1)(H)) is amended by strik16 ing ‘‘section 1861(s)(2)(K)(i) or

17 1861(s)(2)(K)(iii)’’ and inserting ‘‘section

18 1861(s)(2)(K)’’.

19 (b) INCREASED PAYMENT.—

20 (1) FEE SCHEDULE AMOUNT.—Section

21 1833(a)(1)(O) of the Social Security Act (42 U.S.C.

22 1395l(a)(1)(O)) is amended to read as follows: ‘‘(O)

23 with respect to services described in section

24 1861(s)(2)(K)(ii) (relating to nurse practitioner or

25 clinical nurse specialist services), the amounts paid
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1 shall be equal to 80 percent of (i) the lesser of the

2 actual charge or 85 percent of the fee schedule

3 amount provided under section 1848 for the same

4 service provided by a physician who is not a special5 ist; or (ii) in the case of services as an assistant

6 at surgery, the lesser of the actual charge or 85 per7 cent of the amount that would otherwise be recog8 nized if performed by a physician who is serving as

9 an assistant at surgery, and’’.

10 (2) CONFORMING AMENDMENTS.—

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

12 U.S.C. 1395l(r)) is amended—

13 (i) in paragraph (1), by striking ‘‘sec14 tion 1861(s)(2)(K)(iii) (relating to nurse

15 practitioner or clinical nurse specialist

16 services provided in a rural area),’’ and in17 serting ‘‘section 1861(s)(2)(K)(ii) (relating

18 to nurse practitioner or clinical nurse spe19 cialist services),’’;

20 (ii) by striking paragraph (2);

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

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

23 ‘‘section 1861(s)(2)(K)(ii)’’; and

24 (iv) by redesignating paragraph (3) as

25 paragraph (2).
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1 (B) Section 1842(b)(12)(A) of such Act

2 (42 U.S.C. 1395u(b)(12)(A)) is amended in the

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

4 (i), (ii), or (iv) of section 1861(s)(2)(K) (relat5 ing to a physician assistants and nurse practi6 tioners)’’ and inserting ‘‘section

7 1861(s)(2)(K)(i) (relating to physician assist8 ants)’’.

9 (c) DIRECT PAYMENT FOR NURSE PRACTITIONERS

10 AND CLINICAL NURSE SPECIALISTS.—

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

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

13 1395k(a)(2)(B)(iv)) is amended by striking ‘‘pro14 vided in a rural area (as defined in section

15 1886(d)(2)(D))’’.

16 (2) CONFORMING AMENDMENT.—Section

17 1842(b)(6)(C) of such Act (42 U.S.C.

18 1395u(b)(6)(C)) is amended—

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

20 and inserting ‘‘clause (i)’’; and

21 (B) by striking ‘‘or nurse practitioner’’.

22 (d) BONUS PAYMENT FOR SERVICES PROVIDED IN

23 HEALTH PROFESSIONAL SHORTAGE AREAS.—Section

24 1833(m) of such Act (42 U.S.C. 1395l(m)) is amended—

25 (1) by inserting ‘‘(1)’’ after ‘‘(m)’’; and
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1 (2) by adding at the end the following new

2 paragraph:

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

4 or clinical nurse specialist furnished to an individual, de5 scribed in paragraph (1), in an area that is a health pro6 fessional shortage area as described in such paragraph,

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

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

9 monthly or quarterly basis) from the Federal Supple10 mentary Medical Insurance Trust Fund an amount equal

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

12 this part.’’.

13 (e) DEFINITION OF CLINICAL NURSE SPECIALIST

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

15 1395x(aa)(5)) is amended—

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

17 (2) by striking ‘‘The term ‘‘ ‘physician assist18 ant’ ’’ and all that follows through ‘‘who performs’’

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

20 the term ‘nurse practitioner’ mean, for purposes of

21 this title, a physician assistant or nurse practitioner

22 who performs’’; and

23 (3) by adding at the end the following new sub24 paragraph:
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1 ‘‘(B) The term ‘clinical nurse specialist’ means, for

2 purposes of this title, an individual who—

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

4 practice nursing in the State in which the clinical

5 nurse specialist services are performed; and

6 ‘‘(ii) holds a master’s degree in a defined clini7 cal area of nursing from an accredited educational

8 institution.’’.

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

10 this section shall apply with respect to services furnished

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

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