I 

116TH CONGRESS 

1ST SESSION H. R. 2788 

To amend title XVIII of the Social Security Act to modernize provisions 

relating to rural health clinics under Medicare. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 16, 2019 

Mr. SMITH of Nebraska (for himself, Mrs. RODGERS of Washington, Ms. SEWELL of Alabama, and Mr. LOEBSACK) introduced the following bill; 

which was referred to the Committee on Energy and 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 modernize 

provisions relating to rural health clinics under Medicare. 

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 ‘‘Rural Health Clinic 

5 Modernization Act of 2019’’. 


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1 SEC. 2. MODERNIZING PHYSICIAN, PHYSICIAN ASSISTANT, 

2 AND NURSE PRACTITIONER UTILIZATION RE3 QUIREMENTS. 

4 (a) IN GENERAL.—Section 1861(aa) of the Social Se5 curity Act (42 U.S.C. 1395x(aa)) is amended— 

6 (1) in paragraph (2)(B), by striking ‘‘has an 

7 arrangement’’ and all that follows through the first 

8 semicolon and inserting ‘‘meets the requirements de9 scribed in paragraph (8);’’; and 

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

11 paragraph: 

12 ‘‘(8) REQUIREMENTS FOR CERTAIN FACILITIES

13 DESCRIBED.—For purposes of paragraph (2)(B), 

14 with respect to a facility which is not a physician15 directed clinic, the following requirements are de16 scribed in this paragraph: 

17 ‘‘(A) ARRANGEMENT.—The facility has an 

18 arrangement consistent with the provisions of 

19 State and local law relative to the practice, per20 formance, and delivery of health services, with 

21 one or more physician assistants (as defined in 

22 paragraph (5)(A)) or one or more nurse practi23 tioners (as defined in such paragraph). 

24 ‘‘(B) PRACTICE AND OVERSIGHT REQUIRE25 MENTS.— 


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1 ‘‘(i) IN GENERAL.—Subject to clause 

2 (ii), the delivery of health services under 

3 such arrangement shall be in accordance 

4 with State law or the State regulatory 

5 mechanism governing the practice of physi6 cian assistants or nurse practitioners. 

7 ‘‘(ii) EXCEPTION IF NO STATE LAWS

8 OR REGULATIONS APPLICABLE.—In the 

9 case where a State does not have laws or 

10 regulations governing the practice, per11 formance, and delivery of health services 

12 by a physician assistant or nurse practi13 tioner, the Secretary shall adopt regula14 tions for facilities located in such State 

15 that provide for the periodic review by phy16 sicians of covered services furnished by 

17 physician assistants and nurse practi18 tioners, the supervision and guidance by 

19 such physicians of physician assistants and 

20 nurse practitioners, and the preparation by 

21 such physicians of such medical orders for 

22 care and treatment of clinic patients as is 

23 necessary. Such regulations shall also re24 quire facilities located in such a State to 

25 have arrangements with physicians for reVerDate Sep 11 2014 18:30 Jun 03, 2019 Jkt 034408 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2788.IH H2788

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1 ferral of and consultation for patients as 

2 the facility deems necessary and for advice 

3 and assistance in the management of med4 ical emergencies.’’. 

5 (b) EFFECTIVE DATE.—The amendments made by 

6 this section shall take effect on the date of the enactment 

7 of this Act. 

8 SEC. 3. REMOVING OUTDATED LABORATORY REQUIRE9 MENTS. 

10 (a) IN GENERAL.—Section 1861(aa)(2)(G) of the So11 cial Security Act (42 U.S.C. 1395x(aa)(2)(G)) is amended 

12 by striking ‘‘, including clinical laboratory services’’ and 

13 all that follows through ‘‘additional diagnostic services’’ 

14 and inserting the following: ‘‘and has prompt access to 

15 clinical laboratory services and additional diagnostic serv16 ices’’. 

17 (b) EFFECTIVE DATE.—The amendments made by 

18 this section shall take effect on the date of the enactment 

19 of this Act. 

20 SEC. 4. ALLOWING RURAL HEALTH CLINICS THE FLEXI21 BILITY TO CONTRACT WITH PHYSICIAN AS22 SISTANTS AND NURSE PRACTITIONERS. 

23 (a) IN GENERAL.—Section 1861(aa) of the Social Se24 curity Act (42 U.S.C. 1395x(aa)), in the first sentence of 

25 the flush matter following paragraph (2), is amended by 


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1 striking ‘‘(iii) employs a physician assistant or nurse prac2 titioner, and (iv)’’ and inserting ‘‘and (iii)’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 subsection (a) shall take effect on the date of the enact5 ment of this Act. 

6 SEC. 5. ALLOWING RURAL HEALTH CLINICS TO BE THE DIS7 TANT SITE FOR A TELEHEALTH VISIT. 

8 (a) IN GENERAL.—Section 1834(m) of the Social Se9 curity Act (42 U.S.C. 1395m(m)) is amended— 

10 (1) in the first sentence of paragraph (1)— 

11 (A) by striking ‘‘or a practitioner (de12 scribed in section 1842(b)(18)(C))’’ and insert13 ing ‘‘, a practitioner (described in section 

14 1842(b)(18)(C)), or a rural health clinic’’; and 

15 (B) by striking ‘‘or practitioner’’ and in16 serting ‘‘, practitioner, or rural health clinic’’; 

17 (2) in paragraph (2)(A)— 

18 (A) by striking ‘‘or practitioner’’ and in19 serting ‘‘practitioner, or rural health clinic’’; 

20 and 

21 (B) by striking ‘‘such physician or practi22 tioner’’ and inserting ‘‘such physician, practi23 tioner, or rural health clinic’’; and 


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1 (3) in paragraph (4)(A), by striking ‘‘or practi2 tioner’’ and inserting ‘‘practitioner, or rural health 

3 clinic’’. 

4 (b) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to services furnished on or after 

6 the date of the enactment of this Act. 

7 SEC. 6. INCLUDING FACILITIES LOCATED IN CERTAIN 

8 AREAS. 

9 (a) IN GENERAL.—Section 1861(aa) of the Social Se10 curity Act (42 U.S.C. 1395x(aa)) is amended, in the first 

11 sentence of the flush matter following paragraph (2), by 

12 inserting ‘‘or in an area that has been designated by the 

13 chief executive officer of the State and certified by the Sec14 retary as rural’’ after ‘‘Census)’’. 

15 (b) EFFECTIVE DATE.—The amendment made by 

16 this section shall take effect on the date of the enactment 

17 of this Act. 

18 SEC. 7. INCREASING REIMBURSEMENT FOR RURAL 

19 HEALTH CLINICS. 

20 Section 1833(f) of the Social Security Act (42 U.S.C. 

21 1395l(f)) is amended— 

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

23 end and inserting a semicolon; 

24 (2) in paragraph (2)— 


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1 (A) by inserting ‘‘(before 2020)’’ after ‘‘in 

2 a subsequent year’’; and 

3 (B) by striking the period at the end and 

4 inserting a semicolon; and 

5 (3) by adding at the end the following new 

6 paragraphs: 

7 ‘‘(3) in 2020, at $105 per visit; 

8 ‘‘(4) in 2021, at $110 per visit; 

9 ‘‘(5) in 2022, at $115 per visit; and 

10 ‘‘(6) in a subsequent year, at the limit estab11 lished under this subsection for the previous year in12 creased by the percentage increase in the MEI (as 

13 so defined) applicable to primary care services (as so 

14 defined) furnished as of the first day of that year.’’. 

Æ 


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