I 

110TH CONGRESS 

2D SESSION H. R. 5780 

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

of clinical pharmacist practitioner services under part B of the Medicare 

Program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 10, 2008 

Mrs. WILSON of New Mexico (for herself, Mr. ETHERIDGE, and Mr. UDALL

of New Mexico) 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 provide 

for coverage of clinical pharmacist practitioner services 

under part B of the Medicare 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 ‘‘Medicare Clinical Phar5 macist Practitioner Services Coverage Act of 2008’’. 


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1 SEC. 2. MEDICARE COVERAGE OF CLINICAL PHARMACIST 

2 PRACTITIONER SERVICES. 

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

5 (1) by striking ‘‘and’’ at the end of subpara6 graph (Z); 

7 (2) by adding ‘‘and’’ at the end of subpara8 graph (AA); and 

9 (3) by inserting after subparagraph (AA) the 

10 following new subparagraph: 

11 ‘‘(BB) clinical pharmacist practitioner 

12 services (as defined in subsection (ddd)(1)); 

13 and’’. 

14 (b) SERVICES DESCRIBED.—Section 1861 of such 

15 Act (42 U.S.C. 1395x) is amended by adding at the end 

16 the following new subsection: 

17 ‘‘(ddd) CLINICAL PHARMACIST PRACTITIONER SERV18 ICES; CLINICAL PHARMACIST PRACTITIONER.—(1) The 

19 term ‘clinical pharmacist practitioner services’ means such 

20 direct patient care services provided by a pharmacist clini21 cian or clinical pharmacist practitioner, and such services 

22 furnished as incident to the services of the clinician or 

23 practitioner, respectively, which the clinician or practi24 tioner, respectively, is legally authorized to perform under 

25 State law (or the State regulatory mechanism as provided 

26 by State law) in a collaborative practice agreement as 


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1 would otherwise be covered under this part if furnished 

2 by a physician, or as incident to a physician’s professional 

3 service. 

4 ‘‘(2) The terms ‘pharmacist clinician’ and ‘clinical 

5 pharmacist practitioner’ mean a pharmacist who— 

6 ‘‘(A) is certified by a State as a pharmacist cli7 nician or clinical pharmacist practitioner as a result 

8 of completing training in physical assessment and 

9 clinical hours of experience, as required by State law 

10 and the rules of State Boards of Pharmacy, in addi11 tion to any requirements of such State to be a li12 censed pharmacist; 

13 ‘‘(B) has prescriptive authority, as established 

14 by State statute; and 

15 ‘‘(C) is involved in the application of the sci16 entific principles of pharmacology, toxicology, thera17 peutics, clinical pharmacokinetics, 

18 pharmacoeconomics, and other life sciences for the 

19 direct care of patients’’. 

20 (c) PAYMENT.— 

21 (1) IN GENERAL.—Section 1833(a)(1) of such 

22 Act (42 U.S.C. 1395l(a)(1)) is amended— 

23 (A) by striking ‘‘and (V)’’ and inserting 

24 ‘‘(V)’’; and 


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1 (B) by striking the semicolon at the end 

2 and inserting the following: ‘‘, and (W) with re3 spect to clinical pharmacist practitioner services 

4 (as defined in section 1861(ddd)(1)), the 

5 amounts paid shall be 85 percent of the 

6 amounts provided for such services under sec7 tion 1834(n)(1);’’. 

8 (2) ESTABLISHMENT OF FEE SCHEDULES.— 

9 Section 1834 of such Act (42 U.S.C. 1395m) is 

10 amended by adding at the end the following new 

11 subsection: 

12 ‘‘(n) FEE SCHEDULES FOR CLINICAL PHARMACIST

13 PRACTITIONER SERVICES.— 

14 ‘‘(1) DEVELOPMENT.—The Secretary shall de15 velop and implement, for services furnished not later 

16 than January 1, 2010— 

17 ‘‘(A) a relative value scale to serve as the 

18 basis for the payment of clinical pharmacist 

19 practitioner services (as defined in section 

20 1861(ddd)(1)) under this part; and 

21 ‘‘(B) using such scale and appropriate con22 version factors, fee schedules (on a regional, 

23 statewide, locality, or carrier service area basis) 

24 for payment for clinical pharmacist practitioner 

25 services under this part. 


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1 ‘‘(2) PAYMENTS PRIOR TO IMPLEMENTATION

2 OF FEE SCHEDULES.—In the case of clinical phar3 macist practitioner services which are furnished be4 fore the implementation of fee schedules under para5 graph (1)(B) and after January 1, 2009, the 

6 amount of payment made under this part shall be 

7 based on 85 percent of the fee schedule amount ap8 plicable under section 1848 if the services were fur9 nished by a physician.’’. 

10 (3) REPORT TO CONGRESS.—Not later than 

11 September 30, 2009, the Secretary of Health and 

12 Human Services shall submit to Congress a report 

13 on the fee schedules (including relative value scale 

14 and appropriate conversion factors) developed pursu15 ant to section 1834(n)(1) of the Social Security Act 

16 (as added by paragraph (2)) for clinical pharmacist 

17 practitioner services under part B of title XVIII of 

18 such Act. 

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

20 this section shall apply to services furnished on or after 

21 January 1, 2009. 

Æ 


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