I 

111TH CONGRESS 

2D SESSION H. R. 5389 

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 

MAY 25, 2010 

Mr. HEINRICH 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 2010’’. 


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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 (EE); 

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

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

10 following new subparagraph: 

11 ‘‘(GG) clinical pharmacist practitioner 

12 services (as defined in subsection (iii)(1)); and’’. 

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

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

15 the following new subsection: 

16 ‘‘(iii) CLINICAL PHARMACIST PRACTITIONER SERV17 ICES; CLINICAL PHARMACIST PRACTITIONER.—(1) The 

18 term ‘clinical pharmacist practitioner services’ means such 

19 direct patient care services provided by a pharmacist clini20 cian or clinical pharmacist practitioner, and such services 

21 furnished as incident to the services of the clinician or 

22 practitioner, respectively, which the clinician or practi23 tioner, respectively, is legally authorized to perform under 

24 State law (or the State regulatory mechanism as provided 

25 by State law) in a collaborative practice agreement as 

26 would otherwise be covered under this part if furnished 


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

2 service. 

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

4 pharmacist practitioner’ mean a pharmacist who— 

5 ‘‘(A) is certified by a State as a pharmacist cli6 nician or clinical pharmacist practitioner as a result 

7 of completing training in physical assessment and 

8 clinical hours of experience, as required by State law 

9 and the rules of State Boards of Pharmacy, in addi10 tion to any requirements of such State to be a li11 censed pharmacist; 

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

13 by State statute; and 

14 ‘‘(C) is involved in the application of the sci15 entific principles of pharmacology, toxicology, thera16 peutics, clinical pharmacokinetics, 

17 pharmacoeconomics, and other life sciences for the 

18 direct care of patients’’. 

19 (c) PAYMENT.— 

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

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

22 (A) by striking ‘‘and (Z)’’ and inserting 

23 ‘‘(Z)’’; and 

24 (B) by striking the semicolon at the end 

25 and inserting the following: ‘‘, and (AA) with 


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1 respect to clinical pharmacist practitioner serv2 ices (as defined in section 1861(iii)(1)), the 

3 amounts paid shall be 85 percent of the 

4 amounts provided for such services under sec5 tion 1834(p)(1);’’. 

6 (2) ESTABLISHMENT OF FEE SCHEDULES.— 

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

8 amended by adding at the end the following new 

9 subsection: 

10 ‘‘(p) FEE SCHEDULES FOR CLINICAL PHARMACIST

11 PRACTITIONER SERVICES.— 

12 ‘‘(1) DEVELOPMENT.—The Secretary shall de13 velop and implement, for services furnished on or 

14 after January 1, 2011— 

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

16 basis for the payment of clinical pharmacist 

17 practitioner services (as defined in section 

18 1861(iii)(1)) under this part; and 

19 ‘‘(B) using such scale and appropriate con20 version factors, fee schedules (on a regional, 

21 statewide, locality, or carrier service area basis) 

22 for payment for clinical pharmacist practitioner 

23 services under this part. 

24 ‘‘(2) PAYMENTS PRIOR TO IMPLEMENTATION

25 OF FEE SCHEDULES.—In the case of clinical pharVerDate Mar 15 2010 06:54 May 26, 2010 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5389.IH H5389

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1 macist practitioner services which are furnished be2 fore the implementation of fee schedules under para3 graph (1)(B) and after July 1, 2010, the amount of 

4 payment made under this part shall be based on 85 

5 percent of the fee schedule amount applicable under 

6 section 1848 if the services were furnished by a phy7 sician.’’. 

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

9 September 30, 2011, the Secretary of Health and 

10 Human Services shall submit to Congress a report 

11 on the fee schedules (including relative value scale 

12 and appropriate conversion factors) developed pursu13 ant to section 1834(p)(1) of the Social Security Act 

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

15 practitioner services under part B of title XVIII of 

16 such Act. 

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

18 this section shall apply to services furnished on or after 

19 July 1, 2010. 

Æ 


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