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105TH CONGRESS

1ST SESSION H. R. 893

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 HOUSE OF REPRESENTATIVES

FEBRUARY 27, 1997

Mr. TOWNS (for himself and Mrs. JOHNSON of Connecticut) introduced the

following bill; which was referred to the Committee on 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 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 1997’’.
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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.—Clause (ii) of section

6 1861(s)(2)(K)) of the Social Security Act (42 U.S.C.

7 1395x(s)(2)(K)) 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)) which the nurse practitioner or

13 clinical nurse specialist is legally authorized to per14 form by the State in which the services are per15 formed, and such services and supplies furnished as

16 an incident to such services as would be covered

17 under subparagraph (A) if furnished incident to a

18 physician’s professional service;’’.

19 (2) CONFORMING AMENDMENTS.—(A) Section

20 1861(s)(2)(K) of such Act (42 U.S.C.

21 1395x(s)(2)(K)) is further amended—

22 (i) in clause (i), by inserting ‘‘and such

23 services and supplies furnished as incident to

24 such services as would be covered under sub25 paragraph (A) if furnished as an incident to a
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1 physician’s professional service; and’’ after ‘‘are

2 performed,’’; and

3 (ii) by striking clauses (iii) and (iv).

4 (B) Section 1861(b)(4) of such Act (42 U.S.C.

5 1395x(b)(4)) is amended by striking ‘‘clauses (i) or

6 (iii) of subsection (s)(2)(K)’’ and inserting ‘‘sub7 section (s)(2)(K)’’.

8 (C) Section 1862(a)(14) of such Act (42 U.S.C.

9 1395y(a)(14)) is amended by striking ‘‘section

10 1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)’’ and insert11 ing ‘‘section 1861(s)(2)(K)’’.

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

13 U.S.C. 1395cc(a)(1)(H)) is amended by striking

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

15 inserting ‘‘section 1861(s)(2)(K)’’.

16 (b) INCREASED PAYMENT.—

17 (1) FEE SCHEDULE AMOUNT.—Clause (O) of

18 section 1833(a)(1) of such Act (42 U.S.C.

19 1395l(a)(1)) is amended to read as follows: ‘‘(O)

20 with respect to services described in section

21 1861(s)(2)(K)(ii) (relating to nurse practitioner or

22 clinical nurse specialist services), the amounts paid

23 shall be equal to 80 percent of (i) the lesser of the

24 actual charge or 85 percent of the fee schedule

25 amount provided under section 1848 for the same
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1 service provided by a physician who is not a special2 ist, or (ii) in the case of services as an assistant

3 at surgery, the lesser of the actual charge or 85 per4 cent of the amount that would otherwise be recog5 nized if performed by a physician who is serving as

6 an assistant at surgery; and’’.

7 (2) CONFORMING AMENDMENTS.—(A) Section

8 1833(r) of such Act (42 U.S.C. 1395l(r)) is amend9 ed—

10 (i) in paragraph (1), by striking ‘‘section

11 1861(s)(2)(K)(iii) (relating to nurse practi12 tioner or clinical nurse specialist services pro13 vided in a rural area)’’ and inserting ‘‘section

14 1861(s)(2)(K)(ii) (relating to nurse practitioner

15 or clinical nurse specialist services)’’;

16 (ii) by striking paragraph (2);

17 (iii) in paragraph (3), by striking ‘‘section

18 1861(s)(2)(K)(iii)’’ and inserting ‘‘section

19 1861(s)(2)(K)(ii)’’; and

20 (iv) by redesignating paragraph (3) as

21 paragraph (2).

22 (B) Section 1842(b)(12)(A) of such Act (42

23 U.S.C. 1395u(b)(12)(A)) is amended, in the matter

24 preceding clause (i), by striking ‘‘clauses (i), (ii), or

25 (iv) of section 1861(s)(2)(K) (relating to a physician
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1 assistants and nurse practitioners)’’ and inserting

2 ‘‘section 1861(s)(2)(K)(i) (relating to physician as3 sistants)’’.

4 (c) DIRECT PAYMENT FOR NURSE PRACTITIONERS

5 AND CLINICAL NURSE SPECIALISTS.—

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

7 such Act (42 U.S.C. 1395k(a)(2)(B)(iv)) is amended

8 by striking ‘‘provided in a rural area (as defined in

9 section 1886(d)(2)(D))’’.

10 (2) CONFORMING AMENDMENT.—Section

11 1842(b)(6)(C) of such Act (42 U.S.C.

12 1395u(b)(6)(C)) is amended—

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

14 and inserting ‘‘clause (i)’’; and

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

16 (d) BONUS PAYMENT FOR SERVICES PROVIDED IN

17 HEALTH PROFESSIONAL SHORTAGE AREAS.—Section

18 1833(m) of such Act (42 U.S.C. 1395l(m)) is amended.—

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

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

21 paragraph:

22 ‘‘(2) In the case of services of a nurse practi23 tioner or clinical nurse specialist furnished to an in24 dividual described in paragraph (1) in an area that

25 is a health professional shortage area described in
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1 such paragraph, in addition to the amount otherwise

2 paid under this part, there shall also be paid to such

3 service provider (on a monthly or quarterly basis)

4 from the Federal Supplementary Medical Insurance

5 Trust Fund an amount equal to 10 percent of the

6 payment amount for the service under this part.’’.

7 (e) DEFINITION OF CLINICAL NURSE SPECIALIST

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

9 1395×(aa)(5)) is amended—

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

11 (2) by striking ‘‘The term ‘physician assist12 ant’ ’’ and all that follows through ‘‘who performs’’

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

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

15 this title, a physician assistant or nurse practitioner

16 who performs’’; and

17 (3) by adding at the end the following new sub18 paragraph:

19 ‘‘(B) The term ‘clinical nurse specialist’ means, for

20 purposes of this title, an individual who—

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

22 practice nursing in the State in which the clinical

23 nurse specialist services are performed; and
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1 ‘‘(ii) holds a master’s degree in a defined clini2 cal area of nursing from an accredited educational

3 institution.’’.

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

5 this section shall apply with respect to services furnished

6 and supplies provided on and after January 1, 1998.

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