I

105TH CONGRESS

1ST SESSION H. R. 894

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

Medicare reimbursement for physician assistants, 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 physician assistants, 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 ‘‘Physician Assistant

5 Incentive Act of 1997’’.
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1 SEC. 2. INCREASED MEDICARE REIMBURSEMENT FOR PHY2 SICIAN ASSISTANTS.

3 (a) REMOVAL OF RESTRICTION ON SETTINGS.—Sec4 tion 1861(s)(2)(K)(i) of the Social Security Act (42

5 U.S.C. 1395x(s)(2)(K)(i)) is amended by striking ‘‘(I) in

6 a hospital’’ and all that follows through ‘‘shortage area,’’.

7 (b) INCREASED PAYMENT.—Section 1842(b)(12) of

8 such Act (42 U.S.C. 1395u(b)(12)) is amended—

9 (1) in the matter preceding clause (i) of sub10 paragraph (A), by striking ‘‘clauses’’ and all that

11 follows through ‘‘practitioners)’’ and inserting

12 ‘‘clause (ii) of section 1861(s)(2)(K) (relating to

13 nurse practitioners), and clause (iv) of such section

14 insofar as it relates to clause (ii) of such section’’;

15 and

16 (2) by adding at the end the following new sub17 paragraph:

18 ‘‘(C) With respect to services described in clause (i)

19 of section 1861(s)(2)(K) (relating to physician assistants),

20 and clause (iv) of such section insofar as it relates to

21 clause (i) of such section—

22 ‘‘(i) payment under this part may only be made

23 on an assignment-related basis; and

24 ‘‘(ii) the amounts paid under this part shall be

25 equal to 80 percent of (I) the lesser of the actual

26 charge or 85 percent of the fee schedule amount
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1 provided under section 1848 for the same service

2 provided by a physician who is not a specialist; or

3 (II) in the case of services as an assistant at sur4 gery, the lesser of the actual charge or 85 percent

5 of the amount that would otherwise be recognized if

6 performed by a physician who is serving as an as7 sistant at surgery.’’.

8 (c) BONUS PAYMENT FOR SERVICES PROVIDED IN

9 HEALTH PROFESSIONAL SHORTAGE AREAS.—Section

10 1833(m) of such Act (42 U.S.C. 1395l(m)) is amended—

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

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

13 paragraph:

14 ‘‘(2) In the case of services of a physician as15 sistant furnished to an individual described in para16 graph (1) in an area that is a health professional

17 shortage area described in such paragraph, in addi18 tion to the amount otherwise paid under this part,

19 there shall also be paid to such physician assistant

20 (or to an employer in the cases described in subpara21 graph (C) of section 1842(b)(6)) (on a monthly or

22 quarterly basis) from the Federal Supplementary

23 Medical Insurance Trust Fund an amount equal to

24 10 percent of the payment amount for the service

25 under this part.’’.
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1 (d) REMOVAL OF RESTRICTION ON EMPLOYMENT

2 RELATIONSHIP.—Section 1842(b)(6) of such Act (42

3 U.S.C. 1395u(b)(6)) is amended by adding at the end the

4 following new sentence: ‘‘For purposes of clause (C) of the

5 first sentence of this paragraph, an employment relation6 ship may include any independent contractor arrange7 ment, and employer status shall be determined in accord8 ance with the law of the State in which the services de9 scribed in such clause are performed.’’.

10 (e) EFFECTIVE DATE.—The amendments made by

11 this section shall apply with respect to services furnished

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

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