I 

108TH CONGRESS 

2D SESSION H. R. 4724

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 

JUNE 25, 2004

Mr. BURR (for himself, Mr. BALLENGER, Mr. COBLE, and Mr. PRICE of 

North Carolina) 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 2004’’ . 
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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 (U); 

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

9 (3) by inserting after subparagraph (V) the fol10 lowing new subparagraph: 

11 ‘‘(W) clinical pharmacist practitioner serv12 ices (as defined in subsection (ww)(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 ‘‘Clinical Pharmacist Practitioner Services; Clinical 

17 Pharmacist Practitioner 

18 ‘‘(ww)(1) The term ‘clinical pharmacist practitioner 

19 services’ means such direct patient care services provided 

20 by a clinical pharmacist practitioner, and such services are 

21 furnished as an incident to the practitioner’s services, 

22 which the practitioner is legally authorized to perform 

23 under State law (or the State regulatory mechanism as 

24 provided by State law) in a collaborative practice agree25 ment as would otherwise be covered if furnished by a phy-
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1 sician, or as an incident to a physician’s professional serv2 ice. 

3 ‘‘(2) The term ‘clinical pharmacist practitioner’ 

4 means as a pharmacist involved in the application of the 

5 scientific principles of pharmacology, toxicology, thera6 peutics, clinical pharmacokinetics, pharmacoeconomics, 

7 and other life sciences for the direct care of patients.’’. 

8 (c) PAYMENT.—

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

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

11 (A) by striking ‘‘and (U)’’ and inserting 

12 ‘‘(U)’’; and 

13 (B) by striking the semicolon at the end 

14 and inserting the following: ‘‘, and (V) with re15 spect to clinical pharmacist practitioner services 

16 (as defined in section 1861(ww)), the amounts 

17 paid shall be 80 percent of the amounts pro18 vided for such services under section 1834(n);’’. 

19 (2) ESTABLISHMENT OF FEE SCHEDULES.—

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

21 amended by adding at the end the following new 

22 subsection: 

23 ‘‘(n) FEE SCHEDULES FOR CLINICAL PHARMACIST

24 PRACTITIONER SERVICES.—
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1 ‘‘(1) DEVELOPMENT.—The Secretary shall de2 velop and implement, for services furnished not later 

3 than January 1, 2007—

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

5 basis for the payment of clinical pharmacist 

6 practitioner services (as defined in section 

7 1861(ww)) under this part; and 

8 ‘‘(B) using such scale and appropriate con9 version factors, fee schedules (on a regional, 

10 statewide, locality, or carrier service area basis) 

11 for payment for clinical pharmacist practitioner 

12 services under this part. 

13 ‘‘(2) PAYMENTS PRIOR TO IMPLEMENTATION

14 OF FEE SCHEDULES.—In the case of clinical phar15 macist practitioner services which are furnished be16 fore the implementation of fee schedules under para17 graph (1)(B), the amount of payment made under 

18 this part shall be based on 85 percent of the fee 

19 schedule amount applicable under section 1848 if 

20 the service were furnished by a physician.’’. 

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

22 September 30, 2006, the Secretary of Health and 

23 Human Services shall submit a report to Congress 

24 on the fee schedules (including relative value scale 

25 and appropriate conversion factors) developed pursu-
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1 ant to section 1834(n)(1) of the Social Security Act 

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

3 practitioner services under part B of title XVIII of 

4 such Act. 

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

6 this section shall apply to services furnished on or after 

7 January 1, 2005.

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