II 

116TH CONGRESS 

1ST SESSION S. 1037 

To amend title XVIII of the Social Security Act to modernize provisions 

relating to rural health clinics under Medicare. 

IN THE SENATE OF THE UNITED STATES 

APRIL 4, 2019 

Mr. BARRASSO (for himself and Ms. SMITH) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to modernize 

provisions relating to rural health clinics under Medicare. 

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 ‘‘Rural Health Clinic 

5 Modernization Act of 2019’’. 

6 SEC. 2. MODERNIZING PHYSICIAN, PHYSICIAN ASSISTANT, 

7 AND NURSE PRACTITIONER UTILIZATION RE8 QUIREMENTS. 

9 (a) IN GENERAL.—Section 1861(aa) of the Social Se10 curity Act (42 U.S.C. 1395x(aa)) is amended— 


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1 (1) in paragraph (2)(B), by striking ‘‘has an 

2 arrangement’’ and all that follows through the first 

3 semicolon and inserting ‘‘meets the requirements de4 scribed in paragraph (8);’’; and 

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

6 paragraph: 

7 ‘‘(8) REQUIREMENTS FOR CERTAIN FACILITIES

8 DESCRIBED.—For purposes of paragraph (2)(B), 

9 with respect to a facility which is not a physician10 directed clinic, the following requirements are de11 scribed in this paragraph: 

12 ‘‘(A) ARRANGEMENT.—The facility has an 

13 arrangement consistent with the provisions of 

14 State and local law relative to the practice, per15 formance, and delivery of health services, with 

16 one or more physician assistants (as defined in 

17 paragraph (5)(A)) or one or more nurse practi18 tioners (as defined in such paragraph). 

19 ‘‘(B) PRACTICE AND OVERSIGHT REQUIRE20 MENTS.— 

21 ‘‘(i) IN GENERAL.—Subject to clause 

22 (ii), the delivery of health services under 

23 such arrangement shall be in accordance 

24 with State law or the State regulatory 


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1 mechanism governing the practice of physi2 cian assistants or nurse practitioners. 

3 ‘‘(ii) EXCEPTION IF NO STATE LAWS

4 OR REGULATIONS APPLICABLE.—In the 

5 case where a State does not have laws or 

6 regulations governing the practice, per7 formance, and delivery of health services 

8 by a physician assistant or nurse practi9 tioner, the Secretary shall adopt regula10 tions for facilities located in such State 

11 that provide for the periodic review by phy12 sicians of covered services furnished by 

13 physician assistants and nurse practi14 tioners, the supervision and guidance by 

15 such physicians of physician assistants and 

16 nurse practitioners, and the preparation by 

17 such physicians of such medical orders for 

18 care and treatment of clinic patients as is 

19 necessary. Such regulations shall also re20 quire facilities located in such a State to 

21 have arrangements with physicians for re22 ferral of and consultation for patients as 

23 the facility deems necessary and for advice 

24 and assistance in the management of med25 ical emergencies.’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 this section shall take effect on the date of the enactment 

3 of this Act. 

4 SEC. 3. REMOVING OUTDATED LABORATORY REQUIRE5 MENTS. 

6 (a) IN GENERAL.—Section 1861(aa)(2)(G) of the So7 cial Security Act (42 U.S.C. 1395x(aa)(2)(G)) is amended 

8 by striking ‘‘, including clinical laboratory services’’ and 

9 all that follows through ‘‘additional diagnostic services’’ 

10 and inserting the following: ‘‘and has prompt access to 

11 clinical laboratory services and additional diagnostic serv12 ices’’. 

13 (b) EFFECTIVE DATE.—The amendments made by 

14 this section shall take effect on the date of the enactment 

15 of this Act. 

16 SEC. 4. ALLOWING RURAL HEALTH CLINICS THE FLEXI17 BILITY TO CONTRACT WITH PHYSICIAN AS18 SISTANTS AND NURSE PRACTITIONERS. 

19 (a) IN GENERAL.—Section 1861(aa) of the Social Se20 curity Act (42 U.S.C. 1395x(aa)), in the first sentence of 

21 the flush matter following paragraph (2), is amended by 

22 striking ‘‘(iii) employs a physician assistant or nurse prac23 titioner, and (iv)’’ and inserting ‘‘and (iii)’’. 


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1 (b) EFFECTIVE DATE.—The amendment made by 

2 subsection (a) shall take effect on the date of the enact3 ment of this Act. 

4 SEC. 5. ALLOWING RURAL HEALTH CLINICS TO BE THE DIS5 TANT SITE FOR A TELEHEALTH VISIT. 

6 (a) IN GENERAL.—Section 1834(m) of the Social Se7 curity Act (42 U.S.C. 1395m(m)) is amended— 

8 (1) in the first sentence of paragraph (1)— 

9 (A) by striking ‘‘or a practitioner (de10 scribed in section 1842(b)(18)(C))’’ and insert11 ing ‘‘, a practitioner (described in section 

12 1842(b)(18)(C)), or a rural health clinic’’; and 

13 (B) by striking ‘‘or practitioner’’ and in14 serting ‘‘, practitioner, or rural health clinic’’; 

15 (2) in paragraph (2)(A)— 

16 (A) by striking ‘‘or practitioner’’ and in17 serting ‘‘practitioner, or rural health clinic’’; 

18 and 

19 (B) by striking ‘‘such physician or practi20 tioner’’ and inserting ‘‘such physician, practi21 tioner, or rural health clinic’’; and 

22 (3) in paragraph (4)(A), by striking ‘‘or practi23 tioner’’ and inserting ‘‘practitioner, or rural health 

24 clinic’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to services furnished on or after 

3 the date of the enactment of this Act. 

4 SEC. 6. INCLUDING FACILITIES LOCATED IN CERTAIN 

5 AREAS. 

6 (a) IN GENERAL.—Section 1861(aa) of the Social Se7 curity Act (42 U.S.C. 1395x(aa)) is amended, in the first 

8 sentence of the flush matter following paragraph (2), by 

9 inserting ‘‘or in an area that has been designated by the 

10 chief executive officer of the State and certified by the Sec11 retary as rural’’ after ‘‘Census)’’. 

12 (b) EFFECTIVE DATE.—The amendment made by 

13 this section shall take effect on the date of the enactment 

14 of this Act. 

15 SEC. 7. INCREASING REIMBURSEMENT FOR RURAL 

16 HEALTH CLINICS. 

17 Section 1833(f) of the Social Security Act (42 U.S.C. 

18 1395l(f)) is amended— 

19 (1) in paragraph (1), by striking ‘‘, and’’ at the 

20 end and inserting a semicolon; 

21 (2) in paragraph (2)— 

22 (A) by inserting ‘‘(before 2020)’’ after ‘‘in 

23 a subsequent year’’; and 

24 (B) by striking the period at the end and 

25 inserting a semicolon; and 


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1 (3) by adding at the end the following new 

2 paragraphs: 

3 ‘‘(3) in 2020, at $105 per visit; 

4 ‘‘(4) in 2021, at $110 per visit; 

5 ‘‘(5) in 2022, at $115 per visit; and 

6 ‘‘(6) in a subsequent year, at the limit estab7 lished under this subsection for the previous year in8 creased by the percentage increase in the MEI (as 

9 so defined) applicable to primary care services (as so 

10 defined) furnished as of the first day of that year.’’. 

Æ 


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