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103D CONGRESS

1ST SESSION H. R. 1618

To amend title XVIII of the Social Security Act to permit direct payment

under the medicare program for services of registered nurses as assistants at surgery.

IN THE HOUSE OF REPRESENTATIVES

APRIL 1, 1993

Mrs. COLLINS of Illinois introduced the following bill; which was referred

jointly to the Committees on Ways and Means and Energy and Commerce

A BILL

To amend title XVIII of the Social Security Act to permit

direct payment under the medicare program for services

of registered nurses as assistants at surgery.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. DIRECT PAYMENT FOR SERVICES OF REG4 ISTERED NURSES AS ASSISTANTS AT SUR5 GERY.

6 (a) SERVICES COVERED.—Section 1861(s)(2)(K) of

7 the Social Security Act (42 U.S.C 1395x(s)(2)(K)) is

8 amended—

9 (1) in clause (iii), by striking ‘‘and’’ at the end;
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1 (2) in clause (iv), by striking ‘‘clause (i) or (ii)’’

2 and inserting ‘‘clause (i), (ii), or (iv)’’;

3 (3) by redesignating clause (iv) as clause (v);

4 and

5 (4) by inserting after clause (iii) the following

6 new clause:

7 ‘‘(iv) services which would be physicians’ serv8 ices if furnished by a physician (as defined in sub9 section (r)(1)) and which are performed by a reg10 istered nurse under the supervision of a physician

11 (as so defined) as an assistant at surgery and which

12 the registered nurse is legally authorized to perform

13 by the State in which the services are performed,

14 and’’.

15 (b) PAYMENT AMOUNT.—Section 1842(b)(12) of

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

17 (1) by striking ‘‘clauses (i), (ii), or (iv)’’ each

18 place it appears and inserting ‘‘clauses (i), (ii), (iv),

19 or (v)’’; and

20 (2) in subparagraph (A), by striking ‘‘a physi21 cian assistants and nurse practitioners’’ and insert22 ing ‘‘physician assistants, nurse practitioners, and

23 registered nurses’’.
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1 (c) PAYMENTS TO EMPLOYERS.—Section

2 1842(b)(6)(C) of such Act (42 U.S.C. 1395u(b)(6)(C)) is

3 amended—

4 (1) by striking ‘‘clauses (i), (ii), or (iv)’’ and in5 serting ‘‘clauses (i), (ii), (iv), or (v)’’; and

6 (2) by striking ‘‘physician assistant or nurse

7 practitioner’’ and inserting ‘‘physician assistant,

8 nurse practitioner, or registered nurse’’.

9 (d) REDUCTION IN PAYMENTS TO AVOID DUPLICATE

10 PAYMENT.—Notwithstanding any other provision of law,

11 the Secretary of Health and Human Services may reduce

12 the amount of payments otherwise made to hospitals

13 under title XVIII of the Social Security Act to eliminate

14 estimated duplicate payments for historical or current

15 costs attributable to services described in section

16 1861(s)(2)(K)(iv) of such Act (as amended by subsection

17 (a)).

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

19 this section shall apply to services furnished on or

20 after January 1, 1994.

21 SEC. 2. STUDY OF PAYMENT RATES.

22 Not later than April 1, 1994, the Secretary of Health

23 and Human Services shall submit a report to Congress

24 containing recommendations for adjustments to the pay25 ment amounts established under part B of title XVIII of
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1 the Social Security Act for services described in section

2 1861(s)(2)(K)(iv) of such Act (as amended by section

3 1(a)) to ensure that the payment amounts reflect the ap4 proximate costs of furnishing the services, taking into ac5 count the costs of compensation, overhead, and super6 vision attributable to registered nurses.

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