I

103D CONGRESS

1ST SESSION H. R. 1770

To provide incentives for physicians to practice in rural areas and in rural

medically underserved areas.

IN THE HOUSE OF REPRESENTATIVES

APRIL 21, 1993

Mr. ROWLAND (for himself, Mr. HALL of Texas, Mrs. VUCANOVICH, Mr.

THOMAS of Wyoming, Mr. EMERSON, Mr. LANCASTER, Mr. ROBERTS,

Mr. BEREUTER, Mr. SLATTERY, Mr. STENHOLM, Mr. GUNDERSON, Ms.

SNOWE, and Mr. DURBIN) introduced the following bill; which was referred jointly to the Committees on Ways and Means, Energy and Commerce, and Education and Labor

A BILL

To provide incentives for physicians to practice in rural areas

and in rural medically underserved areas.

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 Physicians’

5 Incentives Act of 1993’’.
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1 SEC. 2. DEDUCTION FOR MEDICAL SCHOOL EDUCATION

2 LOAN INTEREST INCURRED BY DOCTORS

3 SERVING IN MEDICALLY UNDERSERVED

4 RURAL AREAS.

5 (a) IN GENERAL.—Paragraph (1) of section 163(h)

6 of the Internal Revenue Code of 1986 (relating to dis7 allowance of deduction for personal interest) is amended

8 by striking ‘‘and’’ at the end of subparagraph (D), by re9 designating subparagraph (E) as subparagraph (F), and

10 by inserting after subparagraph (D) the following new

11 subparagraph:

12 ‘‘(E) any qualified medical education loan

13 interest (within the meaning of paragraph (5)),

14 and’’.

15 (b) QUALIFIED MEDICAL EDUCATION LOAN INTER16 EST DEFINED.—Subsection (h) of section 163 of such

17 Code is amended by redesignating paragraph (5) as para18 graph (6) and by inserting after paragraph (4) the follow19 ing new paragraph:

20 ‘‘(5) QUALIFIED MEDICAL EDUCATION LOAN IN21 TEREST.—

22 ‘‘(A) IN GENERAL.—The term ‘qualified

23 medical education loan interest’ means inter24 est—

25 ‘‘(i) which is on a medical education

26 loan of a physician,
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1 ‘‘(ii) which is paid or accrued by such

2 physician, and

3 ‘‘(iii) which accrues during the pe4 riod—

5 ‘‘(I) such physician is providing

6 primary care (including internal medi7 cine, pediatrics, obstetrics/gynecology,

8 family medicine, and osteopathy) to

9 residents of a medically underserved

10 rural area, and

11 ‘‘(II) such physician’s principal

12 place of abode is in such area.

13 ‘‘(B) MEDICAL EDUCATION LOAN.—The

14 term ‘medical education loan’ means indebted15 ness incurred to pay the individual’s—

16 ‘‘(i) qualified tuition and related ex17 penses (as defined in section 117(b)) in18 curred for the medical education of such

19 individual, or

20 ‘‘(ii) reasonable living expenses while

21 away from home in order to attend an edu22 cational institution described in section

23 170(b)(1)(A)(ii) for the medical education

24 of such individual.
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1 ‘‘(C) PHYSICIAN.—For purposes of sub2 paragraph (A), the term ‘physician’ has the

3 meaning given such term by section 1861(r)(1)

4 of the Social Security Act.

5 ‘‘(D) MEDICALLY UNDERSERVED RURAL

6 AREA.—The term ‘medically underserved rural

7 area’ means any rural area which is a medically

8 underserved area (as defined in section 330(b)

9 or 1302(7) of the Public Health Service Act).’’.

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

11 this section shall apply to taxable years ending after the

12 date of the enactment of this Act.

13 SEC. 3. ELIMINATION OF MEDICARE PAYMENT REDUC14 TIONS FOR NEW DOCTORS FOR SERVICES

15 FURNISHED IN ANY RURAL AREA.

16 (a) IN GENERAL.—Section 1848(a)(4) of the Social

17 Security Act (42 U.S.C. 1395w–4(a)(4)) is amended—

18 (1) by striking ‘‘or services’’ and inserting ‘‘,

19 services’’, and

20 (2) by inserting before the period at the end the

21 following: ‘‘, or services furnished in a rural area (as

22 so defined) by (or under the supervision, or inciden23 tal to services, of) a physician described in section

24 1861(r)(1)’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 subsection (a) shall apply to services furnished after 1993.

3 SEC. 4. EXTENSION OF DEFERMENTS.

4 (a) STAFFORD LOANS.—

5 (1) GSL LOANS.—Section 428(b)(1)(M) of the

6 Higher Education Act of 1965 (20 U.S.C.

7 1078(b)(1)(M)) is amended—

8 (A) by striking ‘‘or’’ at the end of clause

9 (ii);

10 (B) by inserting ‘‘or’’ after the semicolon

11 at the end of clause (iii); and

12 (C) by adding at the end thereof the fol13 lowing new clause:

14 ‘‘(iv) during which the borrower is

15 serving in an internship or residency pro16 gram in preparation for practice in an area

17 of primary care (including internal medi18 cine, pediatrics, obstetrics/gynecology, fam19 ily medicine, and osteopathy);’’.

20 (2) FISL LOANS.—Section 427(a)(2)(C) of

21 such Act (20 U.S.C. 1077(a)(2)(C)) is amended—

22 (A) by striking ‘‘or’’ at the end of clause

23 (ii);

24 (B) by inserting ‘‘or’’ after the semicolon

25 at the end of clause (iii); and
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1 (C) by adding at the end thereof the fol2 lowing new clause:

3 ‘‘(iv) during which the borrower is

4 serving in an internship or residency pro5 gram in preparation for practice in an area

6 of primary care (including internal medi7 cine, pediatrics, obstetrics/gynecology, fam8 ily medicine, and osteopathy);’’.

9 (b) PERKINS LOANS.—Section 464(c)(2)(A) of such

10 Act (20 U.S.C. 1087dd(c)(2)(A)) is amended—

11 (1) by striking ‘‘or’’ at the end of clause (iii);

12 (2) by inserting ‘‘or’’ after the semicolon at the

13 end of clause (iv); and

14 (3) by adding at the end thereof the following

15 new clause:

16 ‘‘(v) during which the borrower is

17 serving in an internship or residency pro18 gram in preparation for practice in an area

19 of primary care (including internal medi20 cine, pediatrics, obstetrics/gynecology, fam21 ily medicine, and osteopathy);’’.

22 (c) EFFECTIVE DATE.—The amendments made by

23 this section shall apply to on and after the date of the

24 enactment of this Act with respect to loans made under
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1 the Higher Education Act of 1965 before, on, or after that

2 date.

3 SEC. 5. CLARIFICATION OF PERMISSIBLE SUBSTITUTE

4 BILLING ARRANGEMENTS FOR PHYSICIANS’

5 SERVICES UNDER THE MEDICARE AND MED6 ICAID PROGRAMS.

7 (a) MEDICARE PROGRAM.—

8 (1) IN GENERAL.—Clause (D) of section

9 1842(b)(6) of the Social Security Act (42 U.S.C.

10 1395u(b)(6)) is amended to read as follows: ‘‘(D)(i)

11 payment may be made to a physician for physicians’

12 services (and services incident to such services) to be

13 provided by a second physician on a reciprocal basis

14 to individuals who are patients of the first physician

15 if (I) the first physician is unavailable to provide the

16 services, (II) the services are not provided by the

17 second physician over a continuous period of longer

18 than 60 days, and (III) the claim form submitted to

19 the carrier includes the second physician’s unique

20 identifier (provided under the system established

21 under subsection (r)) and indicates that the claim

22 meets the requirements of this clause for payment to

23 the first physician; and (ii) payment may be made

24 to a physician for physicians’ services (and services

25 incident to such services) which that physician pays
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1 a second physician on a per diem or other fee-for2 time basis to provide to individuals who are patients

3 of the first physician if (I) the first physician is un4 available to provide the services, (II) the services are

5 not provided by the second physician over a continu6 ous period of longer than 90 days (or such longer

7 period as the Secretary may provide), and (III) the

8 claim form submitted to the carrier includes the sec9 ond physician’s unique identifier (provided under the

10 system established under subsection (r)) and indi11 cates that the claim meets the requirements of this

12 clause for payment to the first physician’’.

13 (2) EFFECTIVE DATE.—The amendment made

14 by paragraph (1) shall apply to services furnished on

15 or after the first day of the first month beginning

16 more than 60 days after the date of the enactment

17 of this Act.

18 (b) MEDICAID PROGRAM.—

19 (1) IN GENERAL.—Section 1902(a)(32)(C) of

20 the Social Security Act (42 U.S.C. 1396a(a)(32)(C))

21 is amended to read as follows:

22 ‘‘(C) payment may be made to a physician

23 for services furnished by a substitute physician

24 under the circumstances described in subpara25 graph (D) of section 1842(b)(6), except that,
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1 for purposes of this subparagraph, any ref2 erence in such subparagraph to ‘a carrier’ or

3 ‘the system established under subsection (r)’ is

4 deemed a reference to the State (or other fiscal

5 agent under the State plan) and to the system

6 established under subsection (x) of this section,

7 respectively.’’.

8 (2) EFFECTIVE DATE.—(A) The amendment

9 made by paragraph (1) shall apply to services fur10 nished on or after the date of the enactment of this

11 Act.

12 (B) Until the first day of the first calendar

13 quarter beginning more than 60 days after the date

14 the Secretary of Health and Human Services estab15 lishes the physician identifier system under section

16 1902(x) of the Social Security Act, the requirement

17 under section 1902(a)(32)(C) of such Act that a

18 claim form submitted must include the second physi19 cian’s unique identifier is deemed to be satisfied if

20 the claim form identifies (in a manner specified by

21 the Secretary of Health and Human Services) the

22 second physician.

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