I

103D CONGRESS

1ST SESSION H. R. 2386

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

medicare reimbursement for nurse practitioners, clinical nurse specialists,

and certified nurse midwives, to increase the delivery of health services

in health professional shortage areas, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JUNE 10, 1993

Mr. TOWNS (for himself and Mr. COYNE) 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 provide

for increased medicare reimbursement for nurse practitioners, clinical nurse specialists, and certified nurse midwives, 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 ‘‘Primary Care Health

5 Practitioner Incentive Act of 1993’’.
2

•HR 2386 IH

1 SEC. 2. INCREASED MEDICARE REIMBURSEMENT FOR PHY2 SICIAN ASSISTANTS, NURSE PRACTITIONERS,

3 CLINICAL NURSE SPECIALISTS, AND CER4 TIFIED NURSE MIDWIVES.

5 (a) INCREASED PAYMENT.—

6 (1) NURSE PRACTITIONERS, CLINICAL NURSE

7 SPECIALISTS, AND CERTIFIED NURSE MIDWIVES.—

8 Section 1833(a)(1) of the Social Security Act (42

9 U.S.C. 1395l(a)(1)) is amended—

10 (A) in subparagraph (K), by striking ‘‘80

11 percent’’ and all that follows through ‘‘physi12 cian)’’ and inserting ‘‘97 percent of the fee

13 schedule amount provided under section 1848

14 for the same service performed by a physician’’;

15 and

16 (B) in subparagraph (M) the second place

17 it appears, by striking ‘‘80 percent’’ and all

18 that follows through ‘‘(r)(2))’’ and inserting

19 ‘‘97 percent of the fee schedule amount pro20 vided under section 1848 for the same service

21 performed by a physician’’.

22 (2) NURSE PRACTITIONERS.—Section

23 1842(b)(12)(A)(ii) of the Social Security Act (42

24 U.S.C. 1395u(b)(12)(A)(ii)) is amended—
3

•HR 2386 IH

1 (A) in subclause (I), by striking ‘‘65 per2 cent’’ and inserting ‘‘65 percent or in the case

3 of nurse practitioner services 97 percent’’; and

4 (B) in subclause (II), by striking ‘‘or for

5 services’’ and all that follows through ‘‘1848’’

6 and inserting ‘‘or in the case of nurse practi7 tioner services 97 percent of the fee schedule

8 amount specified in section 1848 for the same

9 service performed by a physician or for physi10 cian assistants the fee schedule amount speci11 fied in such section’’.

12 (b) DIRECT PAYMENT FOR NURSE PRACTITIONERS

13 OR CLINICAL NURSE SPECIALISTS.—Section

14 1832(a)(2)(B)(iv) of such Act (42 U.S.C.

15 1395k(a)(2(B)(iv)) is amended by striking ‘‘provided in

16 a rural area (as defined in section 1880(d)(2)(D))’’.

17 (c) BONUS PAYMENT FOR SERVICES PROVIDED IN

18 HEALTH PROFESSIONAL SHORTAGE AREAS.—Section

19 1833(m) (42 U.S.C. 1395l(m)) is amended—

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

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

22 paragraph:

23 ‘‘(2) In the case of services of a nurse practitioner,

24 clinical nurse specialist or certified nurse midwife fur25 nished to an individual, described in paragraph (1), in an
4

•HR 2386 IH

1 area that is a health professional shortage area as de2 scribed in such paragraph, in addition to the amount oth3 erwise paid under this part, there shall also be paid to

4 such service provider (or to an employer in the cases de5 scribed in clause (C) of section 1842(b)(6)) (on a monthly

6 or quarterly basis) from the Federal Supplementary Medi7 cal Trust Fund an amount equal to 10 percent of the pay8 ment amount for the service under this part.’’.

9 (d) DEFINITION OF CLINICAL NURSE SPECIALIST

10 CLARIFIED.—Section 1861(aa)(5) of such Act (42 U.S.C.

11 1395x(aa)(5)) is amended—

12 (1) by striking ‘‘clinical nurse specialist’’ each

13 place it appears; and

14 (2) by inserting ‘‘(A)’’ after ‘‘(5)’’ and by add15 ing at the end the following new subparagraph:

16 ‘‘(B) The term ‘clinical specialist’ means, for pur17 poses of this Act, an individual who—

18 ‘‘(i) is a registered nurse and is licensed to

19 practice nursing in the State in which the clinical

20 nurse specialist services are performed; and

21 ‘‘(ii) holds a master’s degree in a defined clini22 cal area of nursing from an accredited educational

23 institution.’’.
5

•HR 2386 IH

1 (e) REMOVAL OF RESTRICTIONS ON SETTINGS.—Sec2 tion 1861(s)(2)(K) of such Act (42 U.S.C.

3 1395x(s)(2)(K)) is amended—

4 (1) in clause (ii), by striking ‘‘in a skilled’’ and

5 all that follows through ‘‘1919(a))’’; and

6 (2) in clause (iii), by striking ‘‘in a rural’’ and

7 all that follows through ‘‘(d)(2)(D))’’.

8 (f) EFFECTIVE DATE.—The amendments made by

9 this section shall apply to services furnished on or after

10 July 1, 1993.

Æ