I
106TH CONGRESS
2D SESSION
H. R. 3911
To amend title XVIII of the Social Security Act to provide for coverage
under the Medicare Program for surgical first assisting services of cer-
tified registered nurse first assistants.
IN THE HOUSE OF REPRESENTATIVES
MARCH 14, 2000
Mr. COLLINS (for himself, Mr. NORWOOD, Mr. HOEKSTRA, Mr. GREENWOOD,
Mr. ENGLISH, Mr. DEAL of Georgia, Mr. FOLEY, Mr. LEWIS of Georgia,
Mrs. JOHNSON of Connecticut, Mr. WISE, Mr. GOSS, Mrs. CAPPS, and
Mr. MCDERMOTT) introduced the following bill; which was referred to the
Committee on 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 jurisdic-
tion of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
for coverage under the Medicare Program for surgical
first assisting services of certified registered nurse first
assistants.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare Certified
Registered Nurse First Assistant Direct Reimbursement
Act of 2000’’.
SEC. 2. MEDICARE COVERAGE OF SURGICAL FIRST ASSIST-
ING SERVICES OF CERTIFIED REGISTERED
NURSE FIRST ASSISTANTS.
(a) SERVICES COVERED.—Section 1861(s)(2) of the
Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (S);
(2) by striking the period at the end of (T) and
inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(U) surgical first assisting services (as defined
in subsection (uu)(1)) furnished by a certified reg-
istered nurse first assistant (as defined in subsection
(uu)(2)).’’.
(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x) is amended by adding
at the end the following new subsection:
‘‘Surgical First Assisting Services; Certified Registered
Nurse First Assistant
‘‘(uu)(1) The term ‘surgical first assisting services’
means services consisting of first assisting a physician
with surgery and related preoperative, intraoperative, and
postoperative care (as determined by the Secretary) fur-
nished by a certified registered nurse first assistant (as
defined in paragraph (2)) which the certified registered
nurse first assistant is legally authorized to perform by
the State in which the services are performed.
‘‘(2) The term ‘certified registered nurse first assist-
ant’ means an individual who—
‘‘(A) is a registered nurse and is licensed to
practice nursing in the State in which the surgical
first assisting services are performed;
‘‘(B) has completed a minimum of 2,000 hours
of first assisting a physician with surgery and re-
lated preoperative, intraoperative, and postoperative
care; and
‘‘(C) is certified as a registered nurse first as-
sistant by an organization recognized by the Sec-
retary.’’.
(c) PAYMENT AMOUNT.—Section 1833(a)(1) of the
Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—
(1) by striking ‘‘and’’ before ‘‘(S)’’; and
(2) by inserting before the semicolon at the end
the following: ‘‘, and (T) with respect to surgical
first assisting services (as defined in section
1861(uu)(1)) furnished by a certified registered
nurse 
first 
assistant 
(as 
defined 
in 
section
1861(uu)(2)), the amount paid shall be 80 percent
of the lesser of the actual charge for the services or
85 percent of the amount determined under the fee
schedule established under section 1848(b) for the
same services if furnished by a physician’’.
(d) PAYMENTS TO EMPLOYERS.—
(1) IN GENERAL.—Section 1833(r) of the So-
cial Security Act (42 U.S.C. 1395l(r)) is amended—
(A) in paragraph (1), by inserting ‘‘or sec-
tion 1861(s)(2)(U) (relating to surgical first as-
sisting services)’’ after ‘‘clinical nurse specialist
services)’’; and
(B) 
in 
paragraph 
(2), 
by 
striking
‘‘1861(s)(2)(K)(ii)’’ 
and 
inserting
‘‘1861(s)(2)(K)(ii) or 1861(s)(2)(U)’’.
(2) APPLICATION OF MANDATORY ASSIGNMENT
RULES.—Section 1842(b)(18)(C)(i) of such Act (42
U.S.C. 1395u(b)(18)(C)(i)) is amended by striking
‘‘physician assistant, nurse practitioner, clinical
nurse specialist’’ and inserting ‘‘physician assistant,
nurse practitioner, clinical nurse specialist, or cer-
tified registered nurse first assistant’’.
(3) EXCLUSION
FROM
BUNDLED
PAYMENTS
FOR COVERED SKILLED NURSING FACILITY SERV-
ICES.—Section 1888(e)(2)(A)(ii) of such Act (42
U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting
‘‘surgical first assisting services of a certified reg-
istered nurse first assistant,’’ after ‘‘services of a
certified registered nurse anesthetist,’’.
(e) REDUCTION IN PAYMENTS TO AVOID DUPLICATE
PAYMENT.—Notwithstanding any other provision of law,
the Secretary of Health and Human Services may reduce
the amount of payments otherwise made to hospitals
under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) to eliminate estimated duplicate payments
for historical or current costs attributable to surgical first
assisting services furnished by certified registered nurse
first assistants as described in section 1861(uu) of such
Act (as added by subsection (a)).
(f) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
the date of the enactment of this Act.
SEC. 3. STUDY OF PAYMENT RATES.
Not later than 180 days after the date of the enact-
ment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report containing rec-
ommendations for adjustments to the payment amounts
established under part B of title XVIII of the Social Secu-
rity Act for surgical first assisting services furnished by
certified registered nurse first assistants (as described in
section 1861(uu) of such Act (as added by section 1(a))
to ensure that the payment amounts reflect the approxi-
mate costs of furnishing such services, taking into account
the costs of compensation, overhead, and supervision at-
tributable to certified registered nurse first assistants.
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