I
104TH CONGRESS
1ST SESSION
H. R. 188
To amend title XVIII of the Social Security Act to permit direct payment
under the medicare program for services of registered nurses as assist-
ants at surgery.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 4, 1995
Mrs. COLLINS of Illinois 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 juris-
diction of the committee concerned
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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. DIRECT PAYMENT FOR SERVICES OF REG-
ISTERED NURSES AS ASSISTANTS AT SUR-
GERY.
(a) SERVICES COVERED.—Section 1861(s)(2)(K) of
the Social Security Act (42 U.S.C 1395x(s)(2)(K)) is
amended—
(1) in clause (iii), by striking ‘‘and’’ at the end;
(2) in clause (iv), by striking ‘‘clause (i) or (ii)’’
and inserting ‘‘clause (i), (ii), or (iv)’’;
(3) by redesignating clause (iv) as clause (v);
and
(4) by inserting after clause (iii) the following
new clause:
‘‘(iv) services which would be physicians’ serv-
ices if furnished by a physician (as defined in sub-
section (r)(1)) and which are performed by a reg-
istered nurse under the supervision of a physician
(as so defined) as an assistant at surgery and which
the registered nurse is legally authorized to perform
by the State in which the services are performed,
and’’.
(b) PAYMENT AMOUNT.—Section 1842(b)(12)(A) of
such Act (42 U.S.C. 1395u(b)(12)) is amended—
(1) by striking ‘‘clauses (i), (ii), or (iv)’’ and in-
serting ‘‘clauses (i), (ii), (iv), or (v)’’; and
(2) by striking ‘‘a physician assistants and
nurse practitioners’’ and inserting ‘‘physician assist-
ants, nurse practitioners, and registered nurses’’.
(c) 
PAYMENTS
TO
EMPLOYERS.—Section
1842(b)(6)(C) of such Act (42 U.S.C. 1395u(b)(6)(C)) is
amended—
(1) by striking ‘‘clauses (i), (ii), or (iv)’’ and in-
serting ‘‘clauses (i), (ii), (iv), or (v)’’; and
(2) by striking ‘‘physician assistant or nurse
practitioner’’ and inserting ‘‘physician assistant,
nurse practitioner, or registered nurse’’.
(d) APPLICATION
OF
MANDATORY
ASSIGNMENT
RULES.—Section 1842(b)(18)(C)(i) of such Act (42
U.S.C. 1395u(b)(18)(C)(i)), as added by section 123(b)(1)
of the Social Security Act Amendments of 1994, is amend-
ed by striking ‘‘A physician’’ and inserting ‘‘A registered
nurse, physician’’.
(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 to eliminate
estimated duplicate payments for historical or current
costs attributable to services described in section
1861(s)(2)(K)(iv) of such Act (as amended by subsection
(a)).
(e) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 1996.
SEC. 2. STUDY OF PAYMENT RATES.
Not later than April 1, 1996, the Secretary of Health
and Human Services shall submit a report to Congress
containing recommendations for adjustments to the pay-
ment amounts established under part B of title XVIII of
the Social Security Act for services described in section
1861(s)(2)(K)(iv) of such Act (as amended by section
1(a)) to ensure that the payment amounts reflect the ap-
proximate costs of furnishing the services, taking into ac-
count the costs of compensation, overhead, and super-
vision attributable to registered nurses.
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