I
104TH CONGRESS
1ST SESSION
H. R. 1750
To amend title XVIII of the Social Security Act to provide for increased
medicare reimbursement for nurse practitioners and clinical nurse special-
ists to increase the delivery of health services in health professional
shortage areas, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 6, 1995
Mr. TOWNS (for himself and Mrs. JOHNSON of Connecticut) 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 sub-
sequently determined by the Speaker, in each case for consideration of
such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
for increased medicare reimbursement for nurse practi-
tioners and clinical nurse specialists to increase the deliv-
ery of health services in health professional shortage
areas, and for other purposes.
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 ‘‘Primary Care Health
Practitioner Incentive Act of 1995’’.
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SEC. 2. INCREASED MEDICARE REIMBURSEMENT FOR
NURSE 
PRACTITIONERS 
AND 
CLINICAL
NURSE SPECIALISTS.
(a) REMOVAL OF RESTRICTIONS ON SETTINGS.—
(1) IN GENERAL.—Section 1861(s)(2)(K)(ii) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395x(s)(2)(K)(ii)) is amended to read as follows:
‘‘(ii) 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 nurse
practitioner or clinical nurse specialist (as defined in
subsection (aa)(5)) working in collaboration (as de-
fined in subsection (aa)(6)) with a physician (as so
defined) which the nurse practitioner or clinical
nurse specialist is legally authorized to perform by
the State in which the services are performed, and
such services and supplies furnished as an incident
to such services as would be covered under subpara-
graph (A) if furnished incident to a physician’s pro-
fessional service;’’.
(2) CONFORMING AMENDMENTS.—
(A) Section 1861(s)(2)(K) of such Act (42
U.S.C. 1395x(s)(2)(K)), as amended by para-
graph (1), is amended—
(i) in clause (i), by inserting ‘‘and
such services and supplies furnished as in-
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cident to such services as would be covered
under subparagraph (A) if furnished as an
incident to a physician’s professional serv-
ice.’’ after ‘‘are performed, and’’; and
(ii) by striking clauses (iii) and (iv).
(B) Section 1861(b)(4) of such Act (42
U.S.C. 1395x(b)(4)) is amended by striking
‘‘clauses (i) or (iii) of subsection (s)(2)(K)’’ and
inserting ‘‘subsection (s)(2)(K)’’.
(C) Section 1862(a)(14) of such Act
(42 U.S.C. 1395y(a)(14)) is amended by
striking 
‘‘section 
1861(s)(2)(K)(i) 
or
1861(s)(2)(K)(iii)’’ and inserting ‘‘section
1861(s)(2)(K)’’.
(D) Section 1866(a)(1)(H) of such
Act 
(42 
U.S.C. 
1395cc(a)(1)(H)) 
is
amended 
by 
striking 
‘‘section
1861(s)(2)(K)(i) 
or 
1861(s)(2)(K)(iii)’’
and inserting ‘‘section 1861(s)(2)(K)’’.
(b) INCREASED PAYMENT.—
(1) 
FEE
SCHEDULE
AMOUNT.—Section
1833(a)(1)(O) of the Social Security Act (42 U.S.C.
1395l(a)(1)(O)) is amended to read as follows: ‘‘(O)
with respect to services described in section
1861(s)(2)(K)(ii) (relating to nurse practitioner or
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clinical nurse specialist services), the amounts paid
shall be equal to 80 percent of (i) the lesser of the
actual charge or 85 percent of the fee schedule
amount provided under section 1848 for the same
service provided by a physician who is not a special-
ist; or (ii) in the case of services as an assistant at
surgery, the lesser of the actual charge or 85 per-
cent of the amount that would otherwise be recog-
nized if performed by a physician who is serving as
an assistant at surgery, and’’.
(2) CONFORMING AMENDMENTS.—
(A) Section 1833(r) of such Act (42
U.S.C. 1395l(r)) is amended—
(i) in paragraph (1), by striking ‘‘sec-
tion 1861(s)(2)(K)(iii) (relating to nurse
practitioner or clinical nurse specialist
services provided in a rural area),’’ and in-
serting ‘‘section 1861(s)(2)(K)(ii) (relating
to nurse practitioner or clinical nurse spe-
cialist services),’’;
(ii) by striking paragraph (2);
(iii) in paragraph (3), by striking
‘‘section 1861(s)(2)(K)(iii)’’ and inserting
‘‘section 1861(s)(2)(K)(ii)’’; and
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(iv) by redesignating paragraph (3) as
paragraph (2).
(B) Section 1842(b)(12)(A) of such Act
(42 U.S.C. 1395u(b)(12)(A)) is amended in the
matter preceding clause (i), by striking ‘‘clauses
(i), (ii), or (iv) of section 1861(s)(2)(K) (relat-
ing to a physician assistants and nurse practi-
tioners)’’ 
and 
inserting 
‘‘section
1861(s)(2)(K)(i) (relating to physician assist-
ants)’’.
(c) DIRECT PAYMENT FOR NURSE PRACTITIONERS
AND CLINICAL NURSE SPECIALISTS.—
(1) IN GENERAL.—Section 1832(a)(2)(B)(iv) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395k(a)(2)(B)(iv)) is amended by striking ‘‘pro-
vided in a rural area (as defined in section
1886(d)(2)(D))’’.
(2) 
CONFORMING
AMENDMENT.—Section
1842(b)(6)(C) 
of 
such 
Act 
(42 
U.S.C.
1395u(b)(6)(C)) is amended—
(A) by striking ‘‘clauses (i), (ii), or (iv)’’
and inserting ‘‘clause (i)’’; and
(B) by striking ‘‘or nurse practitioner’’.
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(d) BONUS PAYMENT FOR SERVICES PROVIDED IN
HEALTH
PROFESSIONAL
SHORTAGE
AREAS.—Section
1833(m) of such Act (42 U.S.C. 1395l(m)) is amended—
(1) by inserting ‘‘(1)’’ after ‘‘(m)’’; and
(2) by adding at the end the following new
paragraph:
‘‘(2) In the case of services of a nurse practitioner
or clinical nurse specialist furnished to an individual, de-
scribed in paragraph (1), in an area that is a health pro-
fessional shortage area as described in such paragraph,
in addition to the amount otherwise paid under this part,
there shall also be paid to such service provider (on a
monthly or quarterly basis) from the Federal Supple-
mentary Medical Insurance Trust Fund an amount equal
to 10 percent of the payment amount for the service under
this part.’’.
(e) DEFINITION OF CLINICAL NURSE SPECIALIST
CLARIFIED.—Section 1861(aa)(5) of such Act (42 U.S.C.
1395x(aa)(5)) is amended—
(1) by inserting ‘‘(A)’’ after ‘‘(5)’’;
(2) by striking ‘‘The term ‘‘ ‘physician assist-
ant’ ’’ and all that follows through ‘‘who performs’’
and inserting ‘‘The term ‘physician assistant’ and
the term ‘nurse practitioner’ mean, for purposes of