I 
116TH CONGRESS 
1ST SESSION H. R. 2788 
To amend title XVIII of the Social Security Act to modernize provisions 
relating to rural health clinics under Medicare. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 16, 2019 
Mr. SMITH of Nebraska (for himself, Mrs. RODGERS of Washington, Ms. SE-
WELL of Alabama, and Mr. LOEBSACK) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently 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 modernize 
provisions relating to rural health clinics under Medicare. 
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 ‘‘Rural Health Clinic 
Modernization Act of 2019’’. 
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SEC. 2. MODERNIZING PHYSICIAN, PHYSICIAN ASSISTANT, 
AND NURSE PRACTITIONER UTILIZATION RE-
QUIREMENTS. 
(a) IN GENERAL.—Section 1861(aa) of the Social Se-
curity Act (42 U.S.C. 1395x(aa)) is amended— 
(1) in paragraph (2)(B), by striking ‘‘has an 
arrangement’’ and all that follows through the first 
semicolon and inserting ‘‘meets the requirements de-
scribed in paragraph (8);’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(8) REQUIREMENTS FOR CERTAIN FACILITIES 
DESCRIBED.—For purposes of paragraph (2)(B), 
with respect to a facility which is not a physician- 
directed clinic, the following requirements are de-
scribed in this paragraph: 
‘‘(A) ARRANGEMENT.—The facility has an 
arrangement consistent with the provisions of 
State and local law relative to the practice, per-
formance, and delivery of health services, with 
one or more physician assistants (as defined in 
paragraph (5)(A)) or one or more nurse practi-
tioners (as defined in such paragraph). 
‘‘(B) PRACTICE AND OVERSIGHT REQUIRE-
MENTS.— 
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‘‘(i) IN GENERAL.—Subject to clause 
(ii), the delivery of health services under 
such arrangement shall be in accordance 
with State law or the State regulatory 
mechanism governing the practice of physi-
cian assistants or nurse practitioners. 
‘‘(ii) EXCEPTION IF NO STATE LAWS 
OR
REGULATIONS
APPLICABLE.—In the 
case where a State does not have laws or 
regulations governing the practice, per-
formance, and delivery of health services 
by a physician assistant or nurse practi-
tioner, the Secretary shall adopt regula-
tions for facilities located in such State 
that provide for the periodic review by phy-
sicians of covered services furnished by 
physician assistants and nurse practi-
tioners, the supervision and guidance by 
such physicians of physician assistants and 
nurse practitioners, and the preparation by 
such physicians of such medical orders for 
care and treatment of clinic patients as is 
necessary. Such regulations shall also re-
quire facilities located in such a State to 
have arrangements with physicians for re-
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ferral of and consultation for patients as 
the facility deems necessary and for advice 
and assistance in the management of med-
ical emergencies.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of the enactment 
of this Act. 
SEC. 3. REMOVING OUTDATED LABORATORY REQUIRE-
MENTS. 
(a) IN GENERAL.—Section 1861(aa)(2)(G) of the So-
cial Security Act (42 U.S.C. 1395x(aa)(2)(G)) is amended 
by striking ‘‘, including clinical laboratory services’’ and 
all that follows through ‘‘additional diagnostic services’’ 
and inserting the following: ‘‘and has prompt access to 
clinical laboratory services and additional diagnostic serv-
ices’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of the enactment 
of this Act. 
SEC. 4. ALLOWING RURAL HEALTH CLINICS THE FLEXI-
BILITY TO CONTRACT WITH PHYSICIAN AS-
SISTANTS AND NURSE PRACTITIONERS. 
(a) IN GENERAL.—Section 1861(aa) of the Social Se-
curity Act (42 U.S.C. 1395x(aa)), in the first sentence of 
the flush matter following paragraph (2), is amended by 
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striking ‘‘(iii) employs a physician assistant or nurse prac-
titioner, and (iv)’’ and inserting ‘‘and (iii)’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act. 
SEC. 5. ALLOWING RURAL HEALTH CLINICS TO BE THE DIS-
TANT SITE FOR A TELEHEALTH VISIT. 
(a) IN GENERAL.—Section 1834(m) of the Social Se-
curity Act (42 U.S.C. 1395m(m)) is amended— 
(1) in the first sentence of paragraph (1)— 
(A) by striking ‘‘or a practitioner (de-
scribed in section 1842(b)(18)(C))’’ and insert-
ing ‘‘, a practitioner (described in section 
1842(b)(18)(C)), or a rural health clinic’’; and 
(B) by striking ‘‘or practitioner’’ and in-
serting ‘‘, practitioner, or rural health clinic’’; 
(2) in paragraph (2)(A)— 
(A) by striking ‘‘or practitioner’’ and in-
serting ‘‘practitioner, or rural health clinic’’; 
and 
(B) by striking ‘‘such physician or practi-
tioner’’ and inserting ‘‘such physician, practi-
tioner, or rural health clinic’’; and 
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(3) in paragraph (4)(A), by striking ‘‘or practi-
tioner’’ and inserting ‘‘practitioner, or rural health 
clinic’’. 
(b) 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. 6. INCLUDING FACILITIES LOCATED IN CERTAIN 
AREAS. 
(a) IN GENERAL.—Section 1861(aa) of the Social Se-
curity Act (42 U.S.C. 1395x(aa)) is amended, in the first 
sentence of the flush matter following paragraph (2), by 
inserting ‘‘or in an area that has been designated by the 
chief executive officer of the State and certified by the Sec-
retary as rural’’ after ‘‘Census)’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall take effect on the date of the enactment 
of this Act. 
SEC. 
7. 
INCREASING 
REIMBURSEMENT 
FOR 
RURAL 
HEALTH CLINICS. 
Section 1833(f) of the Social Security Act (42 U.S.C. 
1395l(f)) is amended— 
(1) in paragraph (1), by striking ‘‘, and’’ at the 
end and inserting a semicolon; 
(2) in paragraph (2)— 
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(A) by inserting ‘‘(before 2020)’’ after ‘‘in 
a subsequent year’’; and 
(B) by striking the period at the end and 
inserting a semicolon; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(3) in 2020, at $105 per visit; 
‘‘(4) in 2021, at $110 per visit; 
‘‘(5) in 2022, at $115 per visit; and 
‘‘(6) in a subsequent year, at the limit estab-
lished under this subsection for the previous year in-
creased by the percentage increase in the MEI (as 
so defined) applicable to primary care services (as so 
defined) furnished as of the first day of that year.’’. 
Æ 
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