I 
111TH CONGRESS 
2D SESSION 
H. R. 6373 
To amend title XIX of the Social Security Act to improve access to advanced 
practice nurses and physician assistants under the Medicaid Program. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2010 
Mr. OLVER (for himself, Ms. BALDWIN, Mrs. CAPPS, Mr. FRANK of Massachu-
setts, Mr. AL GREEN of Texas, Mr. GRIJALVA, Mr. HOLT, Mr. MARKEY 
of Massachusetts, Mrs. MALONEY, and Ms. ROYBAL-ALLARD) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce 
A BILL 
To amend title XIX of the Social Security Act to improve 
access to advanced practice nurses and physician assist-
ants under the Medicaid Program. 
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 ‘‘Medicaid Advanced 
Practice Nurses and Physician Assistants Access Act of 
2009’’. 
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SEC. 2. IMPROVED ACCESS TO SERVICES OF ADVANCED 
PRACTICE NURSES AND PHYSICIAN ASSIST-
ANTS UNDER STATE MEDICAID PROGRAMS. 
(a) PRIMARY CARE CASE MANAGEMENT.—Section 
1905(t)(2) of the Social Security Act (42 U.S.C. 
1396d(t)(2)) is amended by striking subparagraph (B) 
and inserting the following: 
‘‘(B) A nurse practitioner (as defined in section 
1861(aa)(5)(A)). 
‘‘(C) A certified nurse-midwife (as defined in 
section 1861(gg)). 
‘‘(D) A physician assistant (as defined in sec-
tion 1861(aa)(5)(A)).’’. 
(b) 
FEE-FOR-SERVICE
PROGRAM.—Section 
1905(a)(21) of such Act (42 U.S.C. 1396d(a)(21)) is 
amended— 
(1) by inserting ‘‘(A)’’ after ‘‘(21)’’; 
(2) by striking ‘‘services furnished by a certified 
pediatric nurse practitioner or certified family nurse 
practitioner (as defined by the Secretary) which the 
certified pediatric nurse practitioner or certified 
family nurse practitioner’’ and inserting ‘‘services 
furnished by a nurse practitioner (as defined in sec-
tion 1861(aa)(5)(A)) or by a clinical nurse specialist 
(as defined in section 1861(aa)(5)(B)) which the 
nurse practitioner or clinical nurse specialist’’; 
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(3) by striking ‘‘the certified pediatric nurse 
practitioner or certified family nurse practitioner’’ 
and inserting ‘‘the nurse practitioner or clinical 
nurse specialist’’; and 
(4) by inserting before the semicolon at the end 
the following: ‘‘and (B) services furnished by a phy-
sician assistant (as defined in section 1861(aa)(5)) 
with the supervision of a physician which the physi-
cian assistant is legally authorized to perform under 
State law’’. 
(c) INCLUDING
IN MIX
OF SERVICE PROVIDERS 
UNDER MEDICAID MANAGED CARE ORGANIZATIONS.— 
Section 1932(b)(5)(B) of such Act (42 U.S.C. 1396u– 
2(b)(5)(B)) is amended by inserting ‘‘, with such mix in-
cluding nurse practitioners, clinical nurse specialists, phy-
sician assistants, certified nurse midwives, and certified 
registered nurse anesthetists (as defined in section 
1861(bb)(2))’’ after ‘‘services’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished in 
calendar quarters beginning on or after 90 days after the 
date of the enactment of this Act, without regard to 
whether or not final regulations to carry out such amend-
ments have been promulgated by such date. 
Æ 
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