I 
108TH CONGRESS 
2D SESSION 
H. R. 4724
To amend title XVIII of the Social Security Act to provide for coverage 
of clinical pharmacist practitioner services under part B of the Medicare 
Program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 25, 2004
Mr. BURR (for himself, Mr. BALLENGER, Mr. COBLE, and Mr. PRICE of 
North Carolina) 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 subsequently 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 coverage of clinical pharmacist practitioner services 
under part B of the Medicare 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 ‘‘Medicare Clinical Phar-
macist Practitioner Services Coverage Act of 2004’’ .
SEC. 2. MEDICARE COVERAGE OF CLINICAL PHARMACIST 
PRACTITIONER SERVICES. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (U); 
(2) by adding ‘‘and’’ at the end of subpara-
graph (V); and 
(3) by inserting after subparagraph (V) the fol-
lowing new subparagraph: 
‘‘(W) clinical pharmacist practitioner serv-
ices (as defined in subsection (ww)(1)); and’’. 
(b) SERVICES DESCRIBED.—Section 1861 of such 
Act (42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection: 
‘‘Clinical Pharmacist Practitioner Services; Clinical 
Pharmacist Practitioner 
‘‘(ww)(1) The term ‘clinical pharmacist practitioner 
services’ means such direct patient care services provided 
by a clinical pharmacist practitioner, and such services are 
furnished as an incident to the practitioner’s services, 
which the practitioner is legally authorized to perform 
under State law (or the State regulatory mechanism as 
provided by State law) in a collaborative practice agree-
ment as would otherwise be covered if furnished by a phy-
sician, or as an incident to a physician’s professional serv-
ice. 
‘‘(2) The term ‘clinical pharmacist practitioner’ 
means as a pharmacist involved in the application of the 
scientific principles of pharmacology, toxicology, thera-
peutics, clinical pharmacokinetics, pharmacoeconomics, 
and other life sciences for the direct care of patients.’’. 
(c) PAYMENT.—
(1) IN GENERAL.—Section 1833(a)(1) of such 
Act (42 U.S.C. 1395l(a)(1)) is amended—
(A) by striking ‘‘and (U)’’ and inserting 
‘‘(U)’’; and 
(B) by striking the semicolon at the end 
and inserting the following: ‘‘, and (V) with re-
spect to clinical pharmacist practitioner services 
(as defined in section 1861(ww)), the amounts 
paid shall be 80 percent of the amounts pro-
vided for such services under section 1834(n);’’. 
(2) ESTABLISHMENT
OF
FEE
SCHEDULES.—
Section 1834 of such Act (42 U.S.C. 1395m) is 
amended by adding at the end the following new 
subsection: 
‘‘(n) FEE SCHEDULES FOR CLINICAL PHARMACIST 
PRACTITIONER SERVICES.—
‘‘(1) DEVELOPMENT.—The Secretary shall de-
velop and implement, for services furnished not later 
than January 1, 2007—
‘‘(A) a relative value scale to serve as the 
basis for the payment of clinical pharmacist 
practitioner services (as defined in section 
1861(ww)) under this part; and 
‘‘(B) using such scale and appropriate con-
version factors, fee schedules (on a regional, 
statewide, locality, or carrier service area basis) 
for payment for clinical pharmacist practitioner 
services under this part. 
‘‘(2) PAYMENTS
PRIOR
TO
IMPLEMENTATION 
OF FEE SCHEDULES.—In the case of clinical phar-
macist practitioner services which are furnished be-
fore the implementation of fee schedules under para-
graph (1)(B), the amount of payment made under 
this part shall be based on 85 percent of the fee 
schedule amount applicable under section 1848 if 
the service were furnished by a physician.’’. 
(3) REPORT
TO
CONGRESS.—Not later than 
September 30, 2006, the Secretary of Health and 
Human Services shall submit a report to Congress 
on the fee schedules (including relative value scale 
and appropriate conversion factors) developed pursu-
ant to section 1834(n)(1) of the Social Security Act 
(as added by paragraph (2)) for clinical pharmacist 
practitioner services under part B of title XVIII of 
such Act. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2005.
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