I
103D CONGRESS
1ST SESSION
H. R. 2386
To amend title XVIII of the Social Security Act to provide for increased
medicare reimbursement for nurse practitioners, clinical nurse specialists,
and certified nurse midwives, to increase the delivery of health services
in health professional shortage areas, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 10, 1993
Mr. TOWNS (for himself and Mr. COYNE) introduced the following bill; which
was referred jointly to the Committees on Ways and Means and Energy
and Commerce
A BILL
To amend title XVIII of the Social Security Act to provide
for increased medicare reimbursement for nurse practi-
tioners, clinical nurse specialists, and certified nurse mid-
wives, to increase the delivery 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 1993’’.
SEC. 2. INCREASED MEDICARE REIMBURSEMENT FOR PHY-
SICIAN ASSISTANTS, NURSE PRACTITIONERS,
CLINICAL NURSE SPECIALISTS, AND CER-
TIFIED NURSE MIDWIVES.
(a) INCREASED PAYMENT.—
(1) NURSE
PRACTITIONERS, CLINICAL
NURSE
SPECIALISTS, AND CERTIFIED NURSE MIDWIVES.—
Section 1833(a)(1) of the Social Security Act (42
U.S.C. 1395l(a)(1)) is amended—
(A) in subparagraph (K), by striking ‘‘80
percent’’ and all that follows through ‘‘physi-
cian)’’ and inserting ‘‘97 percent of the fee
schedule amount provided under section 1848
for the same service performed by a physician’’;
and
(B) in subparagraph (M) the second place
it appears, by striking ‘‘80 percent’’ and all
that follows through ‘‘(r)(2))’’ and inserting
‘‘97 percent of the fee schedule amount pro-
vided under section 1848 for the same service
performed by a physician’’.
(2) 
NURSE
PRACTITIONERS.—Section
1842(b)(12)(A)(ii) of the Social Security Act (42
U.S.C. 1395u(b)(12)(A)(ii)) is amended—
(A) in subclause (I), by striking ‘‘65 per-
cent’’ and inserting ‘‘65 percent or in the case
of nurse practitioner services 97 percent’’; and
(B) in subclause (II), by striking ‘‘or for
services’’ and all that follows through ‘‘1848’’
and inserting ‘‘or in the case of nurse practi-
tioner services 97 percent of the fee schedule
amount specified in section 1848 for the same
service performed by a physician or for physi-
cian assistants the fee schedule amount speci-
fied in such section’’.
(b) DIRECT PAYMENT FOR NURSE PRACTITIONERS
OR
CLINICAL
NURSE
SPECIALISTS.—Section
1832(a)(2)(B)(iv) 
of 
such 
Act 
(42 
U.S.C.
1395k(a)(2(B)(iv)) is amended by striking ‘‘provided in
a rural area (as defined in section 1880(d)(2)(D))’’.
(c) BONUS PAYMENT FOR SERVICES PROVIDED IN
HEALTH
PROFESSIONAL
SHORTAGE
AREAS.—Section
1833(m) (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,
clinical nurse specialist or certified nurse midwife fur-
nished to an individual, described in paragraph (1), in an
area that is a health professional shortage area as de-
scribed in such paragraph, in addition to the amount oth-
erwise paid under this part, there shall also be paid to
such service provider (or to an employer in the cases de-
scribed in clause (C) of section 1842(b)(6)) (on a monthly
or quarterly basis) from the Federal Supplementary Medi-
cal Trust Fund an amount equal to 10 percent of the pay-
ment amount for the service under this part.’’.
(d) DEFINITION OF CLINICAL NURSE SPECIALIST
CLARIFIED.—Section 1861(aa)(5) of such Act (42 U.S.C.
1395x(aa)(5)) is amended—
(1) by striking ‘‘clinical nurse specialist’’ each
place it appears; and
(2) by inserting ‘‘(A)’’ after ‘‘(5)’’ and by add-
ing at the end the following new subparagraph:
‘‘(B) The term ‘clinical specialist’ means, for pur-
poses of this Act, an individual who—
‘‘(i) is a registered nurse and is licensed to
practice nursing in the State in which the clinical
nurse specialist services are performed; and
‘‘(ii) holds a master’s degree in a defined clini-
cal area of nursing from an accredited educational
institution.’’.
(e) REMOVAL OF RESTRICTIONS ON SETTINGS.—Sec-
tion 
1861(s)(2)(K) 
of 
such 
Act 
(42 
U.S.C.
1395x(s)(2)(K)) is amended—
(1) in clause (ii), by striking ‘‘in a skilled’’ and
all that follows through ‘‘1919(a))’’; and
(2) in clause (iii), by striking ‘‘in a rural’’ and
all that follows through ‘‘(d)(2)(D))’’.
(f) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
July 1, 1993.
Æ