I
105TH CONGRESS
1ST SESSION
H. R. 893
To amend title XVIII of the Social Security Act to provide for increased
Medicare reimbursement for nurse practitioners and clinical nurse spe-
cialists to increase the delivery of health services in health professional
shortage areas, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 27, 1997
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 1997’’.
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 amend-
ed—
(i) in paragraph (1), by striking ‘‘section
1861(s)(2)(K)(iii) (relating to nurse practi-
tioner or clinical nurse specialist services pro-
vided in a rural area)’’ and inserting ‘‘section
1861(s)(2)(K)(ii) (relating to nurse practitioner
or clinical nurse specialist 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
(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) (relating to a physician
assistants and nurse practitioners)’’ and inserting
‘‘section 1861(s)(2)(K)(i) (relating to physician as-
sistants)’’.
(c) DIRECT PAYMENT FOR NURSE PRACTITIONERS
AND CLINICAL NURSE SPECIALISTS.—
(1) IN GENERAL.—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 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’’.
(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 practi-
tioner or clinical nurse specialist furnished to an in-
dividual described in paragraph (1) in an area that
is a health professional shortage area 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 Supplementary 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.
1395×(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
this title, a physician assistant or nurse practitioner
who performs’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(B) The term ‘clinical nurse specialist’ means, for
purposes of this title, 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.’’.
(f) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to services furnished
and supplies provided on and after January 1, 1998.
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