I 
118TH CONGRESS 
1ST SESSION H. R. 3730 
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 25, 2023 
Mr. SMITH of Nebraska (for himself, Mr. BLUMENAUER, Mr. ARMSTRONG, 
and Ms. TOKUDA) 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 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 
Burden Reduction Act’’. 
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SEC. 2. MODERNIZING PHYSICIAN, PHYSICIAN ASSISTANT, 
AND NURSE PRACTITIONER UTILIZATION RE-
QUIREMENTS. 
Section 1861(aa) of the Social Security 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 DE-
SCRIBED.—For purposes of paragraph (2)(B), with re-
spect to a facility which is not a physician-directed clinic, 
the following requirements are described in this para-
graph: 
‘‘(A) ARRANGEMENT.—The facility has an ar-
rangement consistent with the provisions of State 
and local law relative to the practice, performance, 
and delivery of health services, with one or more 
physician assistants (as defined in paragraph 
(5)(A)) or one or more nurse practitioners (as de-
fined in such paragraph). 
‘‘(B) PRACTICE
AND
OVERSIGHT
REQUIRE-
MENTS.—The delivery of health services under such 
arrangement shall be in accordance with State law 
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or the State regulatory mechanism governing the 
practice of physician assistants or nurse practi-
tioners.’’. 
SEC. 3. REMOVING OUTDATED LABORATORY REQUIRE-
MENTS. 
Section 1861(aa)(2)(G) of the Social 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 services’’. 
SEC. 4. ALLOWING RURAL HEALTH CLINICS THE FLEXI-
BILITY TO CONTRACT WITH PHYSICIAN AS-
SISTANTS AND NURSE PRACTITIONERS. 
Section 1861(aa) of the Social Security Act (42 
U.S.C. 1395x(aa)), in the first sentence of the flush mat-
ter following paragraph (2), is amended by inserting ‘‘or 
contracts with’’ after ‘‘(iii) employs’’. 
SEC. 5. URBANIZED AREA FIX. 
Section 1861(aa) of the Social Security Act (42 
U.S.C. 1395x(aa)), in the first sentence of the flush mat-
ter following paragraph (2), is amended by striking ‘‘(i) 
is located in an area that is not an urbanized area’’ and 
inserting ‘‘(i) is located in an area that is not in an urban 
area of 50,000 or more’’. 
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SEC. 6. EXCEPTION TO BEHAVIORAL HEALTH LIMITATION. 
Section 1861(aa) of the Social Security Act (42 
U.S.C. 1395x(aa)), in the first sentence of the flush mat-
ter following paragraph (2), is amended by inserting the 
following before the period: ‘‘, except in the case where 
the facility is located in an area that is designated (under 
section 332(a)(1)(A) of the Public Health Service Act) as 
a mental health professional shortage area’’. 
SEC. 7. EFFECTIVE DATE. 
This Act and the amendments made by this Act shall 
take effect on January 1, 2024, and shall apply to items 
and services furnished on or after such date. 
Æ 
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