I
103D CONGRESS
1ST SESSION
H. R. 1770
To provide incentives for physicians to practice in rural areas and in rural
medically underserved areas.
IN THE HOUSE OF REPRESENTATIVES
APRIL 21, 1993
Mr. ROWLAND (for himself, Mr. HALL of Texas, Mrs. VUCANOVICH, Mr.
THOMAS of Wyoming, Mr. EMERSON, Mr. LANCASTER, Mr. ROBERTS,
Mr. BEREUTER, Mr. SLATTERY, Mr. STENHOLM, Mr. GUNDERSON, Ms.
SNOWE, and Mr. DURBIN) introduced the following bill; which was re-
ferred jointly to the Committees on Ways and Means, Energy and Com-
merce, and Education and Labor
A BILL
To provide incentives for physicians to practice in rural areas
and in rural medically underserved areas.
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 Physicians’
Incentives Act of 1993’’.
SEC. 2. DEDUCTION FOR MEDICAL SCHOOL EDUCATION
LOAN INTEREST INCURRED BY DOCTORS
SERVING 
IN 
MEDICALLY 
UNDERSERVED
RURAL AREAS.
(a) IN GENERAL.—Paragraph (1) of section 163(h)
of the Internal Revenue Code of 1986 (relating to dis-
allowance of deduction for personal interest) is amended
by striking ‘‘and’’ at the end of subparagraph (D), by re-
designating subparagraph (E) as subparagraph (F), and
by inserting after subparagraph (D) the following new
subparagraph:
‘‘(E) any qualified medical education loan
interest (within the meaning of paragraph (5)),
and’’.
(b) QUALIFIED MEDICAL EDUCATION LOAN INTER-
EST DEFINED.—Subsection (h) of section 163 of such
Code is amended by redesignating paragraph (5) as para-
graph (6) and by inserting after paragraph (4) the follow-
ing new paragraph:
‘‘(5) QUALIFIED MEDICAL EDUCATION LOAN IN-
TEREST.—
‘‘(A) IN
GENERAL.—The term ‘qualified
medical education loan interest’ means inter-
est—
‘‘(i) which is on a medical education
loan of a physician,
‘‘(ii) which is paid or accrued by such
physician, and
‘‘(iii) which accrues during the pe-
riod—
‘‘(I) such physician is providing
primary care (including internal medi-
cine, pediatrics, obstetrics/gynecology,
family medicine, and osteopathy) to
residents of a medically underserved
rural area, and
‘‘(II) such physician’s principal
place of abode is in such area.
‘‘(B) MEDICAL
EDUCATION
LOAN.—The
term ‘medical education loan’ means indebted-
ness incurred to pay the individual’s—
‘‘(i) qualified tuition and related ex-
penses (as defined in section 117(b)) in-
curred for the medical education of such
individual, or
‘‘(ii) reasonable living expenses while
away from home in order to attend an edu-
cational institution described in section
170(b)(1)(A)(ii) for the medical education
of such individual.
‘‘(C) PHYSICIAN.—For purposes of sub-
paragraph (A), the term ‘physician’ has the
meaning given such term by section 1861(r)(1)
of the Social Security Act.
‘‘(D) MEDICALLY
UNDERSERVED
RURAL
AREA.—The term ‘medically underserved rural
area’ means any rural area which is a medically
underserved area (as defined in section 330(b)
or 1302(7) of the Public Health Service Act).’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to taxable years ending after the
date of the enactment of this Act.
SEC. 3. ELIMINATION OF MEDICARE PAYMENT REDUC-
TIONS FOR NEW DOCTORS FOR SERVICES
FURNISHED IN ANY RURAL AREA.
(a) IN GENERAL.—Section 1848(a)(4) of the Social
Security Act (42 U.S.C. 1395w–4(a)(4)) is amended—
(1) by striking ‘‘or services’’ and inserting ‘‘,
services’’, and
(2) by inserting before the period at the end the
following: ‘‘, or services furnished in a rural area (as
so defined) by (or under the supervision, or inciden-
tal to services, of) a physician described in section
1861(r)(1)’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to services furnished after 1993.
SEC. 4. EXTENSION OF DEFERMENTS.
(a) STAFFORD LOANS.—
(1) GSL LOANS.—Section 428(b)(1)(M) of the
Higher 
Education 
Act 
of 
1965 
(20 
U.S.C.
1078(b)(1)(M)) is amended—
(A) by striking ‘‘or’’ at the end of clause
(ii);
(B) by inserting ‘‘or’’ after the semicolon
at the end of clause (iii); and
(C) by adding at the end thereof the fol-
lowing new clause:
‘‘(iv) during which the borrower is
serving in an internship or residency pro-
gram in preparation for practice in an area
of primary care (including internal medi-
cine, pediatrics, obstetrics/gynecology, fam-
ily medicine, and osteopathy);’’.
(2) FISL LOANS.—Section 427(a)(2)(C) of
such Act (20 U.S.C. 1077(a)(2)(C)) is amended—
(A) by striking ‘‘or’’ at the end of clause
(ii);
(B) by inserting ‘‘or’’ after the semicolon
at the end of clause (iii); and
(C) by adding at the end thereof the fol-
lowing new clause:
‘‘(iv) during which the borrower is
serving in an internship or residency pro-
gram in preparation for practice in an area
of primary care (including internal medi-
cine, pediatrics, obstetrics/gynecology, fam-
ily medicine, and osteopathy);’’.
(b) PERKINS LOANS.—Section 464(c)(2)(A) of such
Act (20 U.S.C. 1087dd(c)(2)(A)) is amended—
(1) by striking ‘‘or’’ at the end of clause (iii);
(2) by inserting ‘‘or’’ after the semicolon at the
end of clause (iv); and
(3) by adding at the end thereof the following
new clause:
‘‘(v) during which the borrower is
serving in an internship or residency pro-
gram in preparation for practice in an area
of primary care (including internal medi-
cine, pediatrics, obstetrics/gynecology, fam-
ily medicine, and osteopathy);’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to on and after the date of the
enactment of this Act with respect to loans made under
the Higher Education Act of 1965 before, on, or after that
date.
SEC. 5. CLARIFICATION OF PERMISSIBLE SUBSTITUTE
BILLING ARRANGEMENTS FOR PHYSICIANS’
SERVICES UNDER THE MEDICARE AND MED-
ICAID PROGRAMS.
(a) MEDICARE PROGRAM.—
(1) IN
GENERAL.—Clause (D) of section
1842(b)(6) of the Social Security Act (42 U.S.C.
1395u(b)(6)) is amended to read as follows: ‘‘(D)(i)
payment may be made to a physician for physicians’
services (and services incident to such services) to be
provided by a second physician on a reciprocal basis
to individuals who are patients of the first physician
if (I) the first physician is unavailable to provide the
services, (II) the services are not provided by the
second physician over a continuous period of longer
than 60 days, and (III) the claim form submitted to
the carrier includes the second physician’s unique
identifier (provided under the system established
under subsection (r)) and indicates that the claim
meets the requirements of this clause for payment to
the first physician; and (ii) payment may be made
to a physician for physicians’ services (and services
incident to such services) which that physician pays
a second physician on a per diem or other fee-for-
time basis to provide to individuals who are patients
of the first physician if (I) the first physician is un-
available to provide the services, (II) the services are
not provided by the second physician over a continu-
ous period of longer than 90 days (or such longer
period as the Secretary may provide), and (III) the
claim form submitted to the carrier includes the sec-
ond physician’s unique identifier (provided under the
system established under subsection (r)) and indi-
cates that the claim meets the requirements of this
clause for payment to the first physician’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to services furnished on
or after the first day of the first month beginning
more than 60 days after the date of the enactment
of this Act.
(b) MEDICAID PROGRAM.—
(1) IN
GENERAL.—Section 1902(a)(32)(C) of
the Social Security Act (42 U.S.C. 1396a(a)(32)(C))
is amended to read as follows:
‘‘(C) payment may be made to a physician
for services furnished by a substitute physician
under the circumstances described in subpara-
graph (D) of section 1842(b)(6), except that,
for purposes of this subparagraph, any ref-
erence in such subparagraph to ‘a carrier’ or
‘the system established under subsection (r)’ is
deemed a reference to the State (or other fiscal
agent under the State plan) and to the system
established under subsection (x) of this section,
respectively.’’.
(2) EFFECTIVE
DATE.—(A) The amendment
made by paragraph (1) shall apply to services fur-
nished on or after the date of the enactment of this
Act.
(B) Until the first day of the first calendar
quarter beginning more than 60 days after the date
the Secretary of Health and Human Services estab-
lishes the physician identifier system under section
1902(x) of the Social Security Act, the requirement
under section 1902(a)(32)(C) of such Act that a
claim form submitted must include the second physi-
cian’s unique identifier is deemed to be satisfied if
the claim form identifies (in a manner specified by
the Secretary of Health and Human Services) the
second physician.
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