Title: Acupuncture for Heroes and Seniors Act of 2019
Policy area: Armed Forces and National Security

Summary:
Acupuncture for Heroes and Seniors Act of 2019
This bill expands access to acupuncturist services, particularly for veterans and seniors.
Specifically, the bill requires the provision of qualified acupuncturist services for veterans enrolled in the Department of Veterans Affairs (VA) health care system and military members and their dependents under the TRICARE program. A qualified acupuncturist is an individual who is licensed, certified, or otherwise accredited to perform acupuncture services.
The bill also entitles military members and their dependents to qualified acupuncturist services under the TRICARE program without a referral, even if such services are not medically or psychologically necessary to prevent, diagnose, or treat an issue.
The VA must implement a program to provide acupuncturist services in at least one VA facility in each Veterans Integrated Service Network in both urban and rural areas. Such services must be available to veterans enrolled in the VA health care system without the requirement of a referral. The VA must also establish the Advisory Committee on Acupuncturist Services to assist with the implementation of the VA acupuncturist program.
The VA must pay acupuncturists equivalently with how it pays physicians.
The bill provides for coverage for qualified acupuncturist services under the Medicare program and prescribes benefit amounts and payment rules depending on the circumstances of the service.
The bill also makes acupuncturists eligible for appointment as (1) commissioned officers in the Armed Forces, and (2) officers in the commissioned Regular Corps and the Ready Reserve Corps of the Public Health Service.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1183 Introduced in House (IH)]

<DOC>






116th CONGRESS
  1st Session
                                H. R. 1183

 To amend title 10, United States Code, to ensure access to qualified 
acupuncturist services for military members and military dependents, to 
 amend title 38, United States Code, to ensure access to acupuncturist 
  services through the Department of Veterans Affairs, to amend title 
 XVIII of the Social Security Act to provide for coverage of qualified 
acupuncturist services under the Medicare program; to amend the Public 
     Health Service Act to authorize the appointment of qualified 
 acupuncturists as officers in the commissioned Regular Corps and the 
    Ready Reserve Corps of the Public Health Service, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 13, 2019

  Ms. Judy Chu of California introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
   the Committees on Armed Services, Veterans' Affairs, and 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 10, United States Code, to ensure access to qualified 
acupuncturist services for military members and military dependents, to 
 amend title 38, United States Code, to ensure access to acupuncturist 
  services through the Department of Veterans Affairs, to amend title 
 XVIII of the Social Security Act to provide for coverage of qualified 
acupuncturist services under the Medicare program; to amend the Public 
     Health Service Act to authorize the appointment of qualified 
 acupuncturists as officers in the commissioned Regular Corps and the 
    Ready Reserve Corps of the Public Health Service, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Acupuncture for 
Heroes and Seniors Act of 2019''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
Sec. 3. Inclusion of acupuncture services through military health care 
                            system and TRICARE program.
Sec. 4. Acupuncture health services for TRICARE program beneficiaries.
Sec. 5. Appointment of acupuncturists as commissioned officers in the 
                            Armed Forces.
Sec. 6. Inclusion of acupuncturist services at veterans health 
                            facilities.
Sec. 7. Coverage for acupuncturist services under the Medicare program.
Sec. 8. Acupuncturists in the Regular Corps and the Ready Reserve Corps 
                            of the Public Health Service.

SEC. 2. DEFINITIONS.

    In this Act, except as otherwise provided:
            (1) The term ``qualified acupuncturist services'' means--
                    (A) acupuncturist services--
                            (i) that are furnished by a qualified 
                        acupuncturist; and
                            (ii) which the qualified acupuncturist is 
                        legally authorized to perform under State law; 
                        and
                    (B) services and supplies that are furnished by a 
                qualified acupuncturist incident to the services 
                described in subparagraph (A).
            (2) The term ``qualified acupuncturist'' means an 
        individual who is licensed or certified as an acupuncturist by 
        a State or, in the case of an individual in a State that does 
        not provide for such licensure or certification, meets such 
        criteria (such as accreditation through an appropriate 
        nationally recognized certification authority for 
        acupuncturists) as the Secretary of Health and Human Services 
        may specify. In specifying such requirements, the Secretary may 
        use the same requirements as those established by such a 
        certification authority.
            (3) The term ``State'' means the 50 States, the District of 
        Columbia, Puerto Rico, the United States Virgin Islands, Guam, 
        American Samoa, and the Northern Mariana Islands.

SEC. 3. INCLUSION OF ACUPUNCTURE SERVICES THROUGH MILITARY HEALTH CARE 
              SYSTEM AND TRICARE PROGRAM.

    (a) Members of the Uniformed Services.--
            (1) In general.--Chapter 55 of title 10, United States 
        Code, is amended by inserting after section 1074o the following 
        new section:
``Sec. 1074p. Provision of acupuncturist services
    ``In accordance with section 1074(c) of this title, and under 
regulations prescribed by the Secretary, members of the uniformed 
services entitled to medical care under section 1074 shall be entitled 
to qualified acupuncturist services (without the requirement of a 
referral) provided in a military medical treatment facility or a 
private facility by an acupuncturist who is licensed or certified in 
the State in which the facility is located, or, in the case of a 
facility in a State that does not provide for such licensure or 
certification, meets such criteria (such as accreditation through an 
appropriate nationally recognized certification authority for 
acupuncturists) as the Secretary may specify. In specifying such 
requirements, the Secretary may use the same requirements as those 
established by such a certification authority.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 1074o the following new item:

``1074p. Provision of acupuncturist services.''.
    (b) TRICARE Program.--Section 1079(a) of title 10, United States 
Code, is amended--
            (1) in paragraph (12), by inserting ``or paragraph (18)'' 
        after ``except as authorized in paragraph (4)''; and
            (2) by adding at the end the following new paragraph:
            ``(18) Acupuncturist services may be provided without the 
        requirement of a referral if performed by an acupuncturist who 
        is licensed or certified in the State in which the services are 
        furnished, or, in the case of services furnished in a State 
        that does not provide for such licensure or certification, 
        meets such criteria (such as accreditation through an 
        appropriate nationally recognized certification authority for 
        acupuncturists) as the Secretary may specify. In specifying 
        such requirements, the Secretary may use the same requirements 
        as those established by such a certification authority.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date that is 180 days after the date of the enactment of 
this Act.

SEC. 4. ACUPUNCTURE HEALTH SERVICES FOR TRICARE PROGRAM BENEFICIARIES.

    (a) Plan Required.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Defense shall develop a plan to 
provide qualified acupuncturist services, as a permanent part of the 
TRICARE program pursuant to the amendments made by section 3, for 
covered beneficiaries (as defined in section 1072 of title 10, United 
States Code).
    (b) Contents of Plan.--The plan shall require that a contract 
entered into under section 1097 of title 10, United States Code, for 
the delivery of health care services shall--
            (1) include the delivery of qualified acupuncturist 
        services;
            (2) require that qualified acupuncturist services may be 
        provided only by a qualified acupuncturist; and
            (3) provide clarity on the process that a covered 
        beneficiary must use to select and have direct access to a 
        qualified acupuncturist (without the requirement of a 
        referral).
    (c) Implementation of Plan.--The plan developed under subsection 
(a) shall provide for implementation of the plan to begin not later 
than 270 days after the date of enactment of this Act.
    (d) Submission.--The Secretary shall submit to Congress the plan 
developed under subsection (a).

SEC. 5. APPOINTMENT OF ACUPUNCTURISTS AS COMMISSIONED OFFICERS IN THE 
              ARMED FORCES.

    (a) Army.--Section 7068 of title 10, United States Code, is 
amended--
            (1) by inserting ``(a) Medical Service Corps.--'' before 
        ``There is'';
            (2) in paragraph (5)--
                    (A) in subparagraph (D), by striking ``and'';
                    (B) by redesignating subparagraph (E) as 
                subparagraph (F); and
                    (C) by inserting after subparagraph (D) the 
                following new subparagraph:
                    ``(E) the Acupuncture Section; and''; and
            (3) by adding at the end the following new subsection:
    ``(b) Appointment of Acupuncturists.--Acupuncturists who are 
qualified under regulations prescribed by the Secretary of the Army may 
be appointed as commissioned officers in the Acupuncture Section of the 
Medical Service Corps of the Army. Such regulations shall require such 
acupuncturists to be licensed or certified in the State in which the 
services are furnished, or, in the case of services furnished in a 
State that does not provide for such licensure or certification, meets 
such criteria (such as accreditation through an appropriate nationally 
recognized certification authority for acupuncturists) as the Secretary 
of the Army may specify. In specifying such requirements, the Secretary 
may use the same requirements as those established by such a 
certification authority.''.
    (b) Navy.--
            (1) In general.--Chapter 809 of such title is amended by 
        inserting after section 8079 the following new section:
``Sec. 8080. Appointment of acupuncturists in the Medical Service Corps
    ``Acupuncturists who are qualified under regulations prescribed by 
the Secretary of the Navy may be appointed as commissioned officers in 
the Medical Service Corps of the Navy. Such regulations shall require 
such acupuncturists to be licensed or certified in the State in which 
the services are furnished, or, in the case of services furnished in a 
State that does not provide for such licensure or certification, meets 
such criteria (such as accreditation through an appropriate nationally 
recognized certification authority for acupuncturists) as the Secretary 
of the Navy may specify. In specifying such requirements, the Secretary 
may use the same requirements as those established by such a 
certification authority.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 8079 the following new item:

``8080. Appointment of acupuncturists in the Medical Service Corps.''.
    (c) Air Force.--Section 9067(f) of such title is amended--
            (1) by striking ``physician assistant functions and 
        chiropractic functions'' and inserting ``physician assistant 
        functions, chiropractic functions, and acupuncturist 
        functions''; and
            (2) by adding at the end the following new sentence: 
        ``Biomedical service officers may be referred to as the 
        specific career designation, including chiropractic services 
        officer and acupuncturist services officer.''.
    (d) Regulations.--The regulations required to be prescribed by the 
amendments made by this section shall be prescribed not later than 120 
days after the date of the enactment of this Act.

SEC. 6. INCLUSION OF ACUPUNCTURIST SERVICES AT VETERANS HEALTH 
              FACILITIES.

    (a) Acupuncturist Services.--
            (1) In general.--Subchapter II of chapter 17 of title 38, 
        United States Code, is amended by adding at the end the 
        following new section:
``Sec. 1720J. Provision of acupuncturist services
    ``(a) In General.--The Secretary shall carry out a program to 
provide acupuncturist services to veterans enrolled in the health care 
system established under section 1705(a) of this title (without the 
requirement of a referral).
    ``(b) Locations.--The program under subsection (a) shall be carried 
out at in at least one facility of the Department in each Veterans 
Integrated Service Network. In selecting such facilities, the Secretary 
shall ensure that the program is carried out in both urban and rural 
areas.
    ``(c) Services Available.--The Secretary shall ensure that the 
acupuncturist services available under the program are able to address, 
at a minimum, the following:
            ``(1) Chronic and acute pain.
            ``(2) Cancer pain.
            ``(3) Postoperative nausea and vomiting.
            ``(4) Postsurgical gastroparesis syndrome.
            ``(5) Opioid-induced constipation.
            ``(6) Opioid-induced pruritus.
            ``(7) Chemotherapy-induced neuropathy.
            ``(8) Aromatase inhibitor-associated joint pain.
            ``(9) Neck dissection-related pain and dysfunction.
            ``(10) Stress management.
            ``(11) Mental health conditions.
            ``(12) Substance abuse.
            ``(13) Symptoms relating to traumatic brain injury and 
        post-traumatic stress.
    ``(d) Administration.--(1) The Secretary shall carry out the 
program through--
            ``(A) qualified acupuncturists appointed as employees of 
        the Department located at medical centers and clinics of the 
        Department; and
            ``(B) through contract qualified acupuncturists if--
                    ``(i) the Secretary is unable to make appointments 
                described in subparagraph (A);
                    ``(ii) a patient requires specialty care that an 
                employee under such subparagraph is not able to provide 
                to the patient; or
                    ``(iii) there is an emergency that requires the use 
                of such a contract acupuncturist.
    ``(2) The Secretary shall provide training and materials to health 
care providers of the Department who provide primary care to veterans 
to explain the benefits of acupuncturist services.
    ``(3) In this section, the term `qualified acupuncturist' means, 
with respect to the furnishing of services in a State, an individual 
who licensed or certified in the State in which the services are 
furnished, or, in the case of services furnished in a State that does 
not provide for such licensure or certification, meets such criteria 
(such as accreditation through an appropriate nationally recognized 
certification authority for acupuncturists) as the Secretary may 
specify. In specifying such requirements, the Secretary may use the 
same requirements as those established by such a certification 
authority.
    ``(e) Regulations.--The Secretary shall prescribe regulations to 
carry out this section.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 1720I the following new section:

``1720J. Provision of acupuncturist services.''.
            (3) Conforming amendment.--Section 1701(6) of such title is 
        amended by adding at the end the following new subparagraph:
                    ``(H) Acupuncturist services in accordance with 
                section 1720J of this title.''.
    (b) Advisory Committee.--
            (1) In general.--Subchapter III of chapter 5 of such title 
        is amended by adding at the end the following new section:
``Sec. 547. Advisory committee on acupuncturist services
    ``(a) Acupuncture Advisory Committee.--(1) The Secretary shall 
establish an advisory committee to be known as the `Advisory Committee 
on Acupuncturist Services' (in this section referred to as the 
`Committee') to provide the Secretary with assistance and advice in the 
development and implementation of the program established by section 
1720J of this title.
    ``(2) The Committee shall consist of members appointed by the 
Secretary from the general public, including--
            ``(A) not fewer than five practicing acupuncturists, of 
        which at least four shall be State licensed acupuncturists;
            ``(B) one veteran from each of the Armed Forces;
            ``(C) not fewer than two representatives from veterans 
        service organizations; and
            ``(D) a representative of the Department of Defense.
    ``(b) Duties.--The Committee shall--
            ``(1) review and evaluate the ability of a veteran to 
        access an acupuncturist at facilities of the Department;
            ``(2) advise the Secretary with respect to--
                    ``(A) protocols governing direct access to 
                acupuncture care;
                    ``(B) protocols governing the scope of practice of 
                acupuncture practitioners;
                    ``(C) the definitions of services to be provided by 
                acupuncturists; and
                    ``(D) such other matters the Secretary determines 
                appropriate; and
            ``(3) upon the determination of the Secretary that the 
        program of acupuncturist services under section 1720H of this 
        title has been fully implemented, submit to the Secretary a 
        report containing the evaluation of the Committee of the 
        implementation of such program.
    ``(c) Chairman.--The Secretary shall designate one member of the 
Committee to serve as the chairman of the Committee.
    ``(d) Meetings.--The Committee shall meet at the call of the 
Chairman, but not fewer than three times during each fiscal year, 
beginning in the fiscal year following the fiscal year in which this 
section is enacted.
    ``(e) Report.--Following the date on which the Committee submits to 
the Secretary the report under subsection (b)(4), the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and the 
House of Representatives a report containing the following:
            ``(1) A copy of the Committee report, together with the 
        comments of the Secretary on the report.
            ``(2) An explanation of the criteria and rationale that the 
        Secretary used to determine that the program of acupuncturist 
        services under section 1720J of this title was fully 
        implemented, as described in such subsection (b)(4).
            ``(3) The views of the Secretary regarding the future 
        implementation of such program.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 546 the following new item:

``547. Advisory committee on acupuncturist services.''.
    (c) Conforming Amendments.--
            (1) Authority for appointments.--Section 7401(1) of title 
        38, United States Code, is amended by inserting 
        ``acupuncturists,'' after ``chiropractors,''.
            (2) Period of appointments.--Section 7403 of such title is 
        amended by adding at the end the following new subparagraph:
                    ``(I) Acupuncturists.''.
            (3) Pay.--
                    (A) Scale.--Section 7404 of such title is amended--
                            (i) in subsection (a)(2), by inserting ``, 
                        acupuncturists,'' after ``physicians''; and
                            (ii) in the list in subsection (b), by 
                        inserting ``, ACUPUNCTURIST,'' after 
                        ``PHYSICIAN''.
                    (B) Treatment.--Section 7431 of title 38, United 
                States Code, is amended by adding at the end the 
                following new subsection:
    ``(i) Treatment of Acupuncturists.--For purposes of this 
subchapter, an acupuncturist is deemed to be a physician.''.
            (4) Malpractice and negligence suits.--Section 7316(a)(2) 
        of such title is amended by inserting ``acupuncturist,'' after 
        ``chiropractor,''.
            (5) Hours and conditions.--Section 7421(b) of such title is 
        amended by adding at the end the following new paragraph:
            ``(9) Acupuncturists.''.
            (6) Effective date.--The amendments made by paragraph (4) 
        apply with respect to services provided on or after the date 
        that is 270 days after the date of enactment of this Act.

SEC. 7. COVERAGE FOR ACUPUNCTURIST SERVICES UNDER THE MEDICARE PROGRAM.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) by striking ``and'' at the end of subparagraph 
                (GG);
                    (B) by adding ``and'' at the end of subparagraph 
                (HH); and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(II) qualified acupuncturist services (as defined in 
        subsection (jjj)(1));''; and
            (2) by adding at the end the following new subsection:

                   ``Qualified Acupuncturist Services

    ``(jjj)(1) The term `qualified acupuncturist services' means such 
services furnished by a qualified acupuncturist (as defined in 
paragraph (2)), and such services and supplies furnished as an incident 
to services furnished by the qualified acupuncturist, as the qualified 
acupuncturist is legally authorized to perform under State law.
    ``(2) The term `qualified acupuncturist' has the meaning given such 
term in section 2 of the Acupuncture for Heroes and Seniors Act of 
2019.''.
    (b) Payment Rules.--
            (1) Payment under physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``(2)(GG),'' before ``(3),''.
            (2) Separate payment for services of institutional 
        providers.--Section 1833(a)(2)(B) of the Social Security Act 
        (42 U.S.C. 1395l(a)(2)(B)) is amended--
                    (A) in clause (i), by inserting ``and in the case 
                of qualified acupuncturist services,'' after ``1999,'';
                    (B) in clause (ii), by inserting ``or in the case 
                of qualified acupuncturist services,'' after ``1999,''; 
                and
                    (C) in clause (iii), by inserting ``(other than 
                qualified acupuncturist services)'' after ``such 
                services''.
            (3) Qualified acupuncturist treatment as a practitioner.--
        Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 
        1395u(b)(18)(C)) is amended by adding at the end the following 
        new clause:
            ``(vii) A qualified acupuncturist (as defined in section 
        1861(jjj)(2)).''.
            (4) Separate billing for acupuncturist services furnished 
        in an inpatient hospital setting.--Section 1861(b)(4) of the 
        Social Security Act (42 U.S.C. 1395x(b)(4)) is amended by 
        inserting ``qualified acupuncturist services,'' after 
        ``qualified psychologist services,''.
    (c) Effective Date.--The amendments made by this section apply with 
respect to services furnished on or after the date that is 270 days 
after the date of enactment of this Act.

SEC. 8. ACUPUNCTURISTS IN THE REGULAR CORPS AND THE READY RESERVE CORPS 
              OF THE PUBLIC HEALTH SERVICE.

    (a) Authorization of Appointment.--Section 207 of the Public Health 
Service Act (42 U.S.C. 209) is amended--
            (1) in subsection (a)(1), by inserting ``acupuncture,'' 
        after ``nursing,''; and
            (2) by adding at the end the following:
    ``(j) Appointment of Qualified Acupuncturists.--
            ``(1) Eligibility.--Acupuncturists shall be eligible for 
        appointment as officers in the commissioned Regular Corps and 
        the Ready Reserve Corps of the Public Health Service.
            ``(2) Qualification; training, equipment, and 
        preparation.--The Secretary shall ensure that acupuncturists in 
        the commissioned Regular Corps and in the Ready Reserve Corps--
                    ``(A) are qualified acupuncturists (as defined in 
                section 2 of the Acupuncture for Heroes and Seniors Act 
                of 2019); and
                    ``(B) are trained, equipped, and otherwise prepared 
                to fulfill applicable public health and emergency 
                response service responsibilities in the Commissioned 
                Corps.''.
    (b) Required Placement.--
            (1) In general.--Not later than 90 days after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall ensure the appointment of no fewer than 6 
        acupuncturists into the commissioned Regular Corps and the 
        Ready Reserve Corps of the Public Health Service.
            (2) Reports.--Not later than 120 days after the date of 
        enactment of this Act, and quarterly thereafter, the Surgeon 
        General of the Public Health Service shall submit to the 
        Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Health, Education, Labor, 
        and Pensions of the Senate a report on all measures taken by 
        the President, the Surgeon General, and the Secretary of Health 
        and Human Services to carry out the provisions of this section, 
        including the amendments made by this section.
                                 <all>