In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.

SECTION 1. FINDINGS.

    Congress finds the following:
            (1) Twice since 1989, the northwestern coast of Maui, 
        Hawaii, has been plagued with massive blooms of the green alga, 
        Cladorphora sericea. Blooms of the red alga, Hypnea 
        musciformis, have also occurred in the area and in the Kihei 
        area.
            (2) The algal blooms have destroyed corals and other reef-
        building organisms, and have washed up on beaches and severely 
        impeded the recreational use of affected coastal areas.
            (3) The algal blooms are particularly detrimental to the 
        natural ecological balance of the near-shore reef environment.
            (4) Although the specific causes of the algal blooms are 
        uncertain, algal growth is stimulated in a proportional manner 
        by concentrations of chemicals such as fertilizers and 
        insecticides, which enter the ocean through freshwater runoff.
            (5) The Department of Health of the State of Hawaii has 
        indicated that the department does not have the resources at 
        this time to determine the cause of the algal blooms.
            (6) Extensive research will be required to determine the 
        factors that contribute to algal growth.
            (7) Potential sources of nutrients that may contribute to 
        algal growth include the near-shore disposal of sewage in 
        injection wells from the Lahaina Wastewater Treatment Plant, 
        surface runoff from agricultural lands and urban resort areas, 
        and subsurface point sources in the areas.
            (8) The long-term environmental impacts of the algal blooms 
        are unknown, but in the short term, reefs exposed to the algae 
        are being destroyed and the deterioration of the coral has 
        detrimental effects on fish and other wildlife that depend on 
        the reefs for survival.
            (9) The algal blooms are generating negative economic 
        impacts as well as negative biological impacts, as additional 
        reports indicate that the algae are decreasing the intake of 
        fish caught by local fishermen in the affected marine waters.
            (10) The Maui Algae Task Force is comprised of community 
        environmental activists and has been assembled to address the 
        problem of algal blooms.
            (11) The Maui Algae Task Force hopes to work in cooperation 
        with the Department of Health of the State of Hawaii and the 
        Environmental Protection Agency to identify and eradicate the 
        causes of the algal blooms.

SEC. 2. STUDY.

    (a) In General.--The Administrator of the Environmental Protection 
Agency (hereafter in this Act referred to as the ``Administrator'') 
shall conduct a study to--
            (1) determine the causes of recent algal blooms off the 
        northwestern coast of Maui, Hawaii; and
            (2) research alternatives for the improved management of 
        chemicals present in wastewater treatment and fresh water 
        runoff.
    (b) Study Requirements.--In carrying out the study under this 
section, the Administrator shall--
            (1) survey and monitor--
                    (A) seaweed populations and animals for which the 
                seaweed is a food source;
                    (B) surface water runoff sediments in the study 
                area; and
                    (C) inputs into the study area from subsurface 
                point sources, including any such inputs from the 
                Lahaina wastewater treatment plant; and
            (2) study the responses of--
                    (A) the seaweed populations referred to in 
                paragraph (1)(A) to different concentrations of 
                nutrients; and
                    (B) the animals referred to in paragraph (1)(A) to 
                pesticides and other biological toxins.
    (c) Equipment; Grants.--
            (1) Acquisition of equipment.--In carrying out the study 
        under this section, the Administrator is authorized to acquire 
        such monitoring and testing equipment as the Administrator 
        determines necessary.
            (2) Grants.--In carrying out the study under this section, 
        the Administrator is authorized to establish a grant program to 
        provide grants to eligible entities that submit approved 
        applications to the Administrator. The following entities may 
        submit an application to conduct study activities under this 
        section:
                    (A) The Department of Health of the State of 
                Hawaii.
                    (B) The Maui Algae Task Force.
                    (C) Appropriate Federal, State, or county 
                departments or agencies.
                    (D) Any other entity that the Administrator 
                determines to be appropriate.
    (d) Demonstration Projects.--In carrying out the study under this 
section, the Administrator is authorized to establish demonstration 
projects to identify and implement best management practices for the 
control of nonpoint source pollution from erosion and agricultural 
runoff.
    (e) Reports.--
            (1) Interim report.--Not later than 1 year after the date 
        of enactment of this Act, the Administrator shall submit to 
        Congress a report that includes interim results of the study 
        conducted under this section, and such recommendations as the 
        Administrator determines to be appropriate.
            (2) Final report.--Not later than January 31, 1996, the 
        Administrator shall submit to Congress a final report that 
        summarizes the results of the study conducted under this 
        section and includes such recommendations as the Administrator 
        determines to be appropriate.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated to the Environmental Protection Agency to carry out this 
section $500,000 for each of fiscal years 1994 and 1995.
Directs the Administrator of the Environmental Protection Agency to study and report to the Congress on the causes of recent algal blooms off the northwestern coast of Maui, Hawaii, and to research alternatives for the improved management of chemicals present in wastewater treatment and fresh water runoff. 
Authorizes the Administrator to establish:  (1) a grant program to enable eligible entities to conduct study activities; and (2) demonstration projects to implement best management practices for the control of nonpoint source pollution from erosion and agricultural runoff. 
Authorizes appropriations.

SECTION 1. SHORT TITLE, ETC.

    (a) Short Title.--This Act may be cited as the ``Powering American 
Jobs Act of 2014''.
    (b) Amendment of 1986 Code.--Except as otherwise expressly 
provided, whenever in this Act an amendment or repeal is expressed in 
terms of an amendment to, or repeal of, a section or other provision, 
the reference shall be considered to be made to a section or other 
provision of the Internal Revenue Code of 1986.
    (c) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title, etc.
Sec. 2. Extension and modification of credit for nonbusiness energy 
                            property.
Sec. 3. Extension of excise tax credits relating to certain fuels.
Sec. 4. Extension of credit for alternative fuel vehicle refueling 
                            property.
Sec. 5. Extension of incentives for biodiesel and renewable diesel.
Sec. 6. Equalization of excise tax on liquefied natural gas and 
                            liquefied petroleum gas.

SEC. 2. EXTENSION AND MODIFICATION OF CREDIT FOR NONBUSINESS ENERGY 
              PROPERTY.

    (a) In General.--Paragraph (2) of section 25C(g) is amended by 
striking ``December 31, 2013'' and inserting ``December 31, 2015''.
    (b) Updated Energy Star Requirements for Windows, Doors, Skylights, 
and Roofing.--
            (1) In general.--Paragraph (1) of section 25C(c) is amended 
        by striking ``which meets'' and all that follows through 
        ``requirements)''.
            (2) Energy efficient building envelope component.--
        Subsection (c) of section 25C is amended by redesignating 
        paragraphs (2) and (3) as paragraphs (3) and (4), respectively, 
        and by inserting after paragraph (1) the following new 
        paragraph:
            ``(2) Energy efficient building envelope component.--The 
        term `energy efficient building envelope component' means a 
        building envelope component which meets--
                    ``(A) applicable Energy Star program requirements, 
                in the case of a roof or roof products,
                    ``(B) version 6.0 Energy Star program requirements, 
                in the case of an exterior window, a skylight, or an 
                exterior door, and
                    ``(C) the prescriptive criteria for such component 
                established by the 2009 International Energy 
                Conservation Code, as such Code (including supplements) 
                is in effect on the date of the enactment of the 
                American Recovery and Reinvestment Tax Act of 2009, in 
                the case of any other component.''.
            (3) Conforming amendment.--Subparagraph (D) of section 
        25C(c)(3), as so redesignated, is amended to read as follows:
                    ``(D) any roof or roof products which are installed 
                on a dwelling unit and are specifically and primarily 
                designed to reduce the heat gain of such dwelling 
                unit.''.
    (c) Separate Standards for Tankless and Storage Water Heaters.--
Subparagraph (D) of section 25C(d)(3) is amended by striking ``which 
has either'' and all that follows and inserting ``which has--
                            ``(i) in the case of a natural gas, 
                        propane, or oil storage water heater, an energy 
                        factor of at least 0.80 or a thermal efficiency 
                        of at least 90 percent,
                            ``(ii) in the case of an electric heat pump 
                        storage water heater, an energy factor of at 
                        least 2.0,
                            ``(iii) effective April 16, 2015, in the 
                        case of a natural gas, propane, or oil storage 
                        water heater, with a rated BTU input of no more 
                        than 75,000 BTU/hr, an energy factor of at 
                        least 0.80 or, with a rated BTU input greater 
                        than 75,000 BTU/hr, a thermal efficiency of at 
                        least 90 percent,
                            ``(iv) effective April 16, 2015, in the 
                        case of an electric heat pump storage water 
                        heater, with a water storage capacity equal to 
                        or less than 55 gallons, an energy factor of at 
                        least 2.0 or, with a water storage capacity 
                        equal to or greater than 55 gallons, an energy 
                        factor of at least 2.2, and
                            ``(v) in the case of any other water 
                        heater, an energy factor of at least 0.90 or a 
                        thermal efficiency of at least 90 percent, 
                        and''.
    (d) Modification of Testing Standards for Biomass Stoves.--
Subparagraph (E) of section 25C(d)(3) is amended by inserting before 
the period the following: ``, when tested using the higher heating 
value of the fuel and in accordance with the Canadian Standards 
Administration B415.1 test protocol''.
    (e) Modifications to Residential Energy Property Expenditures.--
            (1) Qualified natural gas, propane, or oil furnaces or hot 
        water boilers.--Paragraph (4) of section 25C(d) is amended to 
        read as follows:
            ``(4) Qualified natural gas, propane, or oil furnace or hot 
        water boiler.--The term `qualified natural gas, propane, or oil 
        furnace or hot water boiler' means--
                    ``(A) a natural gas or propane furnace which 
                achieves an annual fuel utilization efficiency rate of 
                not less than 95,
                    ``(B) a natural gas or propane hot water boiler 
                which achieves an annual fuel utilization efficiency 
                rate of not less than 90, and
                    ``(C) an oil furnace or hot water boiler which--
                            ``(i) achieves an annual fuel utilization 
                        efficiency rate of not less than 87, and
                            ``(ii)(I) in the case of a hot water 
                        boiler, is installed with an indirect water 
                        heater, and
                            ``(II) in the case of a furnace, is 
                        installed with an electronically commutated 
                        blower motor.''.
    (f) Effective Date.--The amendments made by this section shall 
apply to property placed in service after December 31, 2013.

SEC. 3. EXTENSION OF EXCISE TAX CREDITS RELATING TO CERTAIN FUELS.

    (a) Excise Tax Credits and Outlay Payments for Biodiesel and 
Renewable Diesel Fuel Mixtures.--
            (1) Paragraph (6) of section 6426(c) is amended by striking 
        ``December 31, 2013'' and inserting ``December 31, 2015''.
            (2) Subparagraph (B) of section 6427(e)(6) is amended by 
        striking ``December 31, 2013'' and inserting ``December 31, 
        2015''.
    (b) Extension of Alternative Fuels Excise Tax Credits.--
            (1) In general.--Sections 6426(d)(5) and 6426(e)(3) are 
        each amended by striking ``December 31, 2013'' and inserting 
        ``December 31, 2015''.
            (2) Outlay payments for alternative fuels.--Subparagraph 
        (C) of section 6427(e)(6) is amended by striking ``December 31, 
        2013'' and inserting ``December 31, 2015''.
    (c) Extension of Alternative Fuels Excise Tax Credits Relating to 
Liquefied Hydrogen.--
            (1) In general.--Sections 6426(d)(5) and 6426(e)(3), as 
        amended by subsection (b), are each amended by striking 
        ``(September 30, 2014 in the case of any sale or use involving 
        liquefied hydrogen)''.
            (2) Outlay payments for alternative fuels.--Paragraph (6) 
        of section 6427(e) is amended--
                    (A) by striking ``except as provided in 
                subparagraph (D), any'' in subparagraph (C), as amended 
                by this Act, and inserting ``any'',
                    (B) by striking the comma at the end of 
                subparagraph (C) and inserting ``, and'', and
                    (C) by striking subparagraph (D) and redesignating 
                subparagraph (E) as subparagraph (D).
    (d) Effective Dates.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply to fuel sold or 
        used after December 31, 2013.
            (2) Liquefied hydrogen.--The amendments made by subsection 
        (c) shall apply to fuels sold or used after September 30, 2014.
    (e) Special Rule for Certain Periods During 2014.--Notwithstanding 
any other provision of law, in the case of--
            (1) any biodiesel mixture credit properly determined under 
        section 6426(c) of the Internal Revenue Code of 1986 for 
        periods after December 31, 2013, and before the date of the 
        enactment of this Act, and
            (2) any alternative fuel credit properly determined under 
        section 6426(d) of such Code for such periods,
such credit shall be allowed, and any refund or payment attributable to 
such credit (including any payment under section 6427(e) of such Code) 
shall be made, only in such manner as the Secretary of the Treasury (or 
the Secretary's delegate) shall provide. Such Secretary shall issue 
guidance within 30 days after the date of the enactment of this Act 
providing for a one-time submission of claims covering periods 
described in the preceding sentence. Such guidance shall provide for a 
180-day period for the submission of such claims (in such manner as 
prescribed by such Secretary) to begin not later than 30 days after 
such guidance is issued. Such claims shall be paid by such Secretary 
not later than 60 days after receipt. If such Secretary has not paid 
pursuant to a claim filed under this subsection within 60 days after 
the date of the filing of such claim, the claim shall be paid with 
interest from such date determined by using the overpayment rate and 
method under section 6621 of such Code.

SEC. 4. EXTENSION OF CREDIT FOR ALTERNATIVE FUEL VEHICLE REFUELING 
              PROPERTY.

    (a) In General.--Subsection (g) of section 30C is amended by 
striking ``placed in service'' and all that follows and inserting 
``placed in service after December 31, 2015.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to property placed in service after December 31, 2013.

SEC. 5. EXTENSION OF INCENTIVES FOR BIODIESEL AND RENEWABLE DIESEL.

    (a) Credits for Biodiesel and Renewable Diesel Used as Fuel.--
Subsection (g) of section 40A is amended by striking ``December 31, 
2013'' and inserting ``December 31, 2015''.
    (b) Effective Date.--The amendment made by this section shall apply 
to fuel sold or used after December 31, 2013.

SEC. 6. EQUALIZATION OF EXCISE TAX ON LIQUEFIED NATURAL GAS AND 
              LIQUEFIED PETROLEUM GAS.

    (a) Liquefied Petroleum Gas.--
            (1) In general.--Subparagraph (B) of section 4041(a)(2) of 
        the Internal Revenue Code of 1986 is amended by striking 
        ``and'' at the end of clause (i), by redesignating clause (ii) 
        as clause (iii), and by inserting after clause (i) the 
        following new clause:
                            ``(ii) in the case of liquefied petroleum 
                        gas, 18.3 cents per energy equivalent of a 
                        gallon of gasoline, and''.
            (2) Energy equivalent of a gallon of gasoline.--Paragraph 
        (2) of section 4041(a) of the Internal Revenue Code of 1986 is 
        amended by adding at the end the following:
                    ``(C) Energy equivalent of a gallon of gasoline.--
                For purposes of this paragraph, the term `energy 
                equivalent of a gallon of gasoline' means, with respect 
                to a liquefied petroleum gas fuel, the amount of such 
                fuel having a Btu content of 115,400 (lower heating 
                value).''.
    (b) Liquefied Natural Gas.--
            (1) In general.--Subparagraph (B) of section 4041(a)(2) of 
        the Internal Revenue Code of 1986, as amended by subsection 
        (a)(1), is amended by striking ``and'' at the end of clause 
        (ii), by striking the period at the end of clause (iii) and 
        inserting ``, and'' and by inserting after clause (iii) the 
        following new clause:
                            ``(iv) in the case of liquefied natural 
                        gas, 24.3 cents per energy equivalent of a 
                        gallon of diesel.''.
            (2) Energy equivalent of a gallon of diesel.--Paragraph (2) 
        of section 4041(a) of the Internal Revenue Code of 1986, as 
        amended by subsection (a)(2), is amended by adding at the end 
        the following:
                    ``(D) Energy equivalent of a gallon of diesel.--For 
                purposes of this paragraph, the term `energy equivalent 
                of a gallon of diesel' means, with respect to a 
                liquefied natural gas fuel, the amount of such fuel 
                having a Btu content of 128,700 (lower heating 
                value).''.
            (3) Conforming amendments.--Section 4041(a)(2)(B)(iv) of 
        the Internal Revenue Code of 1986, as redesignated by 
        subsection (a)(1) and paragraph (1), is amended--
                    (A) by striking ``liquefied natural gas,'', and
                    (B) by striking ``peat), and'' and inserting 
                ``peat) and''.
    (c) Effective Date.--The amendments made by this section shall 
apply to any sale or use of fuel after September 30, 2014.
Powering American Jobs Act of 2014 - Amends the Internal Revenue Code to extend through 2015: (1) the tax credit for nonbusiness energy efficient improvements; (2) excise tax credits and payments for alternative fuels, biodiesel and renewable diesel fuel mixtures, and alternative fuels relating to liquefied hydrogen; (3) the tax credit for alternative fuel vehicle refueling property expenditures; and (4) the income tax credit for biodiesel and renewable fuels. Equalizes the excise tax rate for liquefied natural gas and liquefied petroleum gas. Modifies energy efficiency standards for windows, doors, skylights, roofing, water heaters, biomass stoves, and furnaces or hot water boilers. 

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 disallowance of deduction for 
personal interest) is amended by striking ``and'' at the end of 
subparagraph (D), by redesignating 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 Interest Defined.--Subsection 
(h) of section 163 of such Code is amended by redesignating paragraph 
(5) as paragraph (6) and by inserting after paragraph (4) the following 
new paragraph:
            ``(5) Qualified medical education loan interest.--
                    ``(A) In general.--The term `qualified medical 
                education loan interest' means interest--
                            ``(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 period--
                                    ``(I) such physician is providing 
                                primary care (including internal 
                                medicine, 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 indebtedness incurred to pay the 
                individual's--
                            ``(i) qualified tuition and related 
                        expenses (as defined in section 117(b)) 
                        incurred for the medical education of such 
                        individual, or
                            ``(ii) reasonable living expenses while 
                        away from home in order to attend an 
                        educational institution described in section 
                        170(b)(1)(A)(ii) for the medical education of 
                        such individual.
                    ``(C) Physician.--For purposes of subparagraph (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 REDUCTIONS 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 incidental 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 following new 
                clause:
                            ``(iv) during which the borrower is serving 
                        in an internship or residency program in 
                        preparation for practice in an area of primary 
                        care (including internal medicine, pediatrics, 
                        obstetrics/gynecology, family 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 following new 
                clause:
                            ``(iv) during which the borrower is serving 
                        in an internship or residency program in 
                        preparation for practice in an area of primary 
                        care (including internal medicine, pediatrics, 
                        obstetrics/gynecology, family 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 program in 
                        preparation for practice in an area of primary 
                        care (including internal medicine, pediatrics, 
                        obstetrics/gynecology, family 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 MEDICAID 
              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 unavailable 
        to provide the services, (II) the services are not provided by 
        the second physician over a continuous 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 
        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''.
            (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 subparagraph (D) of section 
                1842(b)(6), except that, for purposes of this 
                subparagraph, any reference 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 furnished 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 establishes 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 physician'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.

Rural Physicians' Incentives Act of 1993 - Amends the Internal Revenue Code to allow a deduction on medical education loan interest of a physician which accrues while the physician is living in and providing primary care to residents of a medically underserved rural area. 
Amends title XVIII (Medicare) of the Social Security Act to exempt services furnished in a rural area from a special fee schedule applicable to new physicians. 
Amends the Higher Education Act of 1965 to extend beyond the normal two-year limit, for borrowers serving an internship or residency program in preparation for practice in an area of primary care, the deferral of payments on:  (1) insured student loans (Stafford Loans), including those eligible for interest subsidies; and (2) low-interest student loans (Perkins Loans). 
Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to modify provisions setting forth requirements concerning billing by one physician for services rendered by another physician in specified circumstances.