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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Medicare Certified Registered Nurse
First Assistant Direct Reimbursement Act of 2000''.

SEC. 2. MEDICARE COVERAGE OF SURGICAL FIRST ASSISTING SERVICES OF
CERTIFIED REGISTERED NURSE FIRST ASSISTANTS.

(a) Services Covered.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(1) by striking ''and'' at the end of subparagraph (S);
(2) by striking the period at the end of (T) and inserting
''; and''; and
(3) by adding at the end the following new subparagraph:
''(U) surgical first assisting services (as defined in
subsection (uu)(1)) furnished by a certified registered nurse
first assistant (as defined in subsection (uu)(2)).''.
(b) Services Described.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended by adding at the end the following new
subsection:

''Surgical First Assisting Services; Certified Registered Nurse First
Assistant

''(uu)(1) The term 'surgical first assisting services' means
services consisting of first assisting a physician with surgery and
related preoperative, intraoperative, and postoperative care (as
determined by the Secretary) furnished by a certified registered nurse
first assistant (as defined in paragraph (2)) which the certified
registered nurse first assistant is legally authorized to perform by
the State in which the services are performed.
''(2) The term 'certified registered nurse first assistant' means
an individual who--
''(A) is a registered nurse and is licensed to practice
nursing in the State in which the surgical first assisting
services are performed;
''(B) has completed a minimum of 2,000 hours of first
assisting a physician with surgery and related preoperative,
intraoperative, and postoperative care; and
''(C) is certified as a registered nurse first assistant by
an organization recognized by the Secretary.''.
(c) Payment Amount.--Section 1833(a)(1) of the Social Security Act
(42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking ''and'' before ''(S)''; and
(2) by inserting before the semicolon at the end the
following: '', and (T) with respect to surgical first assisting
services (as defined in section 1861(uu)(1)) furnished by a
certified registered nurse first assistant (as defined in
section 1861(uu)(2)), the amount paid shall be 80 percent of
the lesser of the actual charge for the services or 85 percent
of the amount determined under the fee schedule established
under section 1848(b) for the same services if furnished by a
physician''.
(d) Payments to Employers.--
(1) In general.--Section 1833(r) of the Social Security Act
(42 U.S.C. 1395l(r)) is amended--
(A) in paragraph (1), by inserting ''or section
1861(s)(2)(U) (relating to surgical first assisting
services)'' after ''clinical nurse specialist
services)''; and
(B) in paragraph (2), by striking
''1861(s)(2)(K)(ii)'' and inserting ''1861(s)(2)(K)(ii)
or 1861(s)(2)(U)''.
(2) Application of mandatory assignment rules.--Section
1842(b)(18)(C)(i) of such Act (42 U.S.C. 1395u(b)(18)(C)(i)) is
amended by striking ''physician assistant, nurse practitioner,
clinical nurse specialist'' and inserting ''physician
assistant, nurse practitioner, clinical nurse specialist, or
certified registered nurse first assistant''.
(3) Exclusion from bundled payments for covered skilled
nursing facility services.--Section 1888(e)(2)(A)(ii) of such
Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting
''surgical first assisting services of a certified registered
nurse first assistant,'' after ''services of a certified
registered nurse anesthetist,''.
(e) Reduction in Payments To Avoid Duplicate Payment.--
Notwithstanding any other provision of law, the Secretary of Health and
Human Services may reduce the amount of payments otherwise made to
hospitals under title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.) to eliminate estimated duplicate payments for historical or
current costs attributable to surgical first assisting services
furnished by certified registered nurse first assistants as described
in section 1861(uu) of such Act (as added by subsection (a)).
(f) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the date of the enactment of
this Act.

SEC. 3. STUDY OF PAYMENT RATES.

Not later than 180 days after the date of the enactment of this
Act, the Secretary of Health and Human Services shall submit to
Congress a report containing recommendations for adjustments to the
payment amounts established under part B of title XVIII of the Social
Security Act for surgical first assisting services furnished by
certified registered nurse first assistants (as described in section
1861(uu) of such Act (as added by section 1(a)) to ensure that the
payment amounts reflect the approximate costs of furnishing such
services, taking into account the costs of compensation, overhead, and
supervision attributable to certified registered nurse first
assistants.
Provides for payment of such nurses on an assignment-related basis.
Excludes services of such nurses from the definition of "covered skilled nursing facility services" for purposes of applying a prospective payment formula for such services.
Directs the Secretary of Health and Human Services to reduce the amount of Medicare payments otherwise made to hospitals to eliminate estimated duplicate payments for historical or current costs attributable to surgical first assisting services furnished by certified registered nurse first assistants.
Requires the Secretary to report to Congress on recommendations for adjustments to the payment amounts established under part B (Supplementary Medical Insurance) of Medicare for surgical first assisting services furnished by such nurses to ensure that the payment amounts reflect the approximate costs of furnishing such services, taking into account the costs of compensation, overhead, and supervision attributable to such nurses.