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H.R. 893 (105th): Primary Care Health Practitioner Incentive Act of 1997

The text of the bill below is as of Feb 27, 1997 (Introduced).


HR 893 IH

105th CONGRESS

1st Session

H. R. 893

To amend title XVIII of the Social Security Act to provide for increased Medicare reimbursement for nurse practitioners and clinical nurse specialists to increase the delivery of health services in health professional shortage areas, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

February 27, 1997

Mr. TOWNS (for himself and Mrs. JOHNSON of Connecticut) introduced the following bill; which was referred to the Committee on 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 provide for increased Medicare reimbursement for nurse practitioners and clinical nurse specialists to increase the delivery of health services in health professional shortage areas, 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.

    This Act may be cited as the ‘Primary Care Health Practitioner Incentive Act of 1997’.

SEC. 2. INCREASED MEDICARE REIMBURSEMENT FOR NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS.

    (a) REMOVAL OF RESTRICTIONS ON SETTINGS-

      (1) IN GENERAL- Clause (ii) of section 1861(s)(2)(K)) of the Social Security Act (42 U.S.C. 1395x(s)(2)(K)) is amended to read as follows:

      ‘(ii) services which would be physicians’ services if furnished by a physician (as defined in subsection (r)(1)) and which are performed by a nurse practitioner or clinical nurse specialist (as defined in subsection (aa)(5)) which the nurse practitioner or clinical nurse specialist is legally authorized to perform by the State in which the services are performed, and such services and supplies furnished as an incident to such services as would be covered under subparagraph (A) if furnished incident to a physician’s professional service;’.

      (2) CONFORMING AMENDMENTS- (A) Section 1861(s)(2)(K) of such Act (42 U.S.C. 1395x(s)(2)(K)) is further amended--

        (i) in clause (i), by inserting ‘and such services and supplies furnished as incident to such services as would be covered under subparagraph (A) if furnished as an incident to a physician’s professional service; and’ after ‘are performed,’; and

        (ii) by striking clauses (iii) and (iv).

      (B) Section 1861(b)(4) of such Act (42 U.S.C. 1395x(b)(4)) is amended by striking ‘clauses (i) or (iii) of subsection (s)(2)(K)’ and inserting ‘subsection (s)(2)(K)’.

      (C) Section 1862(a)(14) of such Act (42 U.S.C. 1395y(a)(14)) is amended by striking ‘section 1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)’ and inserting ‘section 1861(s)(2)(K)’.

      (D) Section 1866(a)(1)(H) of such Act (42 U.S.C. 1395cc(a)(1)(H)) is amended by striking ‘section 1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)’ and inserting ‘section 1861(s)(2)(K)’.

    (b) INCREASED PAYMENT-

      (1) FEE SCHEDULE AMOUNT- Clause (O) of section 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) is amended to read as follows: ‘(O) with respect to services described in section 1861(s)(2)(K)(ii) (relating to nurse practitioner or clinical nurse specialist services), the amounts paid shall be equal to 80 percent of (i) the lesser of the actual charge or 85 percent of the fee schedule amount provided under section 1848 for the same

service provided by a physician who is not a specialist, or (ii) in the case of services as an assistant at surgery, the lesser of the actual charge or 85 percent of the amount that would otherwise be recognized if performed by a physician who is serving as an assistant at surgery; and’.

      (2) CONFORMING AMENDMENTS- (A) Section 1833(r) of such Act (42 U.S.C. 1395l(r)) is amended--

        (i) in paragraph (1), by striking ‘section 1861(s)(2)(K)(iii) (relating to nurse practitioner or clinical nurse specialist services provided in a rural area)’ and inserting ‘section 1861(s)(2)(K)(ii) (relating to nurse practitioner or clinical nurse specialist services)’;

        (ii) by striking paragraph (2);

        (iii) in paragraph (3), by striking ‘section 1861(s)(2)(K)(iii)’ and inserting ‘section 1861(s)(2)(K)(ii)’; and

        (iv) by redesignating paragraph (3) as paragraph (2).

      (B) Section 1842(b)(12)(A) of such Act (42 U.S.C. 1395u(b)(12)(A)) is amended, in the matter preceding clause (i), by striking ‘clauses (i), (ii), or (iv) of section 1861(s)(2)(K) (relating to a physician assistants and nurse practitioners)’ and inserting ‘section 1861(s)(2)(K)(i) (relating to physician assistants)’.

    (c) DIRECT PAYMENT FOR NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS-

      (1) IN GENERAL- Section 1832(a)(2)(B)(iv) of such Act (42 U.S.C. 1395k(a)(2)(B)(iv)) is amended by striking ‘provided in a rural area (as defined in section 1886(d)(2)(D))’.

      (2) CONFORMING AMENDMENT- Section 1842(b)(6)(C) of such Act (42 U.S.C. 1395u(b)(6)(C)) is amended--

        (A) by striking ‘clauses (i), (ii), or (iv)’ and inserting ‘clause (i)’; and

        (B) by striking ‘or nurse practitioner’.

    (d) BONUS PAYMENT FOR SERVICES PROVIDED IN HEALTH PROFESSIONAL SHORTAGE AREAS- Section 1833(m) of such Act (42 U.S.C. 1395l(m)) is amended-

      (1) by inserting ‘(1)’ after ‘(m)’; and

      (2) by adding at the end the following new paragraph:

      ‘(2) In the case of services of a nurse practitioner or clinical nurse specialist furnished to an individual described in paragraph (1) in an area that is a health professional shortage area described in such paragraph, in addition to the amount otherwise paid under this part, there shall also be paid to such service provider (on a monthly or quarterly basis) from the Federal Supplementary Medical Insurance Trust Fund an amount equal to 10 percent of the payment amount for the service under this part.’.

    (e) DEFINITION OF CLINICAL NURSE SPECIALIST CLARIFIED- Section 1861(aa)(5) of such Act (42 U.S.C. 1395.0A(aa)(5)) is amended--

      (1) by inserting ‘(A)’ after ‘(5)’;

      (2) by striking ‘The term ‘physician assistant’ and all that follows through ‘who performs’ and inserting ‘The term ‘physician assistant’ and the term ‘nurse practitioner’ mean, for purposes of this title, a physician assistant or nurse practitioner who performs’; and

      (3) by adding at the end the following new subparagraph:

    ‘(B) The term ‘clinical nurse specialist’ means, for purposes of this title, an individual who--

      ‘(i) is a registered nurse and is licensed to practice nursing in the State in which the clinical nurse specialist services are performed; and

      ‘(ii) holds a master’s degree in a defined clinical area of nursing from an accredited educational institution.’.

    (f) EFFECTIVE DATE- The amendments made by this section shall apply with respect to services furnished and supplies provided on and after January 1, 1998.