[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 833 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                 S. 833

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

               April 28 (legislative day, April 19), 1993

  Mr. Grassley (for himself and Mr. Conrad) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to provide for 
  increased medicare reimbursement for nurse practitioners, clinical 
   nurse specialists, and certified nurse midwives, 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 1991''.

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

    (a) Increased Payment.--
            (1) Nurse practitioners, clinical nurse specialists, and 
        certified nurse midwives.--Section 1833(a)(1) of the Social 
        Security Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) in subparagraph (K), by striking ``80 percent'' 
                and all that follows through ``physician)'' and 
                inserting ``97 percent of the fee schedule amount 
                provided under section 1848 for the same service 
                performed by a physician''; and
                    (B) in subparagraph (M) the second place it 
                appears, by striking ``80 percent'' and all that 
                follows through ``(r)(2))'' and inserting ``97 percent 
                of the fee schedule amount provided under section 1848 
                for the same service performed by a physician''.
            (2) Nurse practitioners.----Section 1842(b)(12)(A)(ii) of 
        the Social Security Act (42 U.S.C. 1395u(b)(12)(A)(ii)) is 
        amended--
                    (A) in subclause (I), by striking ``65 percent'' 
                and inserting ``65 percent or in the case of nurse 
                practitioner services 97 percent''; and
                    (B) in subclause (II), by striking ``or for 
                services'' and all that follows through ``1848'' and 
                inserting ``or in the case of nurse practitioner 
                services 97 percent of the fee schedule amount 
                specified in section 1848 for the same service 
                performed by a physician or for physician assistants 
                the fee schedule amount specified in such section''.
    (b) Direct Payment for Nurse Practitioners or Clinical Nurse 
Specialists.--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 1880(d)(2)(D))''.
    (c) Bonus Payment for Services Provided in Health Professional 
Shortage Areas.--Section 1833(m) (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, clinical 
nurse specialist or certified nurse midwife furnished to an individual, 
described in paragraph (1), in an area that is a health professional 
shortage area as described in such paragraph, in addition to the amount 
otherwise paid under this part, there shall also be paid to such 
service provider (or to an employer in the cases described in clause 
(C) of section 1842(b)(6)) (on a monthly or quarterly basis) from the 
Federal Supplementary Medical Trust Fund an amount equal to 10 percent 
of the payment amount for the service under this part.''.
    (d) Definition of Clinical Nurse Specialist Clarified.--Section 
1861(aa)(5) of such Act (42 U.S.C. 1395x(aa)(5)) is amended--
            (1) by striking ``clinical nurse specialist'' each place it 
        appears; and
            (2) by inserting ``(A)'' after ``(5)'' and by adding at the 
        end the following new subparagraph:
    ``(B) The term `clinical nurse specialist' means, for purposes of 
this Act, 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.''.
    (e) Removal of Restrictions on Settings.--Section 1861(s)(2)(K) of 
such Act (42 U.S.C. 1395x(s)(2)(K)) is amended--
            (1) in clause (ii), by striking ``in a skilled'' and all 
        that follows through ``1919(a))''; and
            (2) in clause (iii), by striking ``in a rural'' and all 
        that follows through ``(d)(2)(D))''.
    (f) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after July 1, 1992.

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