[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 188 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 188

   To amend title XVIII of the Social Security Act to permit direct 
payment under the medicare program for services of registered nurses as 
                         assistants at surgery.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 4, 1995

   Mrs. Collins of Illinois 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 permit direct 
payment under the medicare program for services of registered nurses as 
                         assistants at surgery.

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

SECTION 1. DIRECT PAYMENT FOR SERVICES OF REGISTERED NURSES AS 
              ASSISTANTS AT SURGERY.

    (a) Services Covered.--Section 1861(s)(2)(K) of the Social Security 
Act (42 U.S.C 1395x(s)(2)(K)) is amended--
            (1) in clause (iii), by striking ``and'' at the end;
            (2) in clause (iv), by striking ``clause (i) or (ii)'' and 
        inserting ``clause (i), (ii), or (iv)'';
            (3) by redesignating clause (iv) as clause (v); and
            (4) by inserting after clause (iii) the following new 
        clause:
            ``(iv) services which would be physicians' services if 
        furnished by a physician (as defined in subsection (r)(1)) and 
        which are performed by a registered nurse under the supervision 
        of a physician (as so defined) as an assistant at surgery and 
        which the registered nurse is legally authorized to perform by 
        the State in which the services are performed, and''.
    (b) Payment Amount.--Section 1842(b)(12)(A) of such Act (42 U.S.C. 
1395u(b)(12)) is amended--
            (1) by striking ``clauses (i), (ii), or (iv)'' and 
        inserting ``clauses (i), (ii), (iv), or (v)''; and
            (2) by striking ``a physician assistants and nurse 
        practitioners'' and inserting ``physician assistants, nurse 
        practitioners, and registered nurses''.
    (c) Payments to Employers.--Section 1842(b)(6)(C) of such Act (42 
U.S.C. 1395u(b)(6)(C)) is amended--
            (1) by striking ``clauses (i), (ii), or (iv)'' and 
        inserting ``clauses (i), (ii), (iv), or (v)''; and
            (2) by striking ``physician assistant or nurse 
        practitioner'' and inserting ``physician assistant, nurse 
        practitioner, or registered nurse''.
    (d) Application of Mandatory Assignment Rules.--Section 
1842(b)(18)(C)(i) of such Act (42 U.S.C. 1395u(b)(18)(C)(i)), as added 
by section 123(b)(1) of the Social Security Act Amendments of 1994, is 
amended by striking ``A physician'' and inserting ``A registered nurse, 
physician''.
    (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 to eliminate 
estimated duplicate payments for historical or current costs 
attributable to services described in section 1861(s)(2)(K)(iv) of such 
Act (as amended by subsection (a)).
    (e) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 1996.

SEC. 2. STUDY OF PAYMENT RATES.

    Not later than April 1, 1996, the Secretary of Health and Human 
Services shall submit a report to Congress containing recommendations 
for adjustments to the payment amounts established under part B of 
title XVIII of the Social Security Act for services described in 
section 1861(s)(2)(K)(iv) of such Act (as amended by section 1(a)) to 
ensure that the payment amounts reflect the approximate costs of 
furnishing the services, taking into account the costs of compensation, 
overhead, and supervision attributable to registered nurses.
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