[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 893 Introduced in House (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 x (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.
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