[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5389 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5389

To amend title XVIII of the Social Security Act to provide for coverage 
   of clinical pharmacist practitioner services under part B of the 
                           Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 25, 2010

 Mr. Heinrich introduced the following bill; which was referred to the 
 Committee on Energy and 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 coverage 
   of clinical pharmacist practitioner services under part B of the 
                           Medicare Program.

    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 ``Medicare Clinical Pharmacist 
Practitioner Services Coverage Act of 2010''.

SEC. 2. MEDICARE COVERAGE OF CLINICAL PHARMACIST PRACTITIONER SERVICES.

    (a) Coverage.--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 (EE);
            (2) by adding ``and'' at the end of subparagraph (FF); and
            (3) by inserting after subparagraph (FF) the following new 
        subparagraph:
                    ``(GG) clinical pharmacist practitioner services 
                (as defined in subsection (iii)(1)); and''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended by adding at the end the following new subsection:
    ``(iii) Clinical Pharmacist Practitioner Services; Clinical 
Pharmacist Practitioner.--(1) The term `clinical pharmacist 
practitioner services' means such direct patient care services provided 
by a pharmacist clinician or clinical pharmacist practitioner, and such 
services furnished as incident to the services of the clinician or 
practitioner, respectively, which the clinician or practitioner, 
respectively, is legally authorized to perform under State law (or the 
State regulatory mechanism as provided by State law) in a collaborative 
practice agreement as would otherwise be covered under this part if 
furnished by a physician, or as incident to a physician's professional 
service.
    ``(2) The terms `pharmacist clinician' and `clinical pharmacist 
practitioner' mean a pharmacist who--
            ``(A) is certified by a State as a pharmacist clinician or 
        clinical pharmacist practitioner as a result of completing 
        training in physical assessment and clinical hours of 
        experience, as required by State law and the rules of State 
        Boards of Pharmacy, in addition to any requirements of such 
        State to be a licensed pharmacist;
            ``(B) has prescriptive authority, as established by State 
        statute; and
            ``(C) is involved in the application of the scientific 
        principles of pharmacology, toxicology, therapeutics, clinical 
        pharmacokinetics, pharmacoeconomics, and other life sciences 
        for the direct care of patients''.
    (c) Payment.--
            (1) In general.--Section 1833(a)(1) of such Act (42 U.S.C. 
        1395l(a)(1)) is amended--
                    (A) by striking ``and (Z)'' and inserting ``(Z)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (AA) with respect to 
                clinical pharmacist practitioner services (as defined 
                in section 1861(iii)(1)), the amounts paid shall be 85 
                percent of the amounts provided for such services under 
                section 1834(p)(1);''.
            (2) Establishment of fee schedules.--Section 1834 of such 
        Act (42 U.S.C. 1395m) is amended by adding at the end the 
        following new subsection:
    ``(p) Fee Schedules for Clinical Pharmacist Practitioner 
Services.--
            ``(1) Development.--The Secretary shall develop and 
        implement, for services furnished on or after January 1, 2011--
                    ``(A) a relative value scale to serve as the basis 
                for the payment of clinical pharmacist practitioner 
                services (as defined in section 1861(iii)(1)) under 
                this part; and
                    ``(B) using such scale and appropriate conversion 
                factors, fee schedules (on a regional, statewide, 
                locality, or carrier service area basis) for payment 
                for clinical pharmacist practitioner services under 
                this part.
            ``(2) Payments prior to implementation of fee schedules.--
        In the case of clinical pharmacist practitioner services which 
        are furnished before the implementation of fee schedules under 
        paragraph (1)(B) and after July 1, 2010, the amount of payment 
        made under this part shall be based on 85 percent of the fee 
        schedule amount applicable under section 1848 if the services 
        were furnished by a physician.''.
            (3) Report to congress.--Not later than September 30, 2011, 
        the Secretary of Health and Human Services shall submit to 
        Congress a report on the fee schedules (including relative 
        value scale and appropriate conversion factors) developed 
        pursuant to section 1834(p)(1) of the Social Security Act (as 
        added by paragraph (2)) for clinical pharmacist practitioner 
        services under part B of title XVIII of such Act.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after July 1, 2010.
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