[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2788 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 2788
To amend title XVIII of the Social Security Act to modernize provisions
relating to rural health clinics under Medicare.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 16, 2019
Mr. Smith of Nebraska (for himself, Mrs. Rodgers of Washington, Ms.
Sewell of Alabama, and Mr. Loebsack) 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 modernize provisions
relating to rural health clinics under Medicare.
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 ``Rural Health Clinic Modernization
Act of 2019''.
SEC. 2. MODERNIZING PHYSICIAN, PHYSICIAN ASSISTANT, AND NURSE
PRACTITIONER UTILIZATION REQUIREMENTS.
(a) In General.--Section 1861(aa) of the Social Security Act (42
U.S.C. 1395x(aa)) is amended--
(1) in paragraph (2)(B), by striking ``has an arrangement''
and all that follows through the first semicolon and inserting
``meets the requirements described in paragraph (8);''; and
(2) by adding at the end the following new paragraph:
``(8) Requirements for certain facilities described.--For
purposes of paragraph (2)(B), with respect to a facility which
is not a physician-directed clinic, the following requirements
are described in this paragraph:
``(A) Arrangement.--The facility has an arrangement
consistent with the provisions of State and local law
relative to the practice, performance, and delivery of
health services, with one or more physician assistants
(as defined in paragraph (5)(A)) or one or more nurse
practitioners (as defined in such paragraph).
``(B) Practice and oversight requirements.--
``(i) In general.--Subject to clause (ii),
the delivery of health services under such
arrangement shall be in accordance with State
law or the State regulatory mechanism governing
the practice of physician assistants or nurse
practitioners.
``(ii) Exception if no state laws or
regulations applicable.--In the case where a
State does not have laws or regulations
governing the practice, performance, and
delivery of health services by a physician
assistant or nurse practitioner, the Secretary
shall adopt regulations for facilities located
in such State that provide for the periodic
review by physicians of covered services
furnished by physician assistants and nurse
practitioners, the supervision and guidance by
such physicians of physician assistants and
nurse practitioners, and the preparation by
such physicians of such medical orders for care
and treatment of clinic patients as is
necessary. Such regulations shall also require
facilities located in such a State to have
arrangements with physicians for referral of
and consultation for patients as the facility
deems necessary and for advice and assistance
in the management of medical emergencies.''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of the enactment of this Act.
SEC. 3. REMOVING OUTDATED LABORATORY REQUIREMENTS.
(a) In General.--Section 1861(aa)(2)(G) of the Social Security Act
(42 U.S.C. 1395x(aa)(2)(G)) is amended by striking ``, including
clinical laboratory services'' and all that follows through
``additional diagnostic services'' and inserting the following: ``and
has prompt access to clinical laboratory services and additional
diagnostic services''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of the enactment of this Act.
SEC. 4. ALLOWING RURAL HEALTH CLINICS THE FLEXIBILITY TO CONTRACT WITH
PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS.
(a) In General.--Section 1861(aa) of the Social Security Act (42
U.S.C. 1395x(aa)), in the first sentence of the flush matter following
paragraph (2), is amended by striking ``(iii) employs a physician
assistant or nurse practitioner, and (iv)'' and inserting ``and
(iii)''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act.
SEC. 5. ALLOWING RURAL HEALTH CLINICS TO BE THE DISTANT SITE FOR A
TELEHEALTH VISIT.
(a) In General.--Section 1834(m) of the Social Security Act (42
U.S.C. 1395m(m)) is amended--
(1) in the first sentence of paragraph (1)--
(A) by striking ``or a practitioner (described in
section 1842(b)(18)(C))'' and inserting ``, a
practitioner (described in section 1842(b)(18)(C)), or
a rural health clinic''; and
(B) by striking ``or practitioner'' and inserting
``, practitioner, or rural health clinic'';
(2) in paragraph (2)(A)--
(A) by striking ``or practitioner'' and inserting
``practitioner, or rural health clinic''; and
(B) by striking ``such physician or practitioner''
and inserting ``such physician, practitioner, or rural
health clinic''; and
(3) in paragraph (4)(A), by striking ``or practitioner''
and inserting ``practitioner, or rural health clinic''.
(b) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the date of the enactment of
this Act.
SEC. 6. INCLUDING FACILITIES LOCATED IN CERTAIN AREAS.
(a) In General.--Section 1861(aa) of the Social Security Act (42
U.S.C. 1395x(aa)) is amended, in the first sentence of the flush matter
following paragraph (2), by inserting ``or in an area that has been
designated by the chief executive officer of the State and certified by
the Secretary as rural'' after ``Census)''.
(b) Effective Date.--The amendment made by this section shall take
effect on the date of the enactment of this Act.
SEC. 7. INCREASING REIMBURSEMENT FOR RURAL HEALTH CLINICS.
Section 1833(f) of the Social Security Act (42 U.S.C. 1395l(f)) is
amended--
(1) in paragraph (1), by striking ``, and'' at the end and
inserting a semicolon;
(2) in paragraph (2)--
(A) by inserting ``(before 2020)'' after ``in a
subsequent year''; and
(B) by striking the period at the end and inserting
a semicolon; and
(3) by adding at the end the following new paragraphs:
``(3) in 2020, at $105 per visit;
``(4) in 2021, at $110 per visit;
``(5) in 2022, at $115 per visit; and
``(6) in a subsequent year, at the limit established under
this subsection for the previous year increased by the
percentage increase in the MEI (as so defined) applicable to
primary care services (as so defined) furnished as of the first
day of that year.''.
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