[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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