[Congressional Record Volume 155, Number 1 (Tuesday, January 6, 2009)]
[Senate]
[Pages S64-S67]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. INOUYE:
  S. 63. A bill to amend title XIX of the Social Security Act to 
improve access to advanced practice nurses and physicians assistants 
under the Medicaid Program; to the Committee on Finance.
  Mr. INOUYE. Mr. President, today, I, again, introduce the Medicaid 
Advanced Practice Nurse and Physician Assistants Access Act of 2009. 
This legislation would change the Federal law to expand fee-for-service 
Medicaid to include direct payment for services provided by all nurse 
practitioners, clinical nurse specialists, and physician assistants. It 
would ensure all nurse practitioners, certified nurse midwives, and 
physician assistants are recognized as primary care case managers, and 
require Medicaid panels to include advanced practice nurses on their 
managed care panels.
  Advanced practice nurses are registered nurses who have attained 
additional expertise in the clinical management of health conditions. 
Typically, an advanced practice nurse holds a master's degree with 
didactic and clinical preparation beyond that of the registered nurse. 
They are employed in clinics, hospitals, and private practices. While 
there are many titles given to these advanced practice

[[Page S67]]

nurses, such as pediatric nurse practitioners, family nurse 
practitioners, certified nurse midwives, certified registered nurse 
anesthetists, and clinical nurse specialists, our current Medicaid law 
has not kept up with the multiple specialties and titles of these 
advanced practitioners, nor has it recognized the critical role 
physician assistants play in the delivery of primary care.
  I have been a long-time advocate of advanced practice nurses and 
their ability to extend health care services to our most rural and 
underserved communities. They have improved access to health care in 
Hawaii and throughout the United States by their willingness to 
practice in what some providers might see as undesirable locations--
extremely rural, frontier, or urban areas. This legislation ensures 
they are recognized and reimbursed for providing the necessary health 
care services patients need, and it gives those patients the choice of 
selecting advanced practice nurses and physician assistants as their 
primary care providers.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 63

       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 ``Medicaid Advanced Practice 
     Nurses and Physician Assistants Access Act of 2009''.

     SEC. 2. IMPROVED ACCESS TO SERVICES OF ADVANCED PRACTICE 
                   NURSES AND PHYSICIAN ASSISTANTS UNDER STATE 
                   MEDICAID PROGRAMS.

       (a) Primary Care Case Management.--Section 1905(t)(2) of 
     the Social Security Act (42 U.S.C. 1396d(t)(2)) is amended by 
     striking subparagraph (B) and inserting the following:
       ``(B) A nurse practitioner (as defined in section 
     1861(aa)(5)(A)).
       ``(C) A certified nurse-midwife (as defined in section 
     1861(gg)).
       ``(D) A physician assistant (as defined in section 
     1861(aa)(5)(A)).''.
       (b) Fee-for-Service Program.--Section 1905(a)(21) of such 
     Act (42 U.S.C. 1396d(a)(21)) is amended--
       (1) by inserting ``(A)'' after ``(21)'';
       (2) by striking ``services furnished by a certified 
     pediatric nurse practitioner or certified family nurse 
     practitioner (as defined by the Secretary) which the 
     certified pediatric nurse practitioner or certified family 
     nurse practitioner'' and inserting ``services furnished by a 
     nurse practitioner (as defined in section 1861(aa)(5)(A)) or 
     by a clinical nurse specialist (as defined in section 
     1861(aa)(5)(B)) which the nurse practitioner or clinical 
     nurse specialist'';
       (3) by striking ``the certified pediatric nurse 
     practitioner or certified family nurse practitioner'' and 
     inserting ``the nurse practitioner or clinical nurse 
     specialist''; and
       (4) by inserting before the semicolon at the end the 
     following: ``and (B) services furnished by a physician 
     assistant (as defined in section 1861(aa)(5)) with the 
     supervision of a physician which the physician assistant is 
     legally authorized to perform under State law''.
       (c) Including in Mix of Service Providers Under Medicaid 
     Managed Care Organizations.--Section 1932(b)(5)(B) of such 
     Act (42 U.S.C. 1396u-2(b)(5)(B)) is amended by inserting ``, 
     with such mix including nurse practitioners, clinical nurse 
     specialists, physician assistants, certified nurse midwives, 
     and certified registered nurse anesthetists (as defined in 
     section 1861(bb)(2))'' after ``services''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to items and services furnished in calendar 
     quarters beginning on or after 90 days after the date of the 
     enactment of this Act, without regard to whether or not final 
     regulations to carry out such amendments have been 
     promulgated by such date.
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