NEW PHYSICIANS AND OTHER NEW HEALTH CARE PRACTITIONERS.

SEC. 4106. NEW PHYSICIANS AND OTHER NEW HEALTH CARE PRACTITIONERS. (a) Extension of Customary Charge Limit and Inclusion of Health Care Practitioners.— (1) In general.— Subparagraph (F) of section 1842(b)(4) (42 U.S.C. 1395u(b)(4)) is amended to read as follows: “(F) (i) In the case of physicians’ services and professional services of a health care practitioner (other than primary care services and other than services furnished in a rural area (as defined in section 1886(d)(2)(D)) that is designated, under section 332(a)(l)(A) of the Public Health Service Act, as a health manpower shortage area) furnished during the physician’s or practitioner’s first through fourth years of practice (if payment for those services is made separately under this part and on other than a cost-related basis), the prevailing charge or fee schedule amount to be applied under this part shall be 80 percent for the first year of practice, 85 percent for the second year of practice, 90 percent for the third year of practice, and 95 percent for the fourth year of practice, of the prevailing charge or fee schedule amount for that service under the other provisions of this part. “(ii) For purposes of clause (i): “(I) The term ‘health care practitioner’ means a physician assistant, certified nurse-midwife, qualified psychologist, nurse practitioner, clinical social worker, physical therapist, occupational therapist, respiratory therapist, certified registered nurse anesthetist, or any other practitioner as may be specified by the Secretary. “(II) The term ‘first year of practice’ means, with respect to a physician or practitioner, the first calendar year during the first 6 months of which the physician or practitioner furnishes professional services for which payment is made under this part, and includes any period before such year. “(II) The terms ‘second year of practice’, ‘third year of practice’, and ‘fourth year of practice’ mean the second, third, and fourth calendar years, respectively, following the first year of practice.”. (2) Conforming amendments.— Section 6108(a)(2)(A) of the Omnibus Budget Reconciliation Act of 1989 is amended— (A) by inserting “or 1991” after “1990”, and (B) by inserting “or 1990” after “1989”. (b) Application Under Fee Schedule.— (1) In general.—Section 1848(a) (42 U.S.C. 1395w–4(a)) is amended by adding at the end the following new paragraph: “(4) Treatment of new physicians.—In the case of physicians’ services furnished by a physician before the end of the physician’s first full calendar year of furnishing services for which payment may be made under this part, and during each of the 3 succeeding years, the fee schedule amount to be applied shall be 80 percent, 85 percent, 90 percent, and 95 percent, respectively, of the fee schedule amount applicable to physicians who are not subject to this paragraph. The preceding sentence shall not apply to primary care services or services furnished in a rural area (as defined in section 1886(d)(2)) that is 104 STAT. 1388–62designated under section 322(a)(1)(A) of the Public Health Service Act as a health manpower shortage area.”. (2) Conforming amendments.— Section 1842(b)(4)(F), as amended by subsection (a), is amended— (A) in clause (i), by striking “physicians’ services and”, (B) in clause (i), by striking “physician’s or”, and (C) in clause (ii)(H), by striking “physician or” each place it appears. (c) Conforming Adjustment in Conversion Factor Computation.—In computing the conversion factor under section 1848(d)(1)(B) for 1992, the Secretary of Health and Human Services shall determine the estimated aggregate amount of payments under part B for physicians’ services in 1991 assuming that the amendments made by this section (notwithstanding subsection (d)) applied to all services furnished during such year. (d) Effective Dates.— (1) The amendments made by subsection (a) apply to services furnished after 1990, except that— (A) the provisions concerning the third and fourth years of practice apply only to physicians’ services furnished after 1990 and 1991, respectively, and (B) the provisions concerning the second, third, and fourth years of practice apply only to services of a health care practitioner furnished after 1991, 1992, and 1993, respectively. (2) The amendments made by subsection (b) shall apply to services furnished after 1991.