COVERAGE OF NURSE PRACTITIONERS IN RURAL AREAS.

SEC. 4155. COVERAGE OF NURSE PRACTITIONERS IN RURAL AREAS. (a) In General.—Section 1861(s)(2)(K) (42 U.S.C. 1395x(s)(2)(K)) is amended— (1) in clause (ii), by striking “and” at the end; (2) by redesignating clause (iii) as clause (iv); and (3) by inserting after clause (ii) the following new clause: “(iii) services which would be physicians’ services if furnished by a physician (as defined in subsection (r)(D) and which are performed by a nurse practitioner or clinical nurse specialist (as defined tn subsection (aa)(3)) working in collaboration (as defined in subsection (aa)(4)) with a physician (as defined in subsection (r)(D) in a rural area (as defined in section 1886(d)(2)(D)) which the nurse practitioner or clinical nurse specialist is authorized to perform by the State in which the services are performed, and such services and supplies furnished as an incident to such services as would be covered under subparagraph (A) if furnished as an incident to a physician’s professional service, and”. (b) Payment.— (1) Direct payment.— Section 1832(a)(2)(B) (42 U.S.C. 1395k(a)(2)(B)) is amended— (A) in clause (ii), by striking “and” at the end; (B) in clause (iii), by striking the semicolon and inserting a comma; and (C) by adding at the end the following new clause: “(iv) services of a nurse practitioner or clinical nurse specialist provided in a rural area (as defined in section 1886(d)(2)(D)); and”. (2) Amount.— Section 1833(a)(1) (42 U.S.C. 13951(a)(D) as amended by section 4153(a)(2)(B), is amended— (A) by striking “and” at the end of subparagraph (K); and (B) by inserting after subparagraph (L) the following new subparagraph: “(M) with respect to services described in section 1861(s)(2)(K)(iii) (relating to nurse practitioner or clinical nurse specialist services provided in a rural area), the amounts paid shall be 80 percent of the lesser of the actual charge or the prevailing charge that would be recognized (or, for services furnished on or after January 1, 1992, the fee schedule amount provided under section 1848) if the 104 STAT. 1388–87services had been performed by a physician (subject to the limitation described in subsection (r)(2))”. (3) Cap on prevailing charge; billing only on assignment-related basis.—Section 1833 (42 U.S.C. 13951) is amended by adding at the end the following new subsection: “(r) (1) With respect to services described in section 1861(s)(2)(K)(iii) (relating to nurse practitioner or clinical nurse specialist services provided in a rural area), payment may be made on the basis of a claim or request for payment presented by the nurse practitioner or clinical nurse specialist furnishing such services, or by a hospital, rural primary care hospital, skilled nursing facility or nursing facility (as defined in section 1919(a)), physician, group practice, ambulatory surgical center, with which the nurse practitioner or clinical nurse specialist has an employment or contractual relation-ship that provides for payment to be made under this part for such services to such hospital, physician, group practice, ambulatory surgical center. “(2) (A) For purposes of subsection (a)(l)(M), the prevailing charge for services described in section 1861(s)(2)(K)(iii) may not exceed the applicable percentage (as defined in subparagraph (B)) of the prevailing charge (or, for services furnished on or after January 1, 1992, the fee schedule amount provided under section 1848) determined for such services performed by physicians who are not specialists. “(B) In subparagraph (A), the term ‘applicable percentage’ means— (i) ) 75 percent in the case of services performed in a hospital, and (ii) 85 percent in the case of other services. “(3) (A) Payment under this part for services described in section 1861(s)(2)(K)(iii) may be made only on an assignment-related basis, and any such assignment agreed to by a nurse practitioner or clinical nurse specialist shall be binding upon any other person presenting a claim or request for payment for such services. “(B) Except for deductible and coinsurance amounts applicable under this section, any person who knowingly and willfully presents, or causes to be presented, to an individual enrolled under this part a bill or request for payment for services described in section 1861(s)(2)(K)(iii) in violation of subparagraph (A) is subject to a civil money penalty of not to exceed $2,000 for each such bill or request. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128 A(a). “(4) No hospital or rural primary care hospital that presents a claim or request for payment under this part for services described in section 1861(s)(2)(K)(iii) may treat any uncollected coinsurance amount imposed under this part with respect to such services as a bad debt of such hospital for purposes of this title.”. (c) Conforming Amendment.—Section 1842(b) (42 U.S.C. 1395u(b)) is amended by striking “section 1861(s)(2)(K)” each place it appears in paragraphs (6) and (12) and inserting “clauses (i), (ii), or (iv) of section 1861(s)(2)(K)”. (d) Definition.—Section 1861 (aa)(3) (42 U.S.C. 1395x(aa)(3)) is amended by striking “The term” and all that follows through “who performs” and inserting the following; “The term ‘physician assist-ant’, the term ‘nurse practitioner’, and the term ‘clinical nurse 104 STAT. 1388–88 specialist’ mean, for purposes of this Act, a physician assistant, nurse practitioner, or clinical nurse specialist who performs”. (e) Effective Date.—The amendments made by this section shall apply to services furnished on or after January 1, 1991.