INCREASED MEDICARE REIMBURSEMENT FOR NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS.

SEC. 4511. INCREASED MEDICARE REIMBURSEMENT FOR NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS. (a) Removal of Restrictions on Settings.— (1) In general.—Clause (ii) of section 1861(s)(2)(K) (42 U.S.C. 1395x(s)(2)(K)) is amended to read as follows: “(ii) services which would be physicians’ services if furnished by a physician (as defined in subsection (r)(1)) and which are performed by a nurse practitioner or clinical nurse specialist (as defined in subsection (aa)(5)) working in collaboration (as defined in subsection (aa)(6)) with a physician (as defined in subsection (r)(1)) which the nurse practitioner or clinical nurse specialist is legally 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 incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services;”. (2) Conforming amendments.—(A) Section 1861(s)(2)(K) (42 U.S.C. 1395x(s)(2)(K)) is further amended— (i) in clause (i), by inserting “and such services and supplies furnished as incident to such services as would be covered under subparagraph (A) if furnished incident to a physician’s professional service; and” after “are performed,”; and (ii) by striking clauses (iii) and (iv). (B) Section 1861(b)(4) (42 U.S.C. 1395x(b)(4)) is amended by striking “clauses (i) or (iii) of subsection (s)(2)(K)” and inserting “subsection (s)(2)(K)”. (C) Section 1862(a)(14) (42 U.S.C. 1395y(a)(14)) is amended by striking “section 1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)” and inserting “section 1861(s)(2)(K)”. (D) Section 1866(a)(1)(H) (42 U.S.C. 1395cc(a)(1)(H)) is amended by striking “section 1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)” and inserting “section 1861(s)(2)(K)”. (E) Section 1888(e)(2)(A)(ii) (42 U.S.C. 1395yy(e)(2)(A)(ii)), as added by section 4432(a) (relating to prospective payment system for rehabilitation hospitals), is amended by striking “through (iii)” and inserting “and (ii)”. (b) Increased Payment.— (1) Fee schedule amount.—Subparagraph (O) of section 1833(a)(1) (42 U.S.C. 13951(a)(1)) is amended to read as follows: “(O) with respect to services described in section 1861(s)(2)(K)(ii) (relating to nurse practitioner or clinical nurse specialist services), the amounts paid shall be equal to 80 percent of (i) the lesser of the actual charge or 85 percent of the fee schedule amount provided under section 1848, or (ii) in the case of services as an assistant at surgery, the lesser of the actual charge or 85 percent of the amount that 111 STAT. 443would otherwise be recognized if performed by a physician who is serving as an assistant at surgery; and”. (2) Conforming amendments.—Section 1833(r) (42 U.S.C. 13951(r)) is amended— (A) in paragraph (1), by striking “section 1861(s)(2)(K)(iii) (relating to nurse practitioner or clinical nurse specialist services provided in a rural area)” and inserting “section 1861(s)(2)(K)(ii) (relating to nurse practitioner or clinical nurse specialist services)”; (B) by striking paragraph (2); (C) in paragraph (3), by striking “section 1861(s)(2)(K)(iii)” and inserting “section 1861(s)(2)(K)(ii)”; and (D) by redesignating paragraph (3) as paragraph (2). (c) Direct Payment for Nurse Practitioners and Clinical Nurse Specialists.—Section 1832(a)(2)(B)(iv) (42 U.S.C. 1395k(a)(2)(B)(iv)) is amended by striking “provided in a rural area (as defined in section 1886(d)(2)(D))” and inserting “but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services”. (d) Definition of Clinical Nurse Specialist Clarified.—Section 1861(aa)(5) (42 U.S.C. 1395x(aa)(5)) is amended— (1) by inserting “(A)” after “(5)”; (2) by striking “The term ‘physician assistant’” and all that follows through “who performs” and inserting “The term ‘physician assistant’ and the term ‘nurse practitioner’ mean, for purposes of this title, a physician assistant or nurse practitioner who performs”; and (3) by adding at the end the following new subparagraph: “(B) The term ‘clinical nurse specialist’ means, for purposes of this title, an individual who— “(i) is a registered nurse and is licensed to practice nursing in the State in which the clinical nurse specialist services are performed; and “(ii) holds a master’s degree in a defined clinical area of nursing from an accredited educational institution.”. (e) Effective Date.—The amendments made by this section shall apply with respect to services furnished and supplies provided on and after January 1, 1998.