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II
117TH CONGRESS
1ST SESSION
S. 1362
To amend title XVIII of the Social Security Act to provide for coverage
under the Medicare program of pharmacist services.
IN THE SENATE OF THE UNITED STATES
APRIL 26, 2021
Mr. GRASSLEY (for himself, Mr. CASEY, and Mr. BROWN) introduced the
following bill; which was read twice and referred to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to provide
for coverage under the Medicare program of pharmacist
services.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE.
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This Act may be cited as the ‘‘Pharmacy and Medi-
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cally Underserved Areas Enhancement Act’’.
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SEC. 2. MEDICARE COVERAGE OF PHARMACIST SERVICES.
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(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
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curity Act (42 U.S.C. 1395x(s)(2)) is amended—
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(1) in subparagraph (GG), by striking ‘‘and’’ at
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the end;
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•S 1362 IS
(2) in subparagraph (HH), by striking the pe-
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riod at the end and inserting ‘‘; and’’; and
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(3) by adding at the end the following new sub-
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paragraph:
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‘‘(II) pharmacist services furnished by a phar-
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macist, as licensed by State law, individually or on
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behalf of a pharmacy provider—
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‘‘(i) which the pharmacist is legally author-
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ized to perform in the State in which the indi-
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vidual performs such services;
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‘‘(ii) as would otherwise be covered under
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this part if furnished by a physician, or as an
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incident to a physician’s service; and
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‘‘(iii) in a setting located in a health pro-
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fessional shortage area (as defined in section
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332(a)(1)(A) of the Public Health Service Act),
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medically underserved area, or medically under-
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served
population
(as
defined
in
section
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330(b)(3) of such Act);’’.
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(b) PAYMENT.—Section 1833(a)(1) of the Social Se-
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curity Act (42 U.S.C. 1395l(a)(1)) is amended—
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(1) by striking ‘‘and (DD)’’ and inserting
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‘‘(DD)’’; and
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(2) by inserting before the semicolon at the end
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the following: ‘‘and (EE) with respect to pharmacist
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•S 1362 IS
services (as defined in section 1861(s)(2)(II)), the
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amounts paid shall be equal to 80 percent of the
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lesser of the actual charge or 85 percent of the fee
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schedule amount provided under section 1848 if
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such services had been furnished by a physician’’.
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(c)
EFFECTIVE
DATE;
PHARMACIST
SPECIFIC
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CODES.—
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(1) EFFECTIVE DATE.—The amendments made
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by subsections (a) and (b) shall apply with respect
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to services furnished on or after January 1, 2022.
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(2) PHARMACIST SPECIFIC CODES.—The Sec-
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retary of Health and Human Services shall develop
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pharmacist specific codes, as necessary, under the
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physician fee schedule under section 1848 of the So-
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cial Security Act (42 U.S.C. 1395w–4).
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Æ
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