Rural Health Clinic Modernization Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1037 To amend title XVIII of the Social Security Act to modernize provisions relating to rural health clinics under Medicare. IN THE SENATE OF THE UNITED STATES APRIL 4, 2019 Mr. BARRASSO (for himself and Ms. SMITH) 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 modernize provisions relating to rural health clinics under Medicare. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Rural Health Clinic 4 Modernization Act of 2019’’. 5 SEC. 2. MODERNIZING PHYSICIAN, PHYSICIAN ASSISTANT, 6 AND NURSE PRACTITIONER UTILIZATION RE- 7 QUIREMENTS. 8 (a) IN GENERAL.—Section 1861(aa) of the Social Se- 9 curity Act (42 U.S.C. 1395x(aa)) is amended— 10 VerDate Sep 11 2014 01:42 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1037.IS S1037 pbinns on DSK79D2C42PROD with BILLS 2 •S 1037 IS (1) in paragraph (2)(B), by striking ‘‘has an 1 arrangement’’ and all that follows through the first 2 semicolon and inserting ‘‘meets the requirements de- 3 scribed in paragraph (8);’’; and 4 (2) by adding at the end the following new 5 paragraph: 6 ‘‘(8) REQUIREMENTS FOR CERTAIN FACILITIES 7 DESCRIBED.—For purposes of paragraph (2)(B), 8 with respect to a facility which is not a physician- 9 directed clinic, the following requirements are de- 10 scribed in this paragraph: 11 ‘‘(A) ARRANGEMENT.—The facility has an 12 arrangement consistent with the provisions of 13 State and local law relative to the practice, per- 14 formance, and delivery of health services, with 15 one or more physician assistants (as defined in 16 paragraph (5)(A)) or one or more nurse practi- 17 tioners (as defined in such paragraph). 18 ‘‘(B) PRACTICE AND OVERSIGHT REQUIRE- 19 MENTS.— 20 ‘‘(i) IN GENERAL.—Subject to clause 21 (ii), the delivery of health services under 22 such arrangement shall be in accordance 23 with State law or the State regulatory 24 VerDate Sep 11 2014 01:42 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1037.IS S1037 pbinns on DSK79D2C42PROD with BILLS 3 •S 1037 IS mechanism governing the practice of physi- 1 cian assistants or nurse practitioners. 2 ‘‘(ii) EXCEPTION IF NO STATE LAWS 3 OR REGULATIONS APPLICABLE.—In the 4 case where a State does not have laws or 5 regulations governing the practice, per- 6 formance, and delivery of health services 7 by a physician assistant or nurse practi- 8 tioner, the Secretary shall adopt regula- 9 tions for facilities located in such State 10 that provide for the periodic review by phy- 11 sicians of covered services furnished by 12 physician assistants and nurse practi- 13 tioners, the supervision and guidance by 14 such physicians of physician assistants and 15 nurse practitioners, and the preparation by 16 such physicians of such medical orders for 17 care and treatment of clinic patients as is 18 necessary. Such regulations shall also re- 19 quire facilities located in such a State to 20 have arrangements with physicians for re- 21 ferral of and consultation for patients as 22 the facility deems necessary and for advice 23 and assistance in the management of med- 24 ical emergencies.’’. 25 VerDate Sep 11 2014 01:42 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1037.IS S1037 pbinns on DSK79D2C42PROD with BILLS 4 •S 1037 IS (b) EFFECTIVE DATE.—The amendments made by 1 this section shall take effect on the date of the enactment 2 of this Act. 3 SEC. 3. REMOVING OUTDATED LABORATORY REQUIRE- 4 MENTS. 5 (a) IN GENERAL.—Section 1861(aa)(2)(G) of the So- 6 cial Security Act (42 U.S.C. 1395x(aa)(2)(G)) is amended 7 by striking ‘‘, including clinical laboratory services’’ and 8 all that follows through ‘‘additional diagnostic services’’ 9 and inserting the following: ‘‘and has prompt access to 10 clinical laboratory services and additional diagnostic serv- 11 ices’’. 12 (b) EFFECTIVE DATE.—The amendments made by 13 this section shall take effect on the date of the enactment 14 of this Act. 15 SEC. 4. ALLOWING RURAL HEALTH CLINICS THE FLEXI- 16 BILITY TO CONTRACT WITH PHYSICIAN AS- 17 SISTANTS AND NURSE PRACTITIONERS. 18 (a) IN GENERAL.—Section 1861(aa) of the Social Se- 19 curity Act (42 U.S.C. 1395x(aa)), in the first sentence of 20 the flush matter following paragraph (2), is amended by 21 striking ‘‘(iii) employs a physician assistant or nurse prac- 22 titioner, and (iv)’’ and inserting ‘‘and (iii)’’. 23 VerDate Sep 11 2014 01:42 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1037.IS S1037 pbinns on DSK79D2C42PROD with BILLS 5 •S 1037 IS (b) EFFECTIVE DATE.—The amendment made by 1 subsection (a) shall take effect on the date of the enact- 2 ment of this Act. 3 SEC. 5. ALLOWING RURAL HEALTH CLINICS TO BE THE DIS- 4 TANT SITE FOR A TELEHEALTH VISIT. 5 (a) IN GENERAL.—Section 1834(m) of the Social Se- 6 curity Act (42 U.S.C. 1395m(m)) is amended— 7 (1) in the first sentence of paragraph (1)— 8 (A) by striking ‘‘or a practitioner (de- 9 scribed in section 1842(b)(18)(C))’’ and insert- 10 ing ‘‘, a practitioner (described in section 11 1842(b)(18)(C)), or a rural health clinic’’; and 12 (B) by striking ‘‘or practitioner’’ and in- 13 serting ‘‘, practitioner, or rural health clinic’’; 14 (2) in paragraph (2)(A)— 15 (A) by striking ‘‘or practitioner’’ and in- 16 serting ‘‘practitioner, or rural health clinic’’; 17 and 18 (B) by striking ‘‘such physician or practi- 19 tioner’’ and inserting ‘‘such physician, practi- 20 tioner, or rural health clinic’’; and 21 (3) in paragraph (4)(A), by striking ‘‘or practi- 22 tioner’’ and inserting ‘‘practitioner, or rural health 23 clinic’’. 24 VerDate Sep 11 2014 01:42 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1037.IS S1037 pbinns on DSK79D2C42PROD with BILLS 6 •S 1037 IS (b) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to services furnished on or after 2 the date of the enactment of this Act. 3 SEC. 6. INCLUDING FACILITIES LOCATED IN CERTAIN 4 AREAS. 5 (a) IN GENERAL.—Section 1861(aa) of the Social Se- 6 curity Act (42 U.S.C. 1395x(aa)) is amended, in the first 7 sentence of the flush matter following paragraph (2), by 8 inserting ‘‘or in an area that has been designated by the 9 chief executive officer of the State and certified by the Sec- 10 retary as rural’’ after ‘‘Census)’’. 11 (b) EFFECTIVE DATE.—The amendment made by 12 this section shall take effect on the date of the enactment 13 of this Act. 14 SEC. 7. INCREASING REIMBURSEMENT FOR RURAL 15 HEALTH CLINICS. 16 Section 1833(f) of the Social Security Act (42 U.S.C. 17 1395l(f)) is amended— 18 (1) in paragraph (1), by striking ‘‘, and’’ at the 19 end and inserting a semicolon; 20 (2) in paragraph (2)— 21 (A) by inserting ‘‘(before 2020)’’ after ‘‘in 22 a subsequent year’’; and 23 (B) by striking the period at the end and 24 inserting a semicolon; and 25 VerDate Sep 11 2014 01:42 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1037.IS S1037 pbinns on DSK79D2C42PROD with BILLS 7 •S 1037 IS (3) by adding at the end the following new 1 paragraphs: 2 ‘‘(3) in 2020, at $105 per visit; 3 ‘‘(4) in 2021, at $110 per visit; 4 ‘‘(5) in 2022, at $115 per visit; and 5 ‘‘(6) in a subsequent year, at the limit estab- 6 lished under this subsection for the previous year in- 7 creased by the percentage increase in the MEI (as 8 so defined) applicable to primary care services (as so 9 defined) furnished as of the first day of that year.’’. 10 Æ VerDate Sep 11 2014 01:42 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\S1037.IS S1037 pbinns on DSK79D2C42PROD with BILLS