Rural Health Clinic Modernization Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 2788 To amend title XVIII of the Social Security Act to modernize provisions relating to rural health clinics under Medicare. IN THE HOUSE OF REPRESENTATIVES MAY 16, 2019 Mr. SMITH of Nebraska (for himself, Mrs. RODGERS of Washington, Ms. SE- WELL of Alabama, and Mr. LOEBSACK) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subse- quently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 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 VerDate Sep 11 2014 18:30 Jun 03, 2019 Jkt 034408 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2788.IH H2788 pbinns on DSK79D2C42PROD with BILLS 2 •HR 2788 IH SEC. 2. MODERNIZING PHYSICIAN, PHYSICIAN ASSISTANT, 1 AND NURSE PRACTITIONER UTILIZATION RE- 2 QUIREMENTS. 3 (a) IN GENERAL.—Section 1861(aa) of the Social Se- 4 curity Act (42 U.S.C. 1395x(aa)) is amended— 5 (1) in paragraph (2)(B), by striking ‘‘has an 6 arrangement’’ and all that follows through the first 7 semicolon and inserting ‘‘meets the requirements de- 8 scribed in paragraph (8);’’; and 9 (2) by adding at the end the following new 10 paragraph: 11 ‘‘(8) REQUIREMENTS FOR CERTAIN FACILITIES 12 DESCRIBED.—For purposes of paragraph (2)(B), 13 with respect to a facility which is not a physician- 14 directed clinic, the following requirements are de- 15 scribed in this paragraph: 16 ‘‘(A) ARRANGEMENT.—The facility has an 17 arrangement consistent with the provisions of 18 State and local law relative to the practice, per- 19 formance, and delivery of health services, with 20 one or more physician assistants (as defined in 21 paragraph (5)(A)) or one or more nurse practi- 22 tioners (as defined in such paragraph). 23 ‘‘(B) PRACTICE AND OVERSIGHT REQUIRE- 24 MENTS.— 25 VerDate Sep 11 2014 18:30 Jun 03, 2019 Jkt 034408 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2788.IH H2788 pbinns on DSK79D2C42PROD with BILLS 3 •HR 2788 IH ‘‘(i) IN GENERAL.—Subject to clause 1 (ii), the delivery of health services under 2 such arrangement shall be in accordance 3 with State law or the State regulatory 4 mechanism governing the practice of physi- 5 cian assistants or nurse practitioners. 6 ‘‘(ii) EXCEPTION IF NO STATE LAWS 7 OR REGULATIONS APPLICABLE.—In the 8 case where a State does not have laws or 9 regulations governing the practice, per- 10 formance, and delivery of health services 11 by a physician assistant or nurse practi- 12 tioner, the Secretary shall adopt regula- 13 tions for facilities located in such State 14 that provide for the periodic review by phy- 15 sicians of covered services furnished by 16 physician assistants and nurse practi- 17 tioners, the supervision and guidance by 18 such physicians of physician assistants and 19 nurse practitioners, and the preparation by 20 such physicians of such medical orders for 21 care and treatment of clinic patients as is 22 necessary. Such regulations shall also re- 23 quire facilities located in such a State to 24 have arrangements with physicians for re- 25 VerDate Sep 11 2014 18:30 Jun 03, 2019 Jkt 034408 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2788.IH H2788 pbinns on DSK79D2C42PROD with BILLS 4 •HR 2788 IH ferral of and consultation for patients as 1 the facility deems necessary and for advice 2 and assistance in the management of med- 3 ical emergencies.’’. 4 (b) EFFECTIVE DATE.—The amendments made by 5 this section shall take effect on the date of the enactment 6 of this Act. 7 SEC. 3. REMOVING OUTDATED LABORATORY REQUIRE- 8 MENTS. 9 (a) IN GENERAL.—Section 1861(aa)(2)(G) of the So- 10 cial Security Act (42 U.S.C. 1395x(aa)(2)(G)) is amended 11 by striking ‘‘, including clinical laboratory services’’ and 12 all that follows through ‘‘additional diagnostic services’’ 13 and inserting the following: ‘‘and has prompt access to 14 clinical laboratory services and additional diagnostic serv- 15 ices’’. 16 (b) EFFECTIVE DATE.—The amendments made by 17 this section shall take effect on the date of the enactment 18 of this Act. 19 SEC. 4. ALLOWING RURAL HEALTH CLINICS THE FLEXI- 20 BILITY TO CONTRACT WITH PHYSICIAN AS- 21 SISTANTS AND NURSE PRACTITIONERS. 22 (a) IN GENERAL.—Section 1861(aa) of the Social Se- 23 curity Act (42 U.S.C. 1395x(aa)), in the first sentence of 24 the flush matter following paragraph (2), is amended by 25 VerDate Sep 11 2014 18:30 Jun 03, 2019 Jkt 034408 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2788.IH H2788 pbinns on DSK79D2C42PROD with BILLS 5 •HR 2788 IH striking ‘‘(iii) employs a physician assistant or nurse prac- 1 titioner, and (iv)’’ and inserting ‘‘and (iii)’’. 2 (b) EFFECTIVE DATE.—The amendment made by 3 subsection (a) shall take effect on the date of the enact- 4 ment of this Act. 5 SEC. 5. ALLOWING RURAL HEALTH CLINICS TO BE THE DIS- 6 TANT SITE FOR A TELEHEALTH VISIT. 7 (a) IN GENERAL.—Section 1834(m) of the Social Se- 8 curity Act (42 U.S.C. 1395m(m)) is amended— 9 (1) in the first sentence of paragraph (1)— 10 (A) by striking ‘‘or a practitioner (de- 11 scribed in section 1842(b)(18)(C))’’ and insert- 12 ing ‘‘, a practitioner (described in section 13 1842(b)(18)(C)), or a rural health clinic’’; and 14 (B) by striking ‘‘or practitioner’’ and in- 15 serting ‘‘, practitioner, or rural health clinic’’; 16 (2) in paragraph (2)(A)— 17 (A) by striking ‘‘or practitioner’’ and in- 18 serting ‘‘practitioner, or rural health clinic’’; 19 and 20 (B) by striking ‘‘such physician or practi- 21 tioner’’ and inserting ‘‘such physician, practi- 22 tioner, or rural health clinic’’; and 23 VerDate Sep 11 2014 18:30 Jun 03, 2019 Jkt 034408 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2788.IH H2788 pbinns on DSK79D2C42PROD with BILLS 6 •HR 2788 IH (3) in paragraph (4)(A), by striking ‘‘or practi- 1 tioner’’ and inserting ‘‘practitioner, or rural health 2 clinic’’. 3 (b) EFFECTIVE DATE.—The amendments made by 4 this section shall apply to services furnished on or after 5 the date of the enactment of this Act. 6 SEC. 6. INCLUDING FACILITIES LOCATED IN CERTAIN 7 AREAS. 8 (a) IN GENERAL.—Section 1861(aa) of the Social Se- 9 curity Act (42 U.S.C. 1395x(aa)) is amended, in the first 10 sentence of the flush matter following paragraph (2), by 11 inserting ‘‘or in an area that has been designated by the 12 chief executive officer of the State and certified by the Sec- 13 retary as rural’’ after ‘‘Census)’’. 14 (b) EFFECTIVE DATE.—The amendment made by 15 this section shall take effect on the date of the enactment 16 of this Act. 17 SEC. 7. INCREASING REIMBURSEMENT FOR RURAL 18 HEALTH CLINICS. 19 Section 1833(f) of the Social Security Act (42 U.S.C. 20 1395l(f)) is amended— 21 (1) in paragraph (1), by striking ‘‘, and’’ at the 22 end and inserting a semicolon; 23 (2) in paragraph (2)— 24 VerDate Sep 11 2014 18:30 Jun 03, 2019 Jkt 034408 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2788.IH H2788 pbinns on DSK79D2C42PROD with BILLS 7 •HR 2788 IH (A) by inserting ‘‘(before 2020)’’ after ‘‘in 1 a subsequent year’’; and 2 (B) by striking the period at the end and 3 inserting a semicolon; and 4 (3) by adding at the end the following new 5 paragraphs: 6 ‘‘(3) in 2020, at $105 per visit; 7 ‘‘(4) in 2021, at $110 per visit; 8 ‘‘(5) in 2022, at $115 per visit; and 9 ‘‘(6) in a subsequent year, at the limit estab- 10 lished under this subsection for the previous year in- 11 creased by the percentage increase in the MEI (as 12 so defined) applicable to primary care services (as so 13 defined) furnished as of the first day of that year.’’. 14 Æ VerDate Sep 11 2014 18:30 Jun 03, 2019 Jkt 034408 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H2788.IH H2788 pbinns on DSK79D2C42PROD with BILLS