Federal

Equitable Community Access to Pharmacist Services Act

Source: Congress.gov · 853 words in original text

What This Bill Does

This bill adds pharmacy services to Medicare Part B coverage (the part of Medicare that covers doctor visits and outpatient services). It allows pharmacists to provide and get paid for certain medical services that doctors currently provide, specifically for testing and treatment of certain infectious diseases and during public health emergencies.

Who It Affects

Medicare patients, pharmacists, pharmacies and the Secretary of Health and Human Services.

Key Provisions

• Pharmacists licensed under state law can provide services for patient evaluation and testing or treatment for COVID-19, influenza, respiratory syncytial virus or streptococcal pharyngitis, and Medicare will cover these services (Sec. 2(a)(1)(C)). • Pharmacists can also provide services related to public health emergencies declared under federal law, and Medicare will cover these services (Sec. 2(a)(1)(C)). • Medicare will pay 80 percent of the lesser amount between what the pharmacist actually charges or 85 percent of the standard payment rate for those services (or 100 percent during federal emergencies) (Sec. 2(b)(2)). • Pharmacists cannot charge Medicare patients more than Medicare allows, the same rule that applies to doctors (Sec. 2(c)).

What Changes

Medicare will begin covering and paying for pharmacist services for specific medical visits and public health responses. Pharmacists can enroll to provide these covered services. Pharmacies and pharmacists keep their existing enrollment and payment options under current Medicare rules.

Important Definitions

None defined.

I 118TH CONGRESS 1ST SESSION H. R. 1770 To amend title XVIII of the Social Security Act to provide pharmacy payment of certain services. IN THE HOUSE OF REPRESENTATIVES MARCH 23, 2023 Mr. SMITH of Nebraska (for himself, Mr. SCHNEIDER, Mr. BUCSHON, Ms. MATSUI, Mr. CARTER of Georgia, Mrs. HARSHBARGER, Mr. BILIRAKIS, Mr. BLUMENAUER, Mr. FITZPATRICK, Mr. PETERS, and Ms. SEWELL) introduced the following bill; which was referred to the Committee on En- ergy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdic- tion of the committee concerned A BILL To amend title XVIII of the Social Security Act to provide pharmacy payment of certain services. 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 ‘‘Equitable Community 4 Access to Pharmacist Services Act’’. 5 VerDate Sep 11 2014 21:22 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1770.IH H1770 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 1770 IH SEC. 2. COVERAGE OF PHARMACIST SERVICES UNDER 1 MEDICARE PART B. 2 (a) COVERAGE.—Section 1861(s) of the Social Secu- 3 rity Act (42 U.S.C. 1395x(s)) is amended— 4 (1) in paragraph (2)— 5 (A) in subparagraph (II), by striking 6 ‘‘and’’ at the end; 7 (B) in subparagraph (JJ), by striking the 8 period at the end and inserting ‘‘; and’’; and 9 (C) by adding at the end the following new 10 subparagraph: 11 ‘‘(KK) pharmacist services and such services 12 and supplies furnished as an incident to the phar- 13 macist’s service as would otherwise be covered under 14 part B if furnished by a physician or as an incident 15 to a physician’s service that— 16 ‘‘(i) are furnished by a pharmacist— 17 ‘‘(I) as licensed under State law; or 18 ‘‘(II) pursuant to a Federal emer- 19 gency authority described under section 20 319F–3 or section 361 of the Public 21 Health Service Act, or other similar Fed- 22 eral law; 23 ‘‘(ii) would otherwise be covered under part 24 B if furnished by a physician; and 25 ‘‘(iii) are services— 26 VerDate Sep 11 2014 21:22 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1770.IH H1770 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 1770 IH ‘‘(I) for encounters for the evaluation 1 and management of patients for testing or 2 treatment for COVID–19, influenza, res- 3 piratory syncytial virus, or streptococcal 4 pharyngitis; or 5 ‘‘(II) that address a public health 6 need related to a public health emergency 7 under section 319F–3 or section 361 of 8 the Public Health Service Act, or other 9 similar Federal law.’’; and 10 (2) in paragraph (10), in each of subpara- 11 graphs (A) and (B), by inserting ‘‘, including when 12 furnished by a pharmacist’’ before the semicolon in 13 each such subparagraph. 14 (b) PAYMENT.—Section 1833(a)(1) of the Social Se- 15 curity Act (42 U.S.C. 1395l(a)(1)) is amended— 16 (1) by striking ‘‘and (HH)’’ and inserting 17 ‘‘(HH)’’; and 18 (2) by inserting before the semicolon at the end 19 the following: ‘‘and (II) with respect to pharmacist 20 services described in section 1861(s)(2)(KK), the 21 amounts paid shall be equal to 80 percent of the 22 lesser of (i) the actual charge for the services or (ii) 23 85 percent (or 100 percent, in the case of such serv- 24 ices furnished pursuant to a Federal emergency au- 25 VerDate Sep 11 2014 21:22 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1770.IH H1770 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 1770 IH thority described in clause (i)(II) of such section) of 1 the amount determined under the payment basis 2 under section 1848 for such services.’’. 3 (c) PROHIBITION ON BALANCE BILLING FOR PHAR- 4 MACIST SERVICES.—Section 1842(b)(18)(C) of the Social 5 Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by 6 adding at the end the following: 7 ‘‘(ix) A pharmacist.’’. 8 (d) RULE OF CONSTRUCTION.—Nothing in this sec- 9 tion shall be construed to restrict the ability of pharmacies 10 and pharmacists to enroll and obtain reimbursement 11 under existing pathways under title XVIII of the Social 12 Security Act (42 U.S.C. 1395 et seq.) as of the date of 13 the enactment of this Act, including payment as mass 14 immunizers. 15 (e) IMPLEMENTATION AUTHORITY.—Notwith- 16 standing any other provision of law, the Secretary of 17 Health and Human Services shall implement the provi- 18 sions of, and the amendments made by, this section by 19 interim final rule, program instruction, or otherwise not 20 later than the date that is 60 days after the date of the 21 enactment of this Act. 22 Æ VerDate Sep 11 2014 21:22 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H1770.IH H1770 pbinns on DSKJLVW7X2PROD with $$_JOB

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