What This Bill Does
This bill changes Medicare rules for rural health clinics. It updates requirements about which healthcare workers can work at these clinics and removes some outdated laboratory rules.
Who It Affects
Rural health clinics that receive Medicare payments. Physician assistants and nurse practitioners who work at rural health clinics.
Key Provisions
• Rural health clinics that are not physician-directed can now have arrangements with physician assistants or nurse practitioners instead of requiring a physician, as long as the arrangement follows state and local laws (Sec. 2)
• Rural health clinics must have prompt access to clinical laboratory services and additional diagnostic services, removing the previous requirement that these services be included on-site (Sec. 3)
• Rural health clinics can now contract with physician assistants and nurse practitioners instead of only being able to employ them (Sec. 4)
• A rural health clinic is defined as located in an area that is not in an urban area of 50,000 or more people, changing the previous definition (Sec. 5)
• Rural health clinics in mental health professional shortage areas (areas officially designated as having too few mental health workers) are excepted from behavioral health limitations (Sec. 6)
What Changes
Rural health clinics gain flexibility in how they structure their staffing with physician assistants and nurse practitioners. They no longer need laboratory services physically on-site. The geographic definition of what counts as "rural" becomes more specific.
Important Definitions
None defined in the bill text.
Effective Date
January 1, 2024.
II
118TH CONGRESS
1ST SESSION
S. 198
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
FEBRUARY 1, 2023
Mr. BARRASSO (for himself, Mr. BENNET, Mrs. BLACKBURN, 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
Burden Reduction Act’’.
5
SEC. 2. MODERNIZING PHYSICIAN, PHYSICIAN ASSISTANT,
6
AND NURSE PRACTITIONER UTILIZATION RE-
7
QUIREMENTS.
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Section 1861(aa) of the Social Security Act (42
9
U.S.C. 1395x(aa)) is amended—
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•S 198 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:
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‘‘(8) REQUIREMENTS FOR CERTAIN FACILITIES DE-
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SCRIBED.—For purposes of paragraph (2)(B), with re-
8
spect to a facility which is not a physician-directed clinic,
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the following requirements are described in this para-
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graph:
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‘‘(A) ARRANGEMENT.—The facility has an ar-
12
rangement consistent with the provisions of State
13
and local law relative to the practice, performance,
14
and delivery of health services, with one or more
15
physician assistants (as defined in paragraph
16
(5)(A)) or one or more nurse practitioners (as de-
17
fined in such paragraph).
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‘‘(B) PRACTICE
AND
OVERSIGHT
REQUIRE-
19
MENTS.—The delivery of health services under such
20
arrangement shall be in accordance with State law
21
or the State regulatory mechanism governing the
22
practice of physician assistants or nurse practi-
23
tioners.’’.
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•S 198 IS
SEC. 3. REMOVING OUTDATED LABORATORY REQUIRE-
1
MENTS.
2
Section 1861(aa)(2)(G) of the Social Security Act
3
(42 U.S.C. 1395x(aa)(2)(G)) is amended by striking ‘‘,
4
including clinical laboratory services’’ and all that follows
5
through ‘‘additional diagnostic services’’ and inserting the
6
following: ‘‘and has prompt access to clinical laboratory
7
services and additional diagnostic services’’.
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SEC. 4. ALLOWING RURAL HEALTH CLINICS THE FLEXI-
9
BILITY TO CONTRACT WITH PHYSICIAN AS-
10
SISTANTS AND NURSE PRACTITIONERS.
11
Section 1861(aa) of the Social Security Act (42
12
U.S.C. 1395x(aa)), in the first sentence of the flush mat-
13
ter following paragraph (2), is amended by inserting ‘‘or
14
contracts with’’ after ‘‘(iii) employs’’.
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SEC. 5. URBANIZED AREA FIX.
16
Section 1861(aa) of the Social Security Act (42
17
U.S.C. 1395x(aa)), in the first sentence of the flush mat-
18
ter following paragraph (2), is amended by striking ‘‘(i)
19
is located in an area that is not an urbanized area’’ and
20
inserting ‘‘(i) is located in an area that is not in an urban
21
area of 50,000 or more’’.
22
SEC. 6. EXCEPTION TO BEHAVIORAL HEALTH LIMITATION.
23
Section 1861(aa) of the Social Security Act (42
24
U.S.C. 1395x(aa)), in the first sentence of the flush mat-
25
ter following paragraph (2), is amended by inserting the
26
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•S 198 IS
following before the period: ‘‘, except in the case where
1
the facility is located in an area that is designated (under
2
section 332(a)(1)(A) of the Public Health Service Act) as
3
a mental health professional shortage area’’.
4
SEC. 7. EFFECTIVE DATE.
5
This Act and the amendments made by this Act shall
6
take effect on January 1, 2024, and shall apply to items
7
and services furnished on or after such date.
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Æ
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