S. 5212, Improving Care and Access to Nurses Act
Summary
S. 5212, the Improving Care and Access to Nurses Act, is a Senate bill introduced December 8, 2022 by Merkley to amend titles XVIII and XIX of the Social Security Act and the Bipartisan Budget Act of 2018 to increase access to services provided by advanced practice registered nurses under the Medicare and Medicaid programs. It was referred to the Committee on Finance. The table of contents lists Title I on removal of barriers to practice on nurse practitioners, Title II on certified registered nurse anesthetists, and Title III on certified nurse-midwives, with sections on cardiac rehabilitation programs, home infusion therapy, hospice care services and Medicaid clinic services.
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Cite this document
“S. 5212, Improving Care and Access to Nurses Act.”
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II
117TH CONGRESS
2D SESSION
S. 5212
To amend titles XVIII and XIX of the Social Security Act and the Bipartisan
Budget Act of 2018 to increase access to services provided by advanced
practice registered nurses under the Medicare and Medicaid programs,
and for other purposes.
IN THE SENATE OF THE UNITED STATES
DECEMBER 8, 2022
Mr. MERKLEY introduced the following bill; which was read twice and referred
to the Committee on Finance
A BILL
To amend titles XVIII and XIX of the Social Security Act
and the Bipartisan Budget Act of 2018 to increase ac-
cess to services provided by advanced practice registered
nurses under the Medicare and Medicaid programs, and
for other purposes.
1 Be it enacted by the Senate and House of Representa-
2 tives of the United States of America in Congress assembled,
3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
4 (a) IN GENERAL.—This Act may be cited as the ‘‘Im-
5 proving Care and Access to Nurses Act’’ or the ‘‘I CAN
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6 Act’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of
2 this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—REMOVAL OF BARRIERS TO PRACTICE ON NURSE
PRACTITIONERS
Sec. 101. Expanding access to cardiac rehabilitation programs and pulmonary
rehabilitation programs under Medicare program.
Sec. 102. Permitting nurse practitioners to satisfy Medicare documentation re-
quirement for coverage of certain shoes for individuals with di-
abetes.
Sec. 103. Improvements to the assignment of beneficiaries under the Medicare
shared savings program.
Sec. 104. Expanding the availability of medical nutrition therapy services under
the Medicare program.
Sec. 105. Preserving access to home infusion therapy under the Medicare pro-
gram.
Sec. 106. Increasing access to hospice care services under the Medicare pro-
gram.
Sec. 107. Streamlining care delivery in skilled nursing facilities and nursing fa-
cilities; authorizing medicare and medicaid inpatient hospital
patients to be under the care of a nurse practitioner.
Sec. 108. Improving access to Medicaid clinic services.
TITLE II—REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED
REGISTERED NURSE ANESTHETISTS
Sec. 201. Clarifying that certified registered nurse anesthetists can be reim-
bursed by Medicare for evaluation and management services.
Sec. 202. Revision of conditions of payment relating to services ordered and re-
ferred by certified registered nurse anesthetists.
Sec. 203. Special payment rule for teaching student registered nurse anes-
thetists.
Sec. 204. Removing unnecessary and costly supervision of certified registered
nurse anesthetists.
Sec. 205. CRNA services as a Medicaid-required benefit.
TITLE III—REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED
NURSE-MIDWIVES
Sec. 301. Improving access to training in maternity care.
Sec. 302. Improving Medicare patient access to home health services provided
by certified nurse-midwives.
Sec. 303. Improving access to DMEPOS for Medicare beneficiaries.
Sec. 304. Technical changes to qualifications and conditions with respect to the
services of certified nurse-midwives.
TITLE IV—IMPROVING FEDERAL HEALTH PROGRAMS FOR ALL
ADVANCED PRACTICE REGISTERED NURSES
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Sec. 401. Revising the local coverage determination process under the Medicare
program.
Sec. 402. Locum tenens.
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1 TITLE I—REMOVAL OF BAR-
2 RIERS TO PRACTICE ON
3 NURSE PRACTITIONERS
4 SEC. 101. EXPANDING ACCESS TO CARDIAC REHABILITA-
5 TION PROGRAMS AND PULMONARY REHA-
6 BILITATION PROGRAMS UNDER MEDICARE
7 PROGRAM.
8 (a) CARDIAC REHABILITATION PROGRAMS.—Section
9 1861(eee) of the Social Security Act (42 U.S.C.
10 1395x(eee)) is amended—
11 (1) in paragraph (2)—
12 (A) in subparagraph (A)(i), by striking ‘‘a
13 physician’s office’’ and inserting ‘‘the office of
14 a physician (as defined in subsection (r)(1)) or
15 the office of a nurse practitioner, clinical nurse
16 specialist, or physician assistant (as those terms
17 are defined in subsection (aa)(5))’’; and
18 (B) in subparagraph (C), by inserting ‘‘(as
19 defined in subsection (r)(1)), nurse practitioner,
20 clinical nurse specialist, or physician assistant
21 (as those terms are defined in subsection
22 (aa)(5))’’ after ‘‘physician’’;
23 (2) in paragraph (3)(A), by striking ‘‘physician-
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24 prescribed exercise’’ and inserting ‘‘exercise pre-
25 scribed by a physician (as defined in subsection
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1 (r)(1)), nurse practitioner, clinical nurse specialist,
2 or physician assistant (as those terms are defined in
3 subsection (aa)(5))’’; and
4 (3) in paragraph (5), in the matter preceding
5 subparagraph (A), by inserting ‘‘(as defined in sub-
6 section (r)(1)), nurse practitioner, clinical nurse spe-
7 cialist, or physician assistant (as those terms are de-
8 fined in subsection (aa)(5)),’’ after ‘‘physician’’.
9 (b) PULMONARY REHABILITATION PROGRAMS.—Sec-
10 tion 1861(fff) of the Social Security Act (42 U.S.C.
11 1395x(fff)) is amended—
12 (1) in paragraph (2)(A), by striking ‘‘physician-
13 prescribed exercise’’ and inserting ‘‘exercise pre-
14 scribed by a physician (as defined in subsection
15 (r)(1)), nurse practitioner, clinical nurse specialist,
16 or physician assistant (as those terms are defined in
17 subsection (aa)(5))’’; and
18 (2) in paragraph (3), in the matter preceding
19 subparagraph (A), by inserting after ‘‘physician’’ the
20 following: ‘‘(as defined in subsection (r)(1)), nurse
21 practitioner, clinical nurse specialist, or physician as-
22 sistant (as those terms are defined in subsection
23 (aa)(5)),’’.
24 (c) EFFECTIVE DATE.—
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1 (1) IN GENERAL.—The amendments made by
2 subsections (a) and (b) shall apply to items and
3 services furnished on or after the date that is 3
4 months after the date of enactment of this Act.
5 (2) EXPEDITING IMPLEMENTATION OF SUPER-
6 VISION AUTHORITY.—Section 51008(c) of the Bipar-
7 tisan Budget Act of 2018 (Public Law 115–123; 42
8 U.S.C. 1395x note) is amended by striking ‘‘Janu-
9 ary 1, 2024’’ and inserting ‘‘January 1, 2023’’.
10 SEC. 102. PERMITTING NURSE PRACTITIONERS TO SATISFY
11 MEDICARE DOCUMENTATION REQUIREMENT
12 FOR COVERAGE OF CERTAIN SHOES FOR IN-
13 DIVIDUALS WITH DIABETES.
14 (a) IN GENERAL.—Section 1861(s)(12) of the Social
15 Security Act (42 U.S.C. 1395x(s)(12)) is amended—
16 (1) in subparagraph (A), by inserting ‘‘, nurse
17 practitioner, or physician assistant’’ after ‘‘physi-
18 cian’’; and
19 (2) in subparagraph (C), by inserting ‘‘, nurse
20 practitioner, or physician assistant’’ after ‘‘physi-
21 cian’’ each place it appears.
22 (b) EFFECTIVE DATE.—The amendments made by
23 this section shall apply to items and services furnished on
24 or after January 1, 2023.
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1 SEC. 103. IMPROVEMENTS TO THE ASSIGNMENT OF BENE-
2 FICIARIES UNDER THE MEDICARE SHARED
3 SAVINGS PROGRAM.
4 Section 1899(c)(1) of the Social Security Act (42
5 U.S.C. 1395jjj(c)(1)) is amended—
6 (1) in subparagraph (A), by striking ‘‘and’’ at
7 the end;
8 (2) in subparagraph (B), by striking the period
9 at the end and inserting ‘‘; and’’; and
10 (3) by adding at the end the following new sub-
11 paragraph:
12 ‘‘(C) in the case of performance years be-
13 ginning on or after January 1, 2023, primary
14 care services provided under this title by an
15 ACO professional described in subsection
16 (h)(1)(B).’’.
17 SEC. 104. EXPANDING THE AVAILABILITY OF MEDICAL NU-
18 TRITION THERAPY SERVICES UNDER THE
19 MEDICARE PROGRAM.
20 Section 1861(vv)(1) of the Social Security Act (42
21 U.S.C. 1395x(vv)(1)) is amended by inserting ‘‘, a nurse
22 practitioner, or a clinical nurse specialist (as such terms
23 are defined in subsection (aa)(5))’’ before the period at
24 the end.
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1 SEC. 105. PRESERVING ACCESS TO HOME INFUSION THER-
2 APY UNDER THE MEDICARE PROGRAM.
3 (a) ALLOWING APPLICABLE PROVIDERS TO ESTAB-
4 LISH HOME INFUSION THERAPY PLANS.—Section
5 1861(iii)(1)(B) of the Social Security Act (42 U.S.C.
6 1395x(iii)(1)(B)) is amended—
7 (1) by striking ‘‘a physician (as defined in sub-
8 section (r)(1))’’ and inserting ‘‘an applicable pro-
9 vider (as defined in paragraph (3)(A))’’; and
10 (2) by striking ‘‘a physician (as so defined)’’
11 and inserting ‘‘an applicable provider (as so de-
12 fined)’’.
13 (b) CONFORMING AMENDMENT.—Section 1834(u)(6)
14 of the Social Security Act (42 U.S.C. 1395m(u)(6)) is
15 amended by striking ‘‘physician’’ and inserting ‘‘applicable
16 provider (as defined in section 1861(iii)(3)(A))’’.
17 SEC. 106. INCREASING ACCESS TO HOSPICE CARE SERV-
18 ICES UNDER THE MEDICARE PROGRAM.
19 (a) IN GENERAL.—Section 1814(a)(7)(A) of the So-
20 cial Security Act (42 U.S.C. 1395f(a)(7)(A)) is amend-
21 ed—
22 (1) in clause (i)(I), by striking ‘‘a nurse practi-
23 tioner or’’;
24 (2) in clause (i)(II), by inserting ‘‘or nurse
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25 practitioner’’ after ‘‘physician’’; and
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1 (3) in clause (ii), by striking ‘‘or physician’’ and
2 inserting ‘‘, physician, or nurse practitioner’’.
3 (b) HOSPICE CARE DEFINITION.—Section
4 1861(dd)(1)(C) of the Social Security Act (42 U.S.C.
5 1395x(dd)(1)(C)) is amended by inserting ‘‘or nurse prac-
6 titioner’’ after ‘‘physician’’.
7 SEC. 107. STREAMLINING CARE DELIVERY IN SKILLED
8 NURSING FACILITIES AND NURSING FACILI-
9 TIES; AUTHORIZING MEDICARE AND MED-
10 ICAID INPATIENT HOSPITAL PATIENTS TO BE
11 UNDER THE CARE OF A NURSE PRACTI-
12 TIONER.
13 (a) MEDICARE.—
14 (1) CERTIFICATION OF POST-HOSPITAL EX-
15 TENDED CARE SERVICES.—Section 1814(a)(2) of the
16 Social Security Act (42 U.S.C. 1395f(a)(2)) is
17 amended, in the matter preceding subparagraph (A),
18 by striking ‘‘, or a nurse practitioner,’’ and inserting
19 ‘‘or a nurse practitioner (in accordance with State
20 law), or’’.
21 (2) CERTIFICATION AUTHORITY FOR NURSE
22 PRACTITIONERS.—Section 1814(a)(3) of the Social
23 Security Act (42 U.S.C. 1395f(a)(3)) is amended by
24 inserting ‘‘or nurse practitioner’’ after ‘‘physician’’.
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1 (3) SUPERVISION REQUIREMENT IN SKILLED
2 NURSING FACILITY SERVICES.—Section
3 1819(b)(6)(A) of the Social Security Act (42 U.S.C.
4 1395i–3(b)(6)(A)) is amended—
5 (A) in the heading, by striking ‘‘PHYSI-
6 CIAN SUPERVISION’’ and inserting ‘‘SUPER-
7 VISION’’; and
8 (B) by inserting ‘‘or a nurse practitioner,
9 in accordance with State law’’ after ‘‘physi-
10 cian’’.
11 (4) ADMINISTRATION OF PART B.—Section
12 1842(b)(2)(C) of the Social Security Act (42 U.S.C.
13 1395u(b)(2)(C)) is amended, in the second sentence,
14 by striking ‘‘working in collaboration with that phy-
15 sician’’.
16 (5) PROVISION OF MEDICAL AND OTHER
17 HEALTH SERVICES.—Section 1861(s)(2)(K)(ii) of
18 the Social Security Act (42 U.S.C.
19 1395x(s)(2)(K)(ii)) is amended by striking ‘‘or clin-
20 ical nurse specialist (as defined in subsection
21 (aa)(5)) working in collaboration (as defined in sub-
22 section (aa)(6)) with a physician (as defined in sub-
23 section (r)(1))’’ and inserting ‘‘(as defined in sub-
24 section (aa)(5)(A)), or by a clinical nurse specialist
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25 (as defined in subsection (aa)(5)(B)) working in col-
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1 laboration with a physician (as defined in subsection
2 (r)(1)),’’.
3 (6) PRIVILEGES FOR NURSE PRACTITIONERS.—
4 Section 1861 of the Social Security Act (42 U.S.C.
5 1395x) is amended—
6 (A) in subsection (e)(4), by inserting ‘‘(or
7 nurse practitioner, in accordance with State
8 law)’’ after ‘‘physician’’;
9 (B) in subsection (f)(1), by inserting ‘‘or
10 nurse practitioner’’ after ‘‘physician’’; and
11 (C) in each of subparagraphs (B) and (F)
12 of subsection (ee)(2), by inserting ‘‘or nurse
13 practitioner’’ after ‘‘physician’’.
14 (b) MEDICAID.—
15 (1) CERTIFICATION AUTHORITY FOR NURSE
16 PRACTITIONERS.—Section 1902(a)(44) of the Social
17 Security Act (42 U.S.C. 1396a(a)(44)) is amended
18 to read as follows:
19 ‘‘(44) in each case for which payment for inpa-
20 tient hospital services, skilled nursing facility serv-
21 ices, services in an intermediate care facility de-
22 scribed in section 1905(d), or inpatient mental hos-
23 pital services is made under the State plan—
24 ‘‘(A) a physician or nurse practitioner (or,
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25 in the case of skilled nursing facility services or
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1 intermediate care facility services, a physician
2 or nurse practitioner, or a clinical nurse spe-
3 cialist who is not an employee of the facility but
4 is working in collaboration with a physician)
5 certifies at the time of admission, or, if later,
6 the time the individual applies for medical as-
7 sistance under the State plan (and a physician
8 or nurse practitioner, or a physician assistant
9 under the supervision of a physician, or, in the
10 case of skilled nursing facility services or inter-
11 mediate care facility services, a physician or
12 nurse practitioner, or a clinical nurse specialist
13 who is not an employee of the facility but is
14 working in collaboration with a physician, recer-
15 tifies, where such services are furnished over a
16 period of time, in such cases, at least as often
17 as required under section 1903(g)(6) (or, in the
18 case of services that are services provided in an
19 intermediate care facility, every year), and ac-
20 companied by such supporting material, appro-
21 priate to the case involved, as may be provided
22 in regulations of the Secretary), that such serv-
23 ices are or were required to be given on an in-
24 patient basis because the individual needs or
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25 needed such services, and
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1 ‘‘(B) such services were furnished under a
2 plan established and periodically reviewed and
3 evaluated by a physician or nurse practitioner,
4 or, in the case of skilled nursing facility services
5 or intermediate care facility services, by a phy-
6 sician or nurse practitioner, or a clinical nurse
7 specialist who is not an employee of the facility
8 but is working in collaboration with a physi-
9 cian;’’.
10 (2) NURSING FACILITY SERVICES SUPERVISION
11 AND CLINICAL RECORDS.—Section 1919(b)(6)(A) of
12 the Social Security Act (42 U.S.C. 1396r(b)(6)(A))
13 is amended to read as follows:
14 ‘‘(A) require that the health care of every
15 resident be provided under the supervision of a
16 physician or nurse practitioner (or, at the op-
17 tion of a State, under the supervision of a clin-
18 ical nurse specialist or physician assistant who
19 is not an employee of the facility but who is
20 working in collaboration with a physician);’’.
21 SEC. 108. IMPROVING ACCESS TO MEDICAID CLINIC SERV-
22 ICES.
23 Section 1905(a)(9) of the Social Security Act (42
24 U.S.C. 1396d(a)(9)) is amended by adding ‘‘or nurse
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1 practitioner’’ after ‘‘physician’’ in both places that it ap-
2 pears.
3 TITLE II—REMOVAL OF BAR-
4 RIERS TO PRACTICE ON CER-
5 TIFIED REGISTERED NURSE
6 ANESTHETISTS
7 SEC. 201. CLARIFYING THAT CERTIFIED REGISTERED
8 NURSE ANESTHETISTS CAN BE REIMBURSED
9 BY MEDICARE FOR EVALUATION AND MAN-
10 AGEMENT SERVICES.
11 Section 1861(bb)(1) of the Social Security Act (42
12 U.S.C. 1395x(bb)(1)) is amended by inserting ‘‘, including
13 pre-anesthesia evaluation and management services,’’
14 after ‘‘and related care’’.
15 SEC. 202. REVISION OF CONDITIONS OF PAYMENT RELAT-
16 ING TO SERVICES ORDERED AND REFERRED
17 BY CERTIFIED REGISTERED NURSE ANES-
18 THETISTS.
19 Not later than 3 months after the date of enactment
20 of this Act, the Secretary of Health and Human Services
21 shall revise section 410.69 of title 42, Code of Federal
22 Regulations, to clarify that, for purposes of payment
23 under part B of title XVIII of the Social Security Act—
24 (1) certified registered nurse anesthetists are
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25 authorized to order, certify, and refer services to the
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1 extent allowed under the law of the State in which
2 the services are furnished; and
3 (2) payment shall be made under such part for
4 such services so ordered, certified, or referred by
5 certified registered nurse anesthetists.
6 SEC. 203. SPECIAL PAYMENT RULE FOR TEACHING STU-
7 DENT REGISTERED NURSE ANESTHETISTS.
8 Section 1848(a)(6) of the Social Security Act (42
9 U.S.C. 1395w–4(a)(6)) is amended, in the matter pre-
10 ceding subparagraph (A), by inserting ‘‘or student reg-
11 istered nurse anesthetists’’ after ‘‘physician residents’’.
12 SEC. 204. REMOVING UNNECESSARY AND COSTLY SUPER-
13 VISION OF CERTIFIED REGISTERED NURSE
14 ANESTHETISTS.
15 Section 1861(bb)(2) of the Social Security Act (42
16 U.S.C. 1395x(bb)(2)) is amended—
17 (1) in the second sentence, by inserting ‘‘, but
18 may not require that certified registered nurse anes-
19 thetists provide services under the supervision of a
20 physician’’ after ‘‘certification of nurse anes-
21 thetists’’; and
22 (2) in the third sentence, by inserting ‘‘under
23 the supervision of an anesthesiologist’’ after ‘‘an an-
24 esthesiologist assistant’’.
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1 SEC. 205. CRNA SERVICES AS A MEDICAID-REQUIRED BEN-
2 EFIT.
3 (a) IN GENERAL.—Section 1905(a)(5) of the Social
4 Security Act (42 U.S.C. 1396d(a)(5)) is amended—
5 (1) by striking ‘‘and (B)’’ and inserting ‘‘(B)’’;
6 and
7 (2) by inserting before the semicolon at the end
8 the following: ‘‘, and (C) services furnished by a cer-
9 tified registered nurse anesthetist (as defined in sec-
10 tion 1861(bb)(2)), which such certified registered
11 nurse anesthetist is authorized to perform under
12 State law (or the State regulatory mechanism as
13 provided by State law)’’.
14 (b) PAYMENT.—Section 1902(a) of the Social Secu-
15 rity Act (42 U.S.C. 1396d(a)) is amended—
16 (1) in paragraph (86), by striking ‘‘and’’ at the
17 end;
18 (2) in paragraph (87), by striking the period
19 and inserting ‘‘; and’’; and
20 (3) by inserting after paragraph (87) the fol-
21 lowing new paragraph:
22 ‘‘(88) provide for payment for the services of a
23 certified registered nurse anesthetist (as defined in
24 section 1861(bb)(1)) in amounts no lower than the
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25 amounts, using the same methodology, used for pay-
26 ment for amounts under section 1833(a)(1)(H).’’.
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1 TITLE III—REMOVAL OF BAR-
2 RIERS TO PRACTICE ON CER-
3 TIFIED NURSE-MIDWIVES
4 SEC. 301. IMPROVING ACCESS TO TRAINING IN MATERNITY
5 CARE.
6 (a) MEDICARE PAYMENTS FOR SUPERVISION BY
7 CERTIFIED NURSE-MIDWIVES.—Paragraph (1) of section
8 1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg))
9 is amended to read as follows:
10 ‘‘(1) The term ‘certified nurse-midwife services’
11 means—
12 ‘‘(A) such services furnished by a certified
13 nurse-midwife (as defined in paragraph (2));
14 and
15 ‘‘(B) such services (and such supplies and
16 services furnished as an incident to the nurse-
17 midwife’s service) which—
18 ‘‘(i) the certified nurse-midwife is le-
19 gally authorized to perform under State
20 law (or the State regulatory mechanism
21 provided by State law) as would otherwise
22 be covered if furnished by a physician;
23 ‘‘(ii) are furnished under the super-
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24 vision of a certified-nurse midwife by an
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1 intern or resident-in-training (as described
2 in subsection (b)(6));
3 ‘‘(iii) would otherwise be described in
4 subparagraph (A) if furnished by a cer-
5 tified nurse-midwife; and
6 ‘‘(iv) would otherwise be covered if
7 furnished under the supervision of a physi-
8 cian.’’.
9 (b) CLARIFYING PERMISSIBILITY OF USING CERTAIN
10 GRANTS FOR CLINICAL TRAINING BY CERTIFIED NURSE-
11 MIDWIVES.—Section 811(a)(1) of the Public Health Serv-
12 ice Act (42 U.S.C. 296j(a)(1)) is amended by inserting
13 ‘‘, including clinical training,’’ after ‘‘projects’’.
14 SEC. 302. IMPROVING MEDICARE PATIENT ACCESS TO
15 HOME HEALTH SERVICES PROVIDED BY CER-
16 TIFIED NURSE-MIDWIVES.
17 (a) IN GENERAL.—Section 1835(a) of the Social Se-
18 curity Act (42 U.S.C. 1395n(a)) is amended—
19 (1) in paragraph (2)—
20 (A) by inserting ‘‘or a certified nurse-mid-
21 wife (as defined in section 1861(gg)),’’ after ‘‘or
22 a physician assistant (as defined in section
23 1861(aa)(5)) who is working in accordance with
24 State law,’’; and
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25 (B) in subparagraph (A)—
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1 (i) in each of clauses (ii) and (iii), by
2 striking ‘‘or a physician assistant (as the
3 case may be)’’ and inserting ‘‘a physician
4 assistant, or a certified nurse-midwife (as
5 the case may be)’’; and
6 (ii) in clause (iv), by—
7 (I) inserting ‘‘or by a certified
8 nurse-midwife (as defined in section
9 1861(gg))’’ after ‘‘(but in no case
10 later than the date that is 6 months
11 after the date of the enactment of the
12 CARES Act)’’; and
13 (II) by striking ‘‘(as defined in
14 section 1861(gg))’’; and
15 (2) in the matter following paragraph (2), by
16 striking ‘‘or physician assistant (as the case may
17 be)’’ and inserting ‘‘physician assistant, or certified
18 nurse-midwife (as the case may be)’’ each place it
19 appears.
20 (b) CONFORMING AMENDMENTS.—Section 1895 of
21 the Social Security Act (42 U.S.C. 1395fff) is amended—
22 (1) in subsection (c)(1), by inserting ‘‘a cer-
23 tified nurse-midwife (as defined in section
24 1861(gg)),’’ after ‘‘clinical nurse specialist (as those
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25 terms are defined in section 1861(aa)(5)),’’; and
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1 (2) in subsection (e)(1)(A), by striking ‘‘a phy-
2 sician a nurse practitioner or clinical nurse spe-
3 cialist,’’ and inserting ‘‘a physician, a nurse practi-
4 tioner, a clinical nurse specialist, a certified nurse-
5 midwife,’’.
6 SEC. 303. IMPROVING ACCESS TO DMEPOS FOR MEDICARE
7 BENEFICIARIES.
8 Section 1834(a) of the Social Security Act (42 U.S.C.
9 1395m(a)) is amended—
10 (1) in paragraph (1)(E)(ii) by striking ‘‘or a
11 clinical nurse specialist (as those terms are defined
12 in section 1861(aa)(5))’’ and inserting ‘‘, a clinical
13 nurse specialist (as those terms are defined in sec-
14 tion 1861(aa)(5)), or a certified nurse-midwife (as
15 defined in section 1861(gg))’’; and
16 (2) in paragraph (11)(B)(ii)—
17 (A) by striking ‘‘or a clinical nurse spe-
18 cialist (as those terms are defined in section
19 1861(aa)(5))’’ and inserting ‘‘a clinical nurse
20 specialist (as those terms are defined in section
21 1861(aa)(5)), or a certified nurse-midwife (as
22 defined in section 1861(gg))’’; and
23 (B) by striking ‘‘or specialist’’ and insert-
24 ing ‘‘specialist, or nurse-midwife’’.
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1 SEC. 304. TECHNICAL CHANGES TO QUALIFICATIONS AND
2 CONDITIONS WITH RESPECT TO THE SERV-
3 ICES OF CERTIFIED NURSE-MIDWIVES.
4 Section 1861(gg)(2) of the Social Security Act (42
5 U.S.C. 1395x(gg)(2)) is amended by striking ‘‘, or has
6 been certified by an organization recognized by the Sec-
7 retary’’ and inserting ‘‘and has been certified by the Amer-
8 ican Midwifery Certification Board (or a successor organi-
9 zation)’’.
10 TITLE IV—IMPROVING FEDERAL
11 HEALTH PROGRAMS FOR ALL
12 ADVANCED PRACTICE REG-
13 ISTERED NURSES
14 SEC. 401. REVISING THE LOCAL COVERAGE DETERMINA-
15 TION PROCESS UNDER THE MEDICARE PRO-
16 GRAM.
17 (a) IN GENERAL.—Section 1862(l)(5) of the Social
18 Security Act (42 U.S.C. 1395y(l)(5)) is amended—
19 (1) in subparagraph (D), by adding at the end
20 the following new clauses:
21 ‘‘(vi) Identification of any medical or
22 scientific experts whose advice was ob-
23 tained by such contractor during the devel-
24 opment of such determination, whether or
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25 not such contractor relied on such advice
26 in developing such determination.
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1 ‘‘(vii) A hyperlink to any written com-
2 munication between such contractor and
3 another entity that such contractor relied
4 on when developing such determination.
5 ‘‘(viii) A hyperlink to any rule, guide-
6 line, protocol, or other criterion that such
7 contractor relied on when developing such
8 determination.’’; and
9 (2) by adding at the end the following new sub-
10 paragraphs:
11 ‘‘(E) PROHIBITION ON IMPOSITION OF
12 PRACTITIONER QUALIFICATIONS.—The Sec-
13 retary shall prohibit a Medicare administrative
14 contractor that develops a local coverage deter-
15 mination from imposing such determination on
16 any coverage limitation with respect to the
17 qualifications of a physician (as defined in sec-
18 tion 1861(r)) or a practitioner described in sec-
19 tion 1842(b)(18)(C) who may furnish the item
20 or service that is the subject of such determina-
21 tion.
22 ‘‘(F) CIVIL MONETARY PENALTY.—A
23 Medicare administrative contractor that devel-
24 ops a local coverage determination that fails to
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25 make information described in subparagraph
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1 (D) available as required by the Secretary
2 under such subparagraph or comply with the
3 prohibition under subparagraph (E) is subject
4 to a civil monetary penalty of not more than
5 $10,000 for each such failure. The provisions of
6 section 1128A (other than subsections (a) and
7 (b)) shall apply to a civil money penalty under
8 the previous sentence in the same manner as
9 such provisions apply to a penalty or proceeding
10 under section 1128A(a).’’.
11 (b) TIMING OF REVIEW.—Section 1869(f)(2) of the
12 Social Security Act (42 U.S.C. 1395ff(f)(2)) is amended
13 by adding at the end the following new subparagraph:
14 ‘‘(D) TIMING OF REVIEW.—An aggrieved
15 party may file a complaint described in sub-
16 paragraph (A) with respect to a local coverage
17 determination on or after the date that such de-
18 termination is posted, in accordance with sec-
19 tion 1862(l)(5)(D), on the Internet website of
20 the Medicare administrative contractor making
21 such determination, whether or not such deter-
22 mination has taken effect.’’.
23 (c) EFFECTIVE DATE.—The amendments made by
24 this section shall apply to local coverage determinations
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25 made available on the Internet website of a Medicare ad-
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1 ministrative contractor and on the Medicare Internet
2 website on or after the date of the enactment of this Act.
3 SEC. 402. LOCUM TENENS.
4 (a) IN GENERAL.—Section 1842(b)(6) of the Social
5 Security Act (42 U.S.C. 1395u(b)(6)) is amended—
6 (1) by striking ‘‘and (J)’’ and inserting ‘‘, (J)’’;
7 and
8 (2) by inserting before the period at the end the
9 following ‘‘, and (K) in the case of services furnished
10 by a certified registered nurse anesthetist (as de-
11 fined in section 1861(bb)(2)), nurse practitioner, or
12 clinical nurse specialist (as defined in section
13 1861(aa)(5)), or a certified nurse-midwife (as de-
14 fined in section 1861(gg)(2)), subparagraph (D) of
15 this sentence shall apply to such services and such
16 anesthetist, practitioner, specialist, or nurse-midwife
17 in the same manner as such subparagraph applies to
18 physicians’ services furnished by physicians’’.
19 (b) IMPLEMENTATION.—Not later than 90 days after
20 the date of the enactment of this Act, the Secretary of
21 Health and Human Services shall update all applicable
22 regulations and subregulatory guidance necessary to carry
23 out this section.
Æ
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