S575-119

101. Expanding access to cardiac rehabilitation programs and pulmonary rehabilitation programs under Medicare program Section 1861(eee) of the Social Security Act (42 U.S.C. 1395x(eee)) is amended— in paragraph (2)— in subparagraph (A)(i), by striking a physician’s office and inserting the office setting; and in subparagraph (C), by inserting after physician the following: (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)); in paragraph (3)(A), by striking physician-prescribed exercise and inserting exercise prescribed by a physician (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)); and in paragraph (5), by inserting after physician the following: (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)). Section 1861(fff) of the Social Security Act (42 U.S.C. 1395x(fff)) is amended— in paragraph (2)(A), by striking physician-prescribed exercise and inserting exercise prescribed by a physician (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)); and in paragraph (3), by inserting after physician the following: (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)).

102. Permitting nurse practitioners and physician assistants to satisfy Medicare documentation requirement for coverage of certain shoes for individuals with diabetes Section 1861(s)(12) of the Social Security Act (42 U.S.C. 1395x(s)(12)) is amended— in subparagraph (A), by inserting , nurse practitioner, or physician assistant after physician; and in subparagraph (C), by inserting , nurse practitioner, or physician assistant after each occurrence of physician.

104. Expanding the availability of medical nutrition therapy service Medicare program Section 1861(vv)(1) of the Social Security Act (42 U.S.C. 1395x(vv)(1)) is amended by inserting or a nurse practitioner, a clinical nurse specialist, or a physician assistant (as such terms are defined in subsection (aa)(5)) before the period at the end.

105. Preserving access to home infusion therapy Section 1861(iii)(1)(B) of the Social Security Act (42 U.S.C. 1395x(iii)(1)(B)) is amended— by striking a physician (as defined in subsection (r)(1)) and inserting an applicable provider (as defined in paragraph (3)(A)); and by striking a physician (as so defined) and inserting an applicable provider (as so defined). Section 1834(u)(6) of the Social Security Act (42 U.S.C. 1395m(u)(6)) is amended by striking physician and inserting applicable provider (as defined in section 1861(iii)(3)(A)).

107. Streamlining care delivery in skilled nursing facilities and nursing facilities; authorizing Medicare and Medicaid inpatient hospital patients to be under the care of a nurse practitioner Section 1814(a)(2) of the Social Security Act (42 U.S.C. 1395f(a)(2)) is amended, in the matter preceding subparagraph (A), by striking , or a nurse practitioner, and inserting or a nurse practitioner (in accordance with State law), or. Section 1814(a)(3) of the Social Security Act (42 U.S.C. 1395f(a)(3)) is amended by inserting or nurse practitioner after physician. Section 1819 of the Social Security Act (42 U.S.C. 1395i–3(b)(6)) is amended— in subsection (b)— in paragraph (2)(B), by inserting or nurse practitioner after attending physician; and in paragraph (6)— in the heading, by striking Physician supervision and inserting Supervision; and in subparagraph (A), by inserting or a nurse practitioner, in accordance with State law after physician; and in subsection (c)— in subparagraph (1)(A)(i), by inserting or nurse practitioner after attending physician; in the flush matter at the end of subparagraph (2)(A), by inserting or nurse practitioner after physician in each occurrence; and in subparagraph (3)(A), by inserting or nurse practitioner after physician. Section 1842(b)(2)(C) of the Social Security Act (42 U.S.C. 1395u(b)(2)(C)) is amended, in the second sentence— by inserting or a nurse practitioner after a physician; and by striking or a nurse practitioner working in collaboration with that physician, or both. Section 1861(s)(2)(K)(ii) of the Social Security Act (42 U.S.C. 1395x(s)(2)(K)(ii)) is amended by striking or clinical nurse specialist (as defined in subsection (aa)(5)) working in collaboration (as defined in subsection (aa)(6)) with a physician (as defined in subsection (r)(1)) and inserting (as defined in subsection (aa)(5)(A)), or by a clinical nurse specialist (as defined in subsection (aa)(5)(B)) working in collaboration with a physician (as defined in subsection (r)(1)),. Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— in subsection (e)(4), by inserting (or nurse practitioner, in accordance with State law) after physician; in subsection (f)(1), by inserting or nurse practitioner after physician; and in each of subparagraphs (B) and (F) of subsection (ee)(2), by inserting or nurse practitioner after physician. Section 1902(a)(44) of the Social Security Act (42 U.S.C. 1396a(a)(44)) is amended to read as follows: in each case for which payment for inpatient hospital services, skilled nursing facility services, services in an intermediate care facility described in section 1905(d), or inpatient mental hospital services is made under the State plan— a physician or nurse practitioner (or, in the case of skilled nursing facility services or intermediate care facility services, a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician) certifies at the time of admission, or, if later, the time the individual applies for medical assistance under the State plan (and a physician or nurse practitioner, or a physician assistant under the supervision of a physician, or, in the case of skilled nursing facility services or intermediate care facility services, a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician, recertifies, where such services are furnished over a period of time, in such cases, at least as often as required under section 1903(g)(6) (or, in the case of services that are services provided in an intermediate care facility, every year), and accompanied by such supporting material, appropriate to the case involved, as may be provided in regulations of the Secretary), that such services are or were required to be given on an inpatient basis because the individual needs or needed such services, and such services were furnished under a plan established and periodically reviewed and evaluated by a physician or nurse practitioner, or, in the case of skilled nursing facility services or intermediate care facility services, by a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician; Section 1919(b)(6)(A) of the Social Security Act (42 U.S.C. 1396r(b)(6)(A)) is amended to read as follows: require that the health care of every resident be provided under the supervision of a physician or nurse practitioner (or, at the option of a State, under the supervision of a clinical nurse specialist or physician assistant who is not an employee of the facility but who is working in collaboration with a physician); (44)in each case for which payment for inpatient hospital services, skilled nursing facility services, services in an intermediate care facility described in section 1905(d), or inpatient mental hospital services is made under the State plan—(A)a physician or nurse practitioner (or, in the case of skilled nursing facility services or intermediate care facility services, a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician) certifies at the time of admission, or, if later, the time the individual applies for medical assistance under the State plan (and a physician or nurse practitioner, or a physician assistant under the supervision of a physician, or, in the case of skilled nursing facility services or intermediate care facility services, a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician, recertifies, where such services are furnished over a period of time, in such cases, at least as often as required under section 1903(g)(6) (or, in the case of services that are services provided in an intermediate care facility, every year), and accompanied by such supporting material, appropriate to the case involved, as may be provided in regulations of the Secretary), that such services are or were required to be given on an inpatient basis because the individual needs or needed such services, and(B)such services were furnished under a plan established and periodically reviewed and evaluated by a physician or nurse practitioner, or, in the case of skilled nursing facility services or intermediate care facility services, by a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician;. (A)require that the health care of every resident be provided under the supervision of a physician or nurse practitioner (or, at the option of a State, under the supervision of a clinical nurse specialist or physician assistant who is not an employee of the facility but who is working in collaboration with a physician);.

202. Revision of conditions of payment relating to services ordered and referred by certified registered nurse anesthetists Not later than 3 months after the date of enactment of this Act, the Secretary of Health and Human Services shall revise section 410.69 of title 42, Code of Federal Regulations, to clarify that, for purposes of payment under part B of title XVIII of the Social Security Act— certified registered nurse anesthetists are authorized to order, certify, and refer services to the extent allowed under the law of the State in which the services are furnished; and payment shall be made under such part for such services so ordered, certified, or referred by certified registered nurse anesthetists.

204. Removing unnecessary and costly supervision of certified registered nurse anesthetists Section 1861(bb)(2) of the Social Security Act (42 U.S.C. 1395x(bb)(2)) is amended— in the second sentence, by inserting , but may not require that certified registered nurse anesthetists provide services under the supervision of a physician after certification of nurse anesthetists; and in the third sentence, by inserting under the supervision of an anesthesiologist after an anesthesiologist assistant.

301. Improving access to training in maternity care Paragraph (1) of section 1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) is amended to read as follows: The term certified nurse-midwife services means— such services furnished by a certified nurse-midwife (as defined in paragraph (2)); and such services (and such supplies and services furnished as an incident to the nurse-midwife's service) which— the certified nurse-midwife is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) as would otherwise be covered if furnished by a physician; are furnished under the supervision of a certified-nurse midwife by an intern or resident-in-training (as described in subsection (b)(6)); would otherwise be described in subparagraph (A) if furnished by a certified nurse-midwife; and would otherwise be covered if furnished under the supervision of a physician. Section 811(a)(1) of the Public Health Service Act (42 U.S.C. 296j(a)(1)) is amended by inserting , including clinical training, after projects. (1)The term certified nurse-midwife services means—(A)such services furnished by a certified nurse-midwife (as defined in paragraph (2)); and(B)such services (and such supplies and services furnished as an incident to the nurse-midwife's service) which—(i)the certified nurse-midwife is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) as would otherwise be covered if furnished by a physician;(ii)are furnished under the supervision of a certified-nurse midwife by an intern or resident-in-training (as described in subsection (b)(6));(iii)would otherwise be described in subparagraph (A) if furnished by a certified nurse-midwife; and(iv)would otherwise be covered if furnished under the supervision of a physician..

302. Improving Medicare patient access to home health services provided by certified nurse-midwives Section 1835(a) of the Social Security Act (42 U.S.C. 1395n(a)) is amended— in paragraph (2)— in the matter preceding subparagraph (A), by inserting or a certified nurse-midwife (as defined in section 1861(gg)), after or a physician assistant (as defined in section 1861(aa)(5)) who is working in accordance with State law,; and in subparagraph (A)— in each of clauses (ii) and (iii), by striking or a physician assistant (as the case may be) and inserting a physician assistant, or a certified nurse-midwife (as the case may be); and in clause (iv), by— inserting or by a certified nurse-midwife (as defined in section 1861(gg)) after (but in no case later than the date that is 6 months after the date of the enactment of the CARES Act); and by striking (as defined in section 1861(gg)); and in the matter following paragraph (2), by striking or physician assistant (as the case may be) and inserting physician assistant, or certified nurse-midwife (as the case may be) each place it appears. Section 1895 of the Social Security Act (42 U.S.C. 1395(fff)) is amended— in subsection (c)(1), by inserting the certified nurse-midwife (as defined in section 1861(gg)), after clinical nurse specialist (as those terms are defined in section 1861(aa)(5)),; and in subsection (e)(1)(A), by striking a physician a nurse practitioner or clinical nurse specialist, and inserting a physician, a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife,.

401. Revising the local coverage determination process under the Medicare program Section 1862(l)(5) of the Social Security Act (42 U.S.C. 1395y(l)(5)) is amended— in subparagraph (D), by adding at the end the following new clauses: Identification of any medical or scientific experts whose advice was obtained by such contractor during the development of such determination, whether or not such contractor relied on such advice in developing such determination. A hyperlink to any written communication between such contractor and another entity that such contractor relied on when developing such determination. A hyperlink to any rule, guideline, protocol, or other criterion that such contractor relied on when developing such determination. by adding at the end the following new subparagraphs: The Secretary shall prohibit a Medicare administrative contractor that develops a local coverage determination from imposing such determination on any coverage limitation with respect to the qualifications of a physician (as defined in section 1861(r)) or a practitioner described in section 1842(b)(18)(C) who may furnish the item or service that is the subject of such determination. A Medicare administrative contractor that develops a local coverage determination that fails to make information described in subparagraph (D) available as required by the Secretary under such subparagraph or comply with the prohibition under subparagraph (E) is subject to a civil monetary penalty of not more than $10,000 for each such failure. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). Section 1869(f)(2) of the Social Security Act (42 U.S.C. 1395ff(f)(2)) is amended by adding at the end the following new subparagraph: An aggrieved party may file a complaint described in subparagraph (A) with respect to a local coverage determination on or after the date that such determination is posted, in accordance with section 1862(l)(5)(D), on the Internet website of the Medicare administrative contractor making such determination, whether or not such determination has taken effect. The amendments made by this section shall apply to local coverage determinations made available on the internet website of a Medicare administrative contractor and on the Medicare internet website on or after the date of the enactment of this Act. (vi)Identification of any medical or scientific experts whose advice was obtained by such contractor during the development of such determination, whether or not such contractor relied on such advice in developing such determination.(vii)A hyperlink to any written communication between such contractor and another entity that such contractor relied on when developing such determination.(viii)A hyperlink to any rule, guideline, protocol, or other criterion that such contractor relied on when developing such determination.; and (E)Prohibition on imposition of practitioner qualificationsThe Secretary shall prohibit a Medicare administrative contractor that develops a local coverage determination from imposing such determination on any coverage limitation with respect to the qualifications of a physician (as defined in section 1861(r)) or a practitioner described in section 1842(b)(18)(C) who may furnish the item or service that is the subject of such determination.(F)Civil monetary penaltyA Medicare administrative contractor that develops a local coverage determination that fails to make information described in subparagraph (D) available as required by the Secretary under such subparagraph or comply with the prohibition under subparagraph (E) is subject to a civil monetary penalty of not more than $10,000 for each such failure. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).. (D)Timing of reviewAn aggrieved party may file a complaint described in subparagraph (A) with respect to a local coverage determination on or after the date that such determination is posted, in accordance with section 1862(l)(5)(D), on the Internet website of the Medicare administrative contractor making such determination, whether or not such determination has taken effect..

402. Locum tenens Section 1842(b)(6) of the Social Security Act (42 U.S.C. 1395u(b)(6)) is amended, in the first sentence— by striking and (J) and inserting (J); and by inserting before the period at the end the following: , and (K) in the case of services furnished by a certified registered nurse anesthetist (as defined in section 1861(bb)(2)), nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)), or a certified nurse midwife (as defined in section 1861(gg)(2)), subparagraph (D) of this sentence shall apply to such services and such anesthetist, practitioner, specialist, or nurse-midwife in the same manner as such subparagraph applies to physicians’ services furnished by physicians.