,,ii #aafth ,,congress #ast ,session ,s4 #ajcg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #d1 #bjai,mr4 ,barrasso 7for himself and ,ms4 ,smith7 introduced the following bill2 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 ,medicare4 #a4 ,short title ,this ,act may be cited as the ,rural ,health ,clinic ,modernization ,act of #bjai4 #b4 ,modernizing physician1 physician assistant1 and nurse practitioner utilization requirements 7a7 ,in general ,section #ahfa7;aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77 is amended-- 7#a7 in paragraph 7#b77;,b71 by striking has an arrangement and all that follows through the first semicolon and inserting meets the requirements described in paragraph 7#h722 and 7#b7 by adding at the end the following new paragraph3 7#h7 ,requirements for certain facilities described ,for purposes of paragraph 7#b77;,b71 with respect to a facility which is not a physician-directed clinic1 the following requirements are described in this paragraph3 7,a7 ,arrangement ,the facility has an arrangement consistent with the provisions of ,state and local law relative to the practice1 performance1 and delivery of health services1 with one or more physician assistants 7as defined in paragraph 7#e77;,a77 or one or more nurse practitioners 7as defined in such paragraph74 7,b7 ,practice and oversight requirements 7i7 ,in general ,subject to clause 7ii71 the delivery of health services under such arrangement shall be in accordance with ,state law or the ,state regulatory mechanism governing the practice of physician assistants or nurse practitioners4 7ii7 ,exception if no ,state laws or regulations applicable ,in the case where a ,state does not have laws or regulations governing the practice1 performance1 and delivery of health services by a physician assistant or nurse practitioner1 the ,secretary shall adopt regulations for facilities located in such ,state that provide for the periodic review by physicians of covered services furnished by physician assistants and nurse practitioners1 the supervision and guidance by such physicians of physician assistants and nurse practitioners1 and the preparation by such physicians of such medical orders for care and treatment of clinic patients as is necessary4 ,such regulations shall also require facilities located in such a ,state to have arrangements with physicians for referral of and consultation for patients as the facility deems necessary and for advice and assistance in the management of medical emergencies4 4 7b7 ,effective date ,the amendments made by this section shall take effect on the date of the enactment of this ,act4 #c4 ,removing outdated laboratory requirements 7a7 ,in general ,section #ahfa7;aa77#b77;,g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#b77;,g77 is amended by striking 1 including clinical laboratory services and all that follows through additional diagnostic services and inserting the following3 and has prompt access to clinical laboratory services and additional diagnostic services4 7b7 ,effective date ,the amendments made by this section shall take effect on the date of the enactment of this ,act4 #d4 ,allowing rural health clinics the flexibility to contract with physician assistants and nurse practitioners 7a7 ,in general ,section #ahfa7;aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa771 in the first sentence of the flush matter following paragraph 7#b71 is amended by striking 7iii7 employs a physician assistant or nurse practitioner1 and 7iv7 and inserting and 7iii74 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of the enactment of this ,act4 #e4 ,allowing rural health clinics to be the distant site for a telehealth visit 7a7 ,in general ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7#a7 in the first sentence of paragraph 7#a7-- 7,a7 by striking or a practitioner 7described in section #ahdb7;b77#ah77;,c77 and inserting 1 a practitioner 7described in section #ahdb7;b77#ah77;,c771 or a rural health clinic2 and 7,b7 by striking or practitioner and inserting 1 practitioner1 or rural health clinic2 7#b7 in paragraph 7#b77;,a7-- 7,a7 by striking or practitioner and inserting practitioner1 or rural health clinic2 and 7,b7 by striking such physician or practitioner and inserting such physician1 practitioner1 or rural health clinic2 and 7#c7 in paragraph 7#d77;,a71 by striking or practitioner and inserting practitioner1 or rural health clinic4 7b7 ,effective date ,the amendments made by this section shall apply to services furnished on or after the date of the enactment of this ,act4 #f4 ,including facilities located in certain areas 7a7 ,in general ,section #ahfa7;aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77 is amended1 in the first sentence of the flush matter following paragraph 7#b71 by inserting or in an area that has been designated by the chief executive officer of the ,state and certified by the ,secretary as rural after ,census74 7b7 ,effective date ,the amendment made by this section shall take effect on the date of the enactment of this ,act4 #g4 ,increasing reimbursement for rural health clinics ,section #ahcc7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7f77 is amended-- 7#a7 in paragraph 7#a71 by striking 1 and at the end and inserting a semicolon2 7#b7 in paragraph 7#b7-- 7,a7 by inserting 7before #bjbj7 after in a subsequent year2 and 7,b7 by striking the period at the end and inserting a semicolon2 and 7#c7 by adding at the end the following new paragraphs3 7#c7 in #bjbj1 at #aje per visit2 7#d7 in #bjba1 at #aaj per visit2 7#e7 in #bjbb1 at #aae per visit2 and 7#f7 in a subsequent year1 at the limit established under this subsection for the previous year increased by the percentage increase in the ,,mei 7as so defined7 applicable to primary care services 7as so defined7 furnished as of the first day of that year4 4