,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #bgac  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #ai1 #bjbc,mr4 
,joyce ( ,ohio 7= himself1 ,ms4         
,bonamici1 ,ms4 ,und]wood1 ,mrs4        
,kiggans ( ,virg9ia1 ,ms4 ,s*ak[sky1    
,mr4 ,arm/rong1 ,mr4 ,blum5au]1 ,mr4    
,smi? ( ,nebraska1 ,mr4 ,gro?man1 ,mr4  
,pappas1 & ,ms4 ,ku/]7 introduc$ !      
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d titles ,,xviii & ,,xix
 ( ! ,social ,security ,act to increase 
access to s]vices provid$ by advanc$    
practice regi/]$ nurses "u ! ,m$ic>e &  
,m$icaid programs1 & = o!r purposes4    
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,improv+ ,c>e & ,access to ,nurses    
,act or ! ,i ,,c ,act4  ,i ,removal (   
,b>ri]s to ,practice on ,nurse          

,practition]s  #aja4 ,exp&+ access to   
c>diac rehabilitation programs &        
pulmon>y rehabilitation programs "u     
,m$ic>e program  7a7 ,c>diac            
rehabilitation programs ,section        
#ahfa7;eee7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #aciex7eee77 is am5d$--  
7#a7 9 p>agraph 7#b7-- 7,a7 9           
subp>agraph 7,a77i71 by /rik+ a         
physician's (fice & ins]t+ ! (fice ( a  
physician 7z def9$ 9 subsection 7r77#a77
 or ! (fice ( a nurse practition]1      
cl9ical nurse speciali/1 or physician   
assi/ant 7z ^? t]ms are def9$ 9         
subsection 7aa77#e772 &  7,b7 9         
subp>agraph 7,c71 by ins]t+ 7z def9$ 9  
subsection 7r77#a771 nurse practition]1 
cl9ical nurse speciali/1 or physician   
assi/ant 7z ^? t]ms are def9$ 9         
subsection 7aa77#e77 aft] physician2    
7#b7 9 p>agraph 7#c77;,a71 by /rik+     
physician-prescrib$ ex]cise & ins]t+    
ex]cise prescrib$ by a physician 7z     
def9$ 9 subsection 7r77#a771 nurse      
practition]1 cl9ical nurse speciali/1 or

 physician assi/ant 7z ^? t]ms are def9$
 9 subsection 7aa77#e772 &  7#c7 9      
p>agraph 7#e71 by ins]t+ 7z def9$ 9     
subsection 7r77#a771 nurse practition]1 
cl9ical nurse speciali/1 or physician   
assi/ant 7z ^? t]ms are def9$ 9         
subsection 7aa77#e771 aft] physician4   
7b7 ,pulmon>y rehabilitation programs   
,section #ahfa7;fff7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciex7fff77 is am5d$-- 7#a7 9 p>agraph 
7#b77;,a71 by /rik+ physician-prescrib$ 
ex]cise & ins]t+ ex]cise prescrib$ by a 
physician 7z def9$ 9 subsection         
7r77#a771 nurse practition]1 cl9ical    
nurse speciali/1 or physician assi/ant  
7z ^? t]ms are def9$ 9 subsection       
7aa77#e772 &  7#b7 9 p>agraph 7#c71 by  
ins]t+ aft] physician ! foll[+3 7z def9$
 9 subsection 7r77#a771 nurse           
practition]1 cl9ical nurse speciali/1 or
 physician assi/ant 7z ^? t]ms are def9$
 9 subsection 7aa77#e7714  #ajb4        
,p]mitt+ nurse practition]s to satisfy  
m$ic>e docum5tation requirem5t = cov]age

 ( c]ta9 %oes = individuals ) diabetes  
,section #ahfa7s77#ab7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciex7s77#ab77 is am5d$-- 7#a7 9       
subp>agraph 7,a71 by ins]t+ 1 nurse     
practition]1 or physician assi/ant aft] 
physician2 &  7#b7 9 subp>agraph 7,c71  
by ins]t+ 1 nurse practition]1 or       
physician assi/ant aft] ea* occurr5ce ( 
physician4  #ajc4 ,improvem5ts to !     
assignm5t ( b5efici>ies "u ! ,m$ic>e %>$
 sav+s program ,section #ahii7;c77#a7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acie;jjj7c77#a77 is am5d$-- 7#a7 9     
subp>agraph 7,a71 by /rik+ & at ! end2  
7#b7 9 subp>agraph 7,b71 by /rik+ !     
p]iod at ! end & ins]t+ 2 &2 &  7#c7 by 
add+ at ! end ! foll[+ new subp>agraph3 
7,c7 9 ! case ( p]=mance ye>s beg9n+ on 
or aft] ,janu>y #a1 #bjbd1 prim>y c>e   
s]vices provid$ "u ?is title by an ,,aco
 pr(essional describ$ 9 subsection      
7h77#a77;,b74  4  #ajd4 ,exp&+ !        
availability ( m$ical nutrition !rapy   
s]vice ,m$ic>e program ,section         

#ahfa7vv77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciex7vv77#a77 is am5d$
 by ins]t+ 1 a nurse practition]1 a     
cl9ical nurse speciali/1 or a physician 
assi/ant 7z su* t]ms are def9$ 9        
subsection 7aa77#e77 be=e ! p]iod at !  
end4  #aje4 ,pres]v+ access to home     
infusion !rapy  7a7 ,all[+ applicable   
provid]s ,to e/abli% home infusion !rapy
 plans ,section #ahfa7;iii77#a77;,b7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciex7iii77#a77;,b77 is am5d$-- 7#a7 by
 /rik+ a physician 7z def9$ 9 subsection
 7r77#a77 & ins]t+ an applicable provid]
 7z def9$ 9 p>agraph 7#c77;,a772 &  7#b7
 by /rik+ a physician 7z s def9$7 &     
ins]t+ an applicable provid] 7z s       
def9$74  7b7 ,con=m+ am5dm5t ,section   
#ahcd7u77#f7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciem7u77#f77 is am5d$  
by /rik+ physician & ins]t+ applicable  
provid] 7z def9$ 9 section              
#ahfa7;iii77#c77;,a774  #ajf4 ,increas+ 
access to hospice c>e s]vices  7a7 ,9   
g5]al ,section #ahad7;a77#g77;,a7 ( !   

,social ,security ,act 7#db ,u4,s4,c4   
#acie;f7a77#g77;,a77 is am5d$-- 7#a7 9  
clause 7i77,i71 by /rik+ a nurse        
practition] or2  7#b7 9 clause 7i71 9 ! 
matt] foll[+ subclause 7,,ii71 by ins]t+
 or nurse practition] aft] physician &  
ins]t+ 1 nurse practition]'s aft]       
physician's2 &  7#c7 9 clause 7ii71 by  
/rik+ or physician & ins]t+ 1 physician1
 or nurse practition]4  7b7 ,hospice c>e
 def9ition ,section #ahfa7;dd77#a77;,c7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciex7dd77#a77;,c77 is am5d$ 
by add+ or nurse practition] aft]       
physician4  7c7 ,nurse practition] bill+
 ,n lat] ?an #ij days aft] ! date ( !   
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all revise    
section #dah4cjd ( title #db1 ,code (   
,f$]al ,regulations1 to all[ nurse      
practition]s to bill = s]vices n        
describ$ 9 p>agraph 7a7 ( su* section 9 
! same mann] z physicians may bill = su*
 s]vices 9 accordance ) p>agraph 7b7 (  
su* section4 ,su* revision %all provide 

t su* s]vices furni%$ by a nurse        
practition] %all be payable at ! p]c5t (
 ! physician fee s*$ule specifi$ 9      
section #ahcc7;a77#a77,o7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciel7a77#a77,o774  #ajg4 ,/reaml9+ c>e
 deliv]y 9 skill$ nurs+ facilities &    
nurs+ facilities2 ,au?oriz+ ,m$ic>e &   
,m$icaid inpati5t hospital pati5ts to be
 "u ! c>e ( a nurse practition]  7a7    
,m$ic>e  7#a7 ,c]tification (           
po/-hospital ext5d$ c>e s]vices ,section
 #ahad7;a77#b7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie;f7a77#b77 is  
am5d$ by /rik+ 1 or a nurse practition]1
 & ins]t+ or a nurse practition] 79     
accordance ) ,/ate law71 or4  7#b7      
,c]tification au?ority = nurse          
practition]s ,section #ahad7;a77#c7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acie;f7a77#c77 is am5d$ by ins]t+ or   
nurse practition] aft] physician ! fir/ 
place t x appe>s4  7#c7 ,sup]vision     
requirem5t 9 skill$ nurs+ facility      
s]vices ,section #ahai7;b77#f77;,a7 ( ! 

,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;b77#f77;,a77 is am5d$-- 7,a7
 9 ! head]1 by /rik+ ,physician         
sup]vision & ins]t+ ,sup]vision2 &  7,b7
 by ins]t+ or a nurse practition]1 9    
accordance ) ,/ate law aft] physician4  
7#d7 ,adm9i/ration ( "p ,b ,section     
#ahdb7;b77#b77;,c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acieu7b77#b77;,c77
 is am5d$-- 7,a7 by ins]t+ or a nurse   
practition] aft] a physician2 &  7,b7 by
 /rik+ or a nurse practition] work+ 9   
collaboration ) t physician1 or bo?4    
7#e7 ,provision ( m$ical & o!r heal?    
s]vices ,section #ahfa7s77#b77,k77ii7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciex7s77#b77,k77ii77 is am5d$ by /rik+
 or cl9ical nurse speciali/ 7z def9$ 9  
subsection 7aa77#e77 work+ 9            
collaboration 7z def9$ 9 subsection     
7aa77#f77 ) a physician 7z def9$ 9      
subsection 7r77#a77 & ins]t+ 7z def9$ 9 
subsection 7aa77#e77;,a771 or by a      
cl9ical nurse speciali/ 7z def9$ 9      
subsection 7aa77#e77;,b77 work+ 9       

collaboration ) a physician 7z def9$ 9  
subsection 7r77#a7714  7#f7 ,privileges 
= nurse practition]s ,section #ahfa ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7 is am5d$-- 7,a7 9 subsection    
7e77#d71 by ins]t+ 7or nurse            
practition]1 9 accordance ) ,/ate law7  
aft] physician2  7,b7 9 subsection      
7f77#a71 by ins]t+ or nurse practition]1
 aft] physician2 &  7,c7 9 subsection   
7ee77#b71 by ins]t+ or nurse            
practition]1 aft] physician ea* place t 
x appe>s4  7b7 ,m$icaid  7#a7           
,c]tification au?ority = nurse          
practition]s ,section #aijb7;a77#dd7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif;a7a77#dd77 is am5d$ to read z     
foll[s3  7#dd7 9 ea* case = :i* paym5t =
 inpati5t hospital s]vices1 skill$ nurs+
 facility s]vices1 s]vices 9 an         
int]m$iate c>e facility describ$ 9      
section #aije7;d71 or inpati5t m5tal    
hospital s]vices is made "u ! ,/ate     
plan-- 7,a7 a physician or nurse        
practition] 7or1 9 ! case ( skill$ nurs+

 facility s]vices or int]m$iate c>e     
facility s]vices1 a physician or nurse  
practition]1 or a cl9ical nurse         
speciali/ :o is n an employee ( !       
facility b is work+ 9 collaboration ) a 
physician7 c]tifies at ! "t ( admission1
 or1 if lat]1 ! "t ! individual applies 
= m$ical assi/ance "u ! ,/ate plan 7& a 
physician or nurse practition]1 or a    
physician assi/ant "u ! sup]vision ( a  
physician1 or1 9 ! case ( skill$ nurs+  
facility s]vices or int]m$iate c>e      
facility s]vices1 a physician or nurse  
practition]1 or a cl9ical nurse         
speciali/ :o is n an employee ( !       
facility b is work+ 9 collaboration ) a 
physician1 rec]tifies1 :]e su* s]vices  
are furni%$ ov] a p]iod ( "t1 9 su*     
cases1 at lea/ z (t5 z requir$ "u       
section #aijc7;g77#f7 7or1 9 ! case (   
s]vices t are s]vices provid$ 9 an      
int]m$iate c>e facility1 e ye>71 &      
accompani$ by su* support+ mat]ial1     
appropriate to ! case involv$1 z may be 
provid$ 9 regulations ( ! ,secret>y71 t 

su* s]vices are or 7 requir$ to be giv5 
on an inpati5t basis because !          
individual ne$s or ne$$ su* s]vices1 &  
7,b7 su* s]vices 7 furni%$ "u a plan    
e/abli%$ & p]iodically review$ &        
evaluat$ by a physician or nurse        
practition]1 or1 9 ! case ( skill$ nurs+
 facility s]vices or int]m$iate c>e     
facility s]vices1 by a physician or     
nurse practition]1 or a cl9ical nurse   
speciali/ :o is n an employee ( !       
facility b is work+ 9 collaboration ) a 
physician2  4  7#b7 ,nurs+ facility     
s]vices sup]vision & cl9ical records    
,section #aiai7;b77#f77;,a7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acifr7b77#f77;,a77 is am5d$ to read z  
foll[s3  7,a7 require t ! heal? c>e ( e 
resid5t be provid$ "u ! sup]vision ( a  
physician or nurse practition] 7or1 at !
 option ( a ,/ate1 "u ! sup]vision ( a  
cl9ical nurse speciali/ or physician    
assi/ant :o is n an employee ( !        
facility b :o is work+ 9 collaboration )
 a physician72  4  #ajh4 ,improv+ access

 to ,m$icaid cl9ic s]vices ,section     
#aije7;a77#i7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acif;d7a77#i77 is am5d$
 by add+ or nurse practition] aft]      
physician 9 bo? places t x appe>s4  ,,ii
 ,removal ( ,b>ri]s to ,practice on     
,c]tifi$ ,regi/]$ ,nurse ,ane/heti/s    
#bja4 ,cl>ify+ t c]tifi$ regi/]$ nurse  
ane/heti/s c be reimburs$ by ,m$ic>e =  
evaluation & managem5t s]vices ,section 
#ahfa7;bb77#a7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciex7bb77#a77 is  
am5d$ by ins]t+ 1 includ+ pre-ane/hesia 
evaluation & managem5t s]vices1 aft] &  
relat$ c>e4  #bjb4 ,revision (          
conditions ( paym5t relat+ to s]vices   
ord]$ & ref]r$ by c]tifi$ regi/]$ nurse 
ane/heti/s ,n lat] ?an #c mon?s aft] !  
date ( enactm5t ( ?is ,act1 ! ,secret>y 
( ,heal? & ,human ,s]vices %all revise  
section #daj4fi ( title #db1 ,code (    
,f$]al ,regulations1 to cl>ify t1 =     
purposes ( paym5t "u "p ,b ( title      
,,xviii ( ! ,social ,security ,act--    
7#a7 c]tifi$ regi/]$ nurse ane/heti/s   

are au?oriz$ to ord]1 c]tify1 & ref]    
s]vices to ! ext5t all[$ "u ! law ( !   
,/ate 9 :i* ! s]vices are furni%$2 &    
7#b7 paym5t %all be made "u su* "p = su*
 s]vices s ord]$1 c]tifi$1 or ref]r$ by 
c]tifi$ regi/]$ nurse ane/heti/s4  #bjc4
 ,special paym5t rule = tea*+ /ud5t     
regi/]$ nurse ane/heti/s ,section       
#ahdh7;a77#f7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#d7;a77#f77 is   
am5d$ 9 ! matt] prec$+ subp>agraph 7,a71
 by ins]t+ or /ud5t regi/]$ nurse       
ane/heti/s aft] physician resid5ts4     
#bjd4 ,remov+ unnecess>y & co/ly        
sup]vision ( c]tifi$ regi/]$ nurse      
ane/heti/s ,section #ahfa7;bb77#b7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7bb77#b77 is am5d$-- 7#a7 9 !     
second s5t5ce1 by ins]t+ 1 b may n      
require t c]tifi$ regi/]$ nurse         
ane/heti/s provide s]vices "u !         
sup]vision ( a physician aft]           
c]tification ( nurse ane/heti/s2 &  7#b7
 9 ! ?ird s5t5ce1 by ins]t+ "u !        
sup]vision ( an ane/hesiologi/ aft] an  

ane/hesiologi/ assi/ant4  #bje4 ,,crna  
s]vices z a ,m$icaid-requir$ b5efit  7a7
 ,9 g5]al ,section #aije7;a77#e7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7a77#e77 is am5d$-- 7#a7 by /rik+
 & 7,b7 & ins]t+ 7,b72 &  7#b7 by ins]t+
 be=e ! semicolon at ! end ! foll[+3 1 &
 7,c7 s]vices furni%$ by a c]tifi$      
regi/]$ nurse ane/heti/ 7z def9$ 9      
section #ahfa7;bb77#b771 :i* su* c]tifi$
 regi/]$ nurse ane/heti/ is au?oriz$ to 
p]=m "u ,/ate law 7or ! ,/ate regulatory
 me*anism z provid$ by ,/ate law74  7b7 
,paym5t ,section #aijb7;a7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;d7a77 is am5d$-- 7#a7 9 p>agraph  
7#hf71 by /rik+ & at ! end2  7#b7 9     
p>agraph 7#hg71 by /rik+ ! p]iod &      
ins]t+ 2 &2 &  7#c7 by ins]t+ aft]      
p>agraph 7#hg7 ! foll[+ new p>agraph3   
7#hh7 provide = paym5t = ! s]vices ( a  
c]tifi$ regi/]$ nurse ane/heti/ 7z def9$
 9 section #ahfa7;bb77#a77 9 am\nts no  
l[] ?an ! am\nts1 us+ ! same me?odology1
 us$ = paym5t = am\nts "u section       

#ahcc7;a77#a77;,h74  4  ,,iii ,removal (
 ,b>ri]s to ,practice on ,c]tifi$       
,nurse-,midwives  #cja4 ,improv+ access 
to tra9+ 9 mat]nity c>e  7a7 ,m$ic>e    
paym5ts = sup]vision by c]tifi$         
nurse-,midwives ,p>agraph 7#a7 ( section
 #ahfa7;gg7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #aciex7gg77 is am5d$ to  
read z foll[s3  7#a7 ,! t]m c]tifi$     
nurse-midwife s]vices means-- 7,a7 su*  
s]vices furni%$ by a c]tifi$            
nurse-midwife 7z def9$ 9 p>agraph 7#b772
 &  7,b7 su* s]vices 7& su* supplies &  
s]vices furni%$ z an incid5t to !       
nurse-midwife's s]vice7 :i*-- 7i7 !     
c]tifi$ nurse-midwife is legally        
au?oriz$ to p]=m "u ,/ate law 7or !     
,/ate regulatory me*anism provid$ by    
,/ate law7 z w\ld o!rwise be cov]$ if   
furni%$ by a physician2  7ii7 are       
furni%$ "u ! sup]vision ( a             
c]tifi$-nurse midwife by an int]n or    
resid5t-9-tra9+ 7z describ$ 9 subsection
 7b77#f772  7iii7 w\ld o!rwise be       
describ$ 9 subp>agraph 7,a7 if furni%$  

by a c]tifi$ nurse-midwife2 &  7iv7 w\ld
 o!rwise be cov]$ if furni%$ "u !       
sup]vision ( a physician4  4  7b7       
,cl>ify+ p]missibility ( us+ c]ta9      
grants = cl9ical tra9+ by c]tifi$       
nurse-,midwives ,section #haa7;a77#a7 ( 
! ,public ,heal? ,s]vice ,act 7#db      
,u4,s4,c4 #bif;j7a77#a77 is am5d$ by    
ins]t+ 1 includ+ cl9ical tra9+1 aft]    
projects4  #cjb4 ,improv+ m$ic>e pati5t 
access to home heal? s]vices provid$ by 
c]tifi$ nurse-midwives  7a7 ,9 g5]al    
,section #ahce7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acien7a77 is      
am5d$-- 7#a7 9 p>agraph 7#b7-- 7,a7 by  
ins]t+ or a c]tifi$ nurse-midwife 7z    
def9$ 9 section #ahfa7;gg771 aft] or a  
physician assi/ant 7z def9$ 9 section   
#ahfa7;aa77#e77 :o is work+ 9 accordance
 ) ,/ate law12 &  7,b7 9 subp>agraph    
7,a7-- 7i7 9 ea* ( clauses 7ii7 & 7iii71
 by /rik+ or a physician assi/ant 7z !  
case may be7 & ins]t+ a physician       
assi/ant1 or a c]tifi$ nurse-midwife 7z 
! case may be72 &  7ii7 9 clause 7iv71  

by-- 7,i7 ins]t+ or by a c]tifi$        
nurse-midwife 7z def9$ 9 section        
#ahfa7;gg77 aft] 7b 9 no case lat] ?an !
 date t is #f mon?s aft] ! date ( !     
enactm5t ( ! ,,c>es ,act72 &  7,,ii7 by 
/rik+ 7z def9$ 9 section #ahfa7;gg772 & 
7#b7 9 ! matt] foll[+ p>agraph 7#b71 by 
/rik+ or physician assi/ant 7z ! case   
may be7 & ins]t+ physician assi/ant1 or 
c]tifi$ nurse-midwife 7z ! case may be7 
ea* place x appe>s4  7b7 ,con=m+        
am5dm5ts ,section #ahie ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acie7;fff77 is am5d$-- 7#a7 9          
subsection 7c77#a71 by ins]t+ a c]tifi$ 
nurse-midwife 7z def9$ 9 section        
#ahfa7;gg771 aft] cl9ical nurse         
speciali/ 7z ^? t]ms are def9$ 9 section
 #ahfa7;aa77#e7712 &  7#b7 9 subsection 
7e77#a77;,a71 by /rik+ a physician a    
nurse practition] or cl9ical nurse      
speciali/1 & ins]t+ a physician1 a nurse
 practition]1 a cl9ical nurse speciali/1
 a c]tifi$ nurse-midwife14  #cjc4       
,improv+ access to ,,dmepos = ,m$ic>e   

b5efici>ies ,section #ahcd7;a7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7a77 is am5d$-- 7#a7 9 p>agraph   
7#a77;,e77ii7 by /rik+ or a cl9ical     
nurse speciali/ 7z ^? t]ms are def9$ 9  
section #ahfa7;aa77#e77 & ins]t+ 1 a    
cl9ical nurse speciali/ 7z ^? t]ms are  
def9$ 9 section #ahfa7;aa77#e771 or a   
c]tifi$ nurse-midwife 7z def9$ 9 section
 #ahfa7;gg772 &  7#b7 9 p>agraph        
7#aa77;,b77ii7-- 7,a7 by /rik+ or a     
cl9ical nurse speciali/ 7z ^? t]ms are  
def9$ 9 section #ahfa7;aa77#e77 & ins]t+
 a cl9ical nurse speciali/ 7z ^? t]ms   
are def9$ 9 section #ahfa 7aa77#e771 or 
a c]tifi$ nurse-midwife 7z def9$ 9      
#ahfa7;gg772 &  7,b7 by /rik+ or        
speciali/ & ins]t+ speciali/1 or        
nurse-midwife4  #cjd4 ,te*nical *anges  
to qualifications & conditions ) respect
 to ! s]vices ( c]tifi$ nurse-midwives  
,section #ahfa7;gg77#b7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciex7gg77#b77 is am5d$ by /rik+ 1 or  
has be5 c]tifi$ by an organization      

recogniz$ by ! ,secret>y & ins]t+ & has 
be5 c]tifi$ by ! ,am]ican ,midwif]y     
,c]tification ,bo>d 7or a successor     
organization74  ,,iv ,improv+ ,f$]al    
,heal? ,programs = ,all ,advanc$        
,practice ,regi/]$ ,nurses  #dja4       
,revis+ ! local cov]age det]m9ation     
process "u ! ,m$ic>e program  7a7 ,9    
g5]al ,section #ahfb7l77#e7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciey7l77#e77 is am5d$-- 7#a7 9        
subp>agraph 7,d71 by add+ at ! end !    
foll[+ new clauses3  7vi7 ,id5tification
 ( any m$ical or sci5tific exp]ts ^:    
advice 0 obta9$ by su* contractor dur+ !
 developm5t ( su* det]m9ation1 :e!r or n
 su* contractor reli$ on su* advice 9   
develop+ su* det]m9ation4  7vii7 ,a     
hyp]l9k to any writt5 communication     
betwe5 su* contractor & ano!r entity t  
su* contractor reli$ on :5 develop+ su* 
det]m9ation4  7viii7 ,a hyp]l9k to any  
rule1 guidel9e1 protocol1 or o!r        
crit]ion t su* contractor reli$ on :5   
develop+ su* det]m9ation4  2 &  7#b7 by 

add+ at ! end ! foll[+ new subp>agraphs3
  7,e7 ,prohibition on imposition (     
practition] qualifications ,! ,secret>y 
%all prohibit a ,m$ic>e adm9i/rative    
contractor t develops a local cov]age   
det]m9ation f impos+ su* det]m9ation on 
any cov]age limitation ) respect to !   
qualifications ( a physician 7z def9$ 9 
section #ahfa7r77 or a practition]      
describ$ 9 section #ahdb7;b77#ah77;,c7  
:o may furni% ! item or s]vice t is !   
subject ( su* det]m9ation4  7,f7 ,civil 
monet>y p5alty ,a ,m$ic>e adm9i/rative  
contractor t develops a local cov]age   
det]m9ation t fails to make in=mation   
describ$ 9 subp>agraph 7,d7 available z 
requir$ by ! ,secret>y "u su*           
subp>agraph or comply ) ! prohibition "u
 subp>agraph 7,e7 is subject to a civil 
monet>y p5alty ( n m ?an #aj1jjj = ea*  
su* failure4 ,! provisions ( section    
#aabh;,a 7o!r ?an subsections 7a7 & 7b77
 %all apply to a civil money p5alty "u !
 previ\s s5t5ce 9 ! same mann] z su*    
provisions apply to a p5alty or proce$+ 

"u section #aabh;,a7a74  4  7b7 ,tim+ ( 
review ,section #ahfi7;f77#b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acie;ff7f77#b77 is am5d$ by add+ at !  
end ! foll[+ new subp>agraph3  7,d7     
,tim+ ( review ,an aggriev$ p>ty may    
file a compla9t describ$ 9 subp>agraph  
7,a7 ) respect to a local cov]age       
det]m9ation on or aft] ! date t su*     
det]m9ation is po/$1 9 accordance )     
section #ahfb7l77#e77;,d71 on ! ,int]net
 website ( ! ,m$ic>e adm9i/rative       
contractor mak+ su* det]m9ation1 :e!r or
 n su* det]m9ation has tak5 effect4  4  
7c7 ,effective date ,! am5dm5ts made by 
?is section %all apply to local cov]age 
det]m9ations made available on ! int]net
 website ( a ,m$ic>e adm9i/rative       
contractor & on ! ,m$ic>e int]net       
website on or aft] ! date ( ! enactm5t (
 ?is ,act4  #djb4 ,locum t55s ,section  
#ahdb7;b77#f7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acieu7b77#f77 is       
am5d$-- 7#a7 by /rik+ & 7,j7 & ins]t+ 1 
7,j72 &  7#b7 by add+ 1 & 7,k7 9 ! case 

( s]vices furni%$ by a c]tifi$ regi/]$  
nurse ane/heti/ 7z def9$ 9 section      
#ahfa7;bb77#b771 nurse practition]1 or  
cl9ical nurse speciali/ 7z def9$ 9      
section #ahfa7;aa77#e771 or a c]tifi$   
nurse midwife 7z def9$ 9 section        
#ahfa7;gg77#b77 aft] 7z def9$ 9 section 
#ahhf7;d77#b77;,d774  ,v ,miscellane\s  
#eja4 ,effective date ,! provisions (1  
includ+ am5dm5ts made by1 ?is ,act 7o!r 
?an sections #ajc & #dja7 %all apply )  
respect to items & s]vices furni%$ on or
 aft] ! date t is #ij days aft] ! date (
 ! enactm5t ( ?is ,act4 ,not)/&+ any o!r
 provision ( law1 ! ,secret>y ( ,heal? &
 ,human ,s]vices %all implem5t su*      
provisions1 includ+ su* am5dm5ts1 ?r\gh 
int]im f9al rule or subregulatory       
guidance if ! ,secret>y det]m9es su*    
implem5tation to be necess>y = purposes 
( comply+ ) ! prec$+ s5t5ce or ) any o!r
 effective date provid$ 9 ?is ,act4