,,ii  #aahth ,,congress  #ast ,session  
,s4 #aih  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,february #a1       
#bjbc,mr4 ,barrasso 7for himself1 ,mr4  
,bennet1 ,mrs4 ,blackburn1 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 ,burden ,reduction ,act4  #b4   
,modernizing physician1 physician       
assistant1 and nurse practitioner       
utilization requirements ,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 ,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  4   
#c4 ,removing outdated laboratory       
requirements ,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  #d4
 ,allowing rural health clinics the     
flexibility to contract with physician  
assistants and nurse practitioners      
,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 inserting or        
contracts with after 7iii7 employs4  #e4
 ,urbanized area fix ,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  
7i7 is located in an area that is not an
 urbanized area and inserting 7i7 is    
located in an area that is not in an    

urban area of #ej1jjj or more4  #f4     
,exception to behavioral health         
limitation ,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 inserting the       
following before the period3 1 except in
 the case where the facility is located 
in an area that is designated 7under    
section #ccb7;a77#a77;,a7 of the ,public
 ,health ,service ,act7 as a mental     
health professional shortage area4  #g4 
,effective date ,this ,act and the      
amendments made by this ,act shall take 
effect on ,january #a1 #bjbd1 and shall 
apply to items and services furnished on
 or after such date4