,,ii  #aah? ,,congress  #a/ ,session    
,s4 #aih  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #a1 #bjbc,mr4 
,b>rasso 7= himself1 ,mr4 ,b5net1 ,mrs4 
,blackburn1 & ,ms4 ,smi?7 introduc$ !   
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xviii ( ! ,social      
,security ,act to mod]nize provisions   
relat+ to rural heal? cl9ics "u ,m$ic>e4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,rural ,heal? ,cl9ic ,burd5         
,r$uction ,act4  #b4 ,mod]niz+          
physician1 physician assi/ant1 & nurse  
practition] utilization requirem5ts     
,section #ahfa7;aa7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#aciex7aa77 is am5d$-- 7#a7 9 p>agraph  
7#b77;,b71 by /rik+ has an arrangem5t & 
all t foll[s ?r\gh ! fir/ semicolon &   
ins]t+ meets ! requirem5ts describ$ 9   
p>agraph 7#h722 &  7#b7 by add+ at ! end
 ! foll[+ new p>agraph3  7#h7           
,requirem5ts = c]ta9 facilities describ$
 ,= purposes ( p>agraph 7#b77;,b71 )    

respect to a facility :i* is n a        
physician-direct$ cl9ic1 ! foll[+       
requirem5ts are describ$ 9 ?is p>agraph3
 7,a7 ,arrangem5t ,! facility has an    
arrangem5t consi/5t ) ! provisions (    
,/ate & local law relative to !         
practice1 p]=mance1 & deliv]y ( heal?   
s]vices1 ) "o or m physician assi/ants  
7z def9$ 9 p>agraph 7#e77;,a77 or "o or 
m nurse practition]s 7z def9$ 9 su*     
p>agraph74  7,b7 ,practice & ov]sight   
requirem5ts ,! deliv]y ( heal? s]vices  
"u su* arrangem5t %all be 9 accordance )
 ,/ate law or ! ,/ate regulatory        
me*anism gov]n+ ! practice ( physician  
assi/ants or nurse practition]s4  4  #c4
 ,remov+ outdat$ laboratory requirem5ts 
,section #ahfa7;aa77#b77;,g7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciex7aa77#b77;,g77 is am5d$ by /rik+ 1
 includ+ cl9ical laboratory s]vices &   
all t foll[s ?r\gh additional diagno/ic 
s]vices & ins]t+ ! foll[+3 & has prompt 
access to cl9ical laboratory s]vices &  
additional diagno/ic s]vices4  #d4      

,all[+ rural heal? cl9ics ! flexibility 
to contract ) physician assi/ants &     
nurse practition]s ,section #ahfa7;aa7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciex7aa771 9 ! fir/ s5t5ce ( ! flu%  
matt] foll[+ p>agraph 7#b71 is am5d$ by 
ins]t+ or contracts ) aft] 7iii7        
employs4  #e4 ,urbaniz$ area fix        
,section #ahfa7;aa7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#aciex7aa771 9 ! fir/ s5t5ce ( ! flu%   
matt] foll[+ p>agraph 7#b71 is am5d$ by 
/rik+ 7i7 is locat$ 9 an area t is n an 
urbaniz$ area & ins]t+ 7i7 is locat$ 9  
an area t is n 9 an urban area ( #ej1jjj
 or m4  #f4 ,exception to behavioral    
heal? limitation ,section #ahfa7;aa7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciex7aa771 9 ! fir/ s5t5ce ( ! flu%   
matt] foll[+ p>agraph 7#b71 is am5d$ by 
ins]t+ ! foll[+ be=e ! p]iod3 1 except 9
 ! case :]e ! facility is locat$ 9 an   
area t is designat$ 7"u section         
#ccb7;a77#a77;,a7 ( ! ,public ,heal?    
,s]vice ,act7 z a m5tal heal?           

pr(essional %ortage area4  #g4          
,effective date ,?is ,act & ! am5dm5ts  
made by ?is ,act %all take effect on    
,janu>y #a1 #bjbd1 & %all apply to items
 & s]vices furni%$ on or aft] su* date4