,i  #aaith ,,congress  #ast ,session    
,h4 ,r4 #eaii  ,,in ,,the ,,house ,,of  
,,representatives  ,september #h1       
#bjbe,mr4 ,mann 7for himself1 ,ms4      
,tokuda1 ,mr4 ,zinke1 ,mr4 ,ciscomani1  
,mr4 ,johnson of ,georgia1 ,mr4 ,fields1
 ,mr4 ,mannion1 ,mr4 ,thompson of       
,mississippi1 ,mr4 ,costa1 ,mr4 ,baird1 
,mr4 ,valadao1 ,mr4 ,pappas1 ,ms4       
,boebert1 and ,mr4 ,smith of ,nebraska7 
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce1 and in addition to the   
,committee on ,ways and ,means1 for a   
period to be subsequently determined by 
the ,speaker1 in each case for          
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
amend title ,,xviii of the ,social      
,security ,act to modernize physician1  
physician assistant1 and nurse          
practitioner utilization requirements4  
#a4 ,short title  ,this ,act may be     
cited as the ,modernizing ,rural        

,physician ,assistant and ,nurse        
,practitioner ,utilization ,act of      
#bjbe4  #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 ,effective date ,this ,act and the  
amendments made by this ,act shall take 
effect on ,january #a1 #bjbg1 and shall 
apply to items and services furnished on
 or after such date4