,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #eaii  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,septemb] #h1         
#bjbe,mr4 ,mann 7= himself1 ,ms4        
,tokuda1 ,mr4 ,z9ke1 ,mr4 ,ciscomani1   
,mr4 ,johnson ( ,georgia1 ,mr4 ,fields1 
,mr4 ,mannion1 ,mr4 ,?ompson (          
,mississippi1 ,mr4 ,co/a1 ,mr4 ,baird1  
,mr4 ,valadao1 ,mr4 ,pappas1 ,ms4       
,boeb]t1 & ,mr4 ,smi? ( ,nebraska7      
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 title ,,xviii ( !     
,social ,security ,act to mod]nize      
physician1 physician assi/ant1 & nurse  
practition] utilization requirem5ts4    
#a4 ,%ort title  ,?is ,act may be cit$ z
 ! ,mod]niz+ ,rural ,physician ,assi/ant
 & ,nurse ,practition] ,utilization ,act
 ( #bjbe4  #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 ,effective date   
,?is ,act & ! am5dm5ts made by ?is ,act 
%all take effect on ,janu>y #a1 #bjbg1 &
 %all apply to items & s]vices furni%$  
on or aft] su* date4