,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #gajf  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,janu>y #ae1          
#bjbf,mrs4 ,kiggans ( ,virg9ia 7= h]self
 & ,mrs4 ,d+ell7 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 /reaml9e c>e deliv]y 9
 skill$ nurs+ facilities & nurs+        
facilities "u ! ,m$ic>e & ,m$icaid      
programs4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,enhanc+ ,skill$ ,nurs+    
,facilities ,act4  #b4 ,/reaml9+ c>e    
deliv]y 9 skill$ nurs+ facilities &     
nurs+ facilities  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+ :o    

does n & all t foll[s ?r\gh physician11 
& ins]t+ work+ 9 accordance ) ,/ate     
law14  7#b7 ,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$-- 7,a7
 9 ! head]1 by /rik+ ,physician         
sup]vision & ins]t+ ,sup]vision2 &  7,b7
 by ins]t+ or a nurse practition] or    
physician assi/ant1 9 accordance ) ,/ate
 law aft] physician4  7#c7 ,adm9i/ration
 ( "p ,b ,section #ahdb7;b77#b77;,c7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acieu7b77#b77;,c77 is am5d$-- 7,a7 by  
ins]t+ 1 a nurse practition]1 or a      
physician assi/ant aft] a physician2 &  
7,b7 by /rik+ & includes a physician    
assi/ant act+ "u ! sup]vision ( !       
physician or a nurse practition] work+ 9
 collaboration ) t physician1 or bo?4   
7#d7 ,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#e7 ,scope (    
s]vices ,section #ahai7;b77#b77;,b7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;b77#b77;,b77 is am5d$ by    
ins]t+ 7or a nurse practition]1         
physician assi/ant1 or cl9ical nurse    
speciali/ work+ 9 accordance ) ,/ate    
law7 aft] att5d+ physician4  7#f7       
,resid5ts' rights ,section #ahai7;c7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;i-#c7;c77 is am5d$-- 7,a7 9       
p>agraph 7#a77;,a77i71 by ins]t+ nurse  
practition]1 physician assi/ant1 or     
cl9ical nurse speciali/ work+ 9         
accordance ) ,/ate law aft] att5d+      
physician2  7,b7 9 p>agraph 7#b77;,a71 9

 ! matt] foll[+ clause 7vi7-- 7i7 by    
ins]t+ nurse practition]1 physician     
assi/ant1 or cl9ical nurse speciali/    
work+ 9 accordance ) ,/ate law aft]     
resid5t's physician2 &  7ii7 by ins]t+ 1
 nurse practition]1 physician assi/ant1 
or cl9ical nurse speciali/ work+ 9      
accordance ) ,/ate law aft] a physician2
 &  7,c7 9 p>agraph 7#c77;,a71 by ins]t+
 1 nurse practition]1 physician         
assi/ant1 or cl9ical nurse speciali/    
work+ 9 accordance ) ,/ate law aft]     
physician4  7b7 ,m$icaid  7#a7          
,c]tification ( skill$ nurs+ facility   
s]vices & int]m$iate c>e facility       
s]vices ,section #aijb7;a77#dd7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77#dd77 is am5d$-- 7,a7 9      
subp>agraph 7,a7-- 7i7 by /rik+ 7or1 9 !
 case ( skill$ nurs+ facility s]vices or
 int]m$iate c>e facility s]vices &      
ins]t+ 7or1 9 ! case ( int]m$iate c>e   
facility s]vices2  7ii7 by /rik+        
physician7 c]tifies & ins]t+ physician1 
or1 9 ! case ( skill$ nurs+ facility    

s]vices1 a physician1 or a nurse        
practition]1 a physician assi/ant1 or a 
cl9ical nurse speciali/ work+ 9         
accordance ) ,/ate law7 c]tifies2  7iii7
 by /rik+ a physician1 or1 9 ! case (   
skill$ nurs+ facility s]vices or &      
ins]t+ a physician1 or1 9 ! case (2 &   
7iv7 by ins]t+ or1 9 ! case ( skill$    
nurs+ facility s]vices1 a physician1 or 
a nurse practition]1 a physician        
assi/ant1 or a cl9ical nurse speciali/  
work+ 9 accordance ) ,/ate law1 be=e    
rec]tifies2 &  7,b7 9 subp>agraph 7,b7--
 7i7 by /rik+ skill$ nurs+ facility     
s]vices or2 &  7ii7 by ins]t+ 1 or1 9 ! 
case ( skill$ nurs+ facility s]vices1 a 
physician1 or a nurse practition]1 a    
physician assi/ant1 or a cl9ical nurse  
speciali/ work+ 9 accordance ) ,/ate law
 be=e ! semicolon4  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] or a     
physician assi/ant 7or1 at ! option ( a 
,/ate1 "u ! sup]vision ( a cl9ical nurse
 speciali/72  4