Medicare Clinical Pharmacist Practitioner Services Coverage Act of 2004

Medicare Clinical Pharmacist Practitioner Services Coverage Act of 2004 - Amends title XVIII (Medicare) of the Social Security Act to provide for Medicare coverage of authorized clinical pharmacist practitioner (CPP) services involving toxicology, therapeutics, clinical pharmacokinetics, pharmacoeconomics, and other life sciences for the direct care of patients, which would otherwise be covered if furnished by a physician, or as an incident to a physician's professional service. Requires such services to be performed under State law or regulation in a collaborative practice agreement.

Requires Medicare beneficiaries to pay 20 percent coinsurance.

Directs the Secretary of Health and Human Services to develop, and report to Congress on, CPP fee schedules meeting specified requirements for services furnished by January 1, 2007. Requires CPP's to be reimbursed at 85 percent of applicable physicians' rates as of January 1, 2005, until such fee schedules are implemented.

[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4724 Introduced in House (IH)]






108th CONGRESS
  2d Session
                                H. R. 4724

To amend title XVIII of the Social Security Act to provide for coverage 
   of clinical pharmacist practitioner services under part B of the 
                           Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 25, 2004

Mr. Burr (for himself, Mr. Ballenger, Mr. Coble, and Mr. Price of North 
  Carolina) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, 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 provide for coverage 
   of clinical pharmacist practitioner services under part B of the 
                           Medicare Program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as ``Medicare Clinical Pharmacist 
Practitioner Services Coverage Act of 2004'' .

SEC. 2. MEDICARE COVERAGE OF CLINICAL PHARMACIST PRACTITIONER SERVICES.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (U);
            (2) by adding ``and'' at the end of subparagraph (V); and
            (3) by inserting after subparagraph (V) the following new 
        subparagraph:
                    ``(W) clinical pharmacist practitioner services (as 
                defined in subsection (ww)(1)); and''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended by adding at the end the following new subsection:

   ``Clinical Pharmacist Practitioner Services; Clinical Pharmacist 
                              Practitioner

    ``(ww)(1) The term `clinical pharmacist practitioner services' 
means such direct patient care services provided by a clinical 
pharmacist practitioner, and such services are furnished as an incident 
to the practitioner's services, which the practitioner is legally 
authorized to perform under State law (or the State regulatory 
mechanism as provided by State law) in a collaborative practice 
agreement as would otherwise be covered if furnished by a physician, or 
as an incident to a physician's professional service.
    ``(2) The term `clinical pharmacist practitioner' means as a 
pharmacist involved in the application of the scientific principles of 
pharmacology, toxicology, therapeutics, clinical pharmacokinetics, 
pharmacoeconomics, and other life sciences for the direct care of 
patients.''.
    (c) Payment.--
            (1) In general.--Section 1833(a)(1) of such Act (42 U.S.C. 
        1395l(a)(1)) is amended--
                    (A) by striking ``and (U)'' and inserting ``(U)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (V) with respect to 
                clinical pharmacist practitioner services (as defined 
                in section 1861(ww)), the amounts paid shall be 80 
                percent of the amounts provided for such services under 
                section 1834(n);''.
            (2) Establishment of fee schedules.--Section 1834 of such 
        Act (42 U.S.C. 1395m) is amended by adding at the end the 
        following new subsection:
    ``(n) Fee Schedules for Clinical Pharmacist Practitioner 
Services.--
            ``(1) Development.--The Secretary shall develop and 
        implement, for services furnished not later than January 1, 
        2007--
                    ``(A) a relative value scale to serve as the basis 
                for the payment of clinical pharmacist practitioner 
                services (as defined in section 1861(ww)) under this 
                part; and
                    ``(B) using such scale and appropriate conversion 
                factors, fee schedules (on a regional, statewide, 
                locality, or carrier service area basis) for payment 
                for clinical pharmacist practitioner services under 
                this part.
            ``(2) Payments prior to implementation of fee schedules.--
        In the case of clinical pharmacist practitioner services which 
        are furnished before the implementation of fee schedules under 
        paragraph (1)(B), the amount of payment made under this part 
        shall be based on 85 percent of the fee schedule amount 
        applicable under section 1848 if the service were furnished by 
        a physician.''.
            (3) Report to congress.--Not later than September 30, 2006, 
        the Secretary of Health and Human Services shall submit a 
        report to Congress on the fee schedules (including relative 
        value scale and appropriate conversion factors) developed 
        pursuant to section 1834(n)(1) of the Social Security Act (as 
        added by paragraph (2)) for clinical pharmacist practitioner 
        services under part B of title XVIII of such Act.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2005.
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