Page:United States Statutes at Large Volume 104 Part 2.djvu/494

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104 STAT. 1388-86 PUBLIC LAW 101-508—NOV. 5, 1990 42 USC 1395W-2. 42 USC 1395/ note. 42 USC 1395Z note. 42 USC 1395/ note. requests for testing during the year in which the test is performed". (2) The heading of section 1846 of such Act is amended by striking "OF" and inserting "OR SUPPLIERS OF". (3) Effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1986, section 9339(b) of the Omnibus Budget Reconciliation Act of 1986 is amended by striking paragraph (3). (4) Section 6111(b)(2) of the Omnibus Budget Reconciliation Act of 1989 is amended by striking "January 1, 1990" and inserting "May 1, 1990". (5) The amendments made by paragraphs (1)(A)^^ (1)(B), (2), and (4) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989, and the amendment made by paragraph (1)(C) shall take effect January 1, 1991. SEC. 4155. COVERAGE OF NURSE PRACTITIONERS IN RURAL AREAS. (a) IN GENERAL.— Section 1861(s)(2)(K) (42 U.S.C. 1395x(s)(2)(K)) is amended— (1) in clause (ii), by striking "and" at the end; (2) by redesignating clause (iii) as clause (iv); and (3) by inserting after clause (ii) the following new clause: "(iii) services which would be physicians' services if furnished by a physician (as defined in subsection (r)(l)) and which are performed by a nurse practitioner or clinical nurse specialist (as defined in subsection (aa)(3)) working in collaboration (as defined in subsection (aa)(4)) with a physician (as defined in subsection (r)(l)) in a rural area (as defined in section 1886(d)(2)(D)) which the nurse practitioner or clinical nurse specialist is authorized to perform by the State in which the services are performed, and such services and supplies furnished as an incident to such services as would be covered under subparagraph (A) if furnished as an incident to a physician's professional servipe, and". (b) PAYMENT, — (1) DIRECT PAYMENT.— Section 1832(a)(2)(B) (42 U.S.C. 1395k(a)(2)(B)) is amended— (A) in clause (ii), by striking "and" at the end; (B) in clause (iii), by striking the semicolon and inserting a comma; and (C) by adding at the end the following new clause: "(iv) services of a nurse practitioner or clinical nurse specialist provided in a rural area (as defined in section 1886(d)(2)(D)); and". (2) AMOUNT. —Section 1833(a)(1) (42 U.S.C. 13951(a)(1)) as amended by section 4153(a)(2)(B), is amended— (A) by striking "and" at the end of subparagraph (K); and (B) by inserting after subparagraph (L) the following new subparagraph: "(M) with respect to services described in section 1861(s)(2)(K)(iii) (relating to nurse practitioner or clinical nurse specialist services provided in a rural area), the amounts paid shall be 80 percent of the lesser of the actual charge or the prevailing charge that would be recognized (or, for services furnished on or after January 1, 1992, the fee schedule amount provided under section 1848) if the " So in original. Probably should be "(I)(A),".