103 STAT. 2218 PUBLIC LAW 101-239—DEC. 19, 1989 42 USC 1395u note. 42 USC 1395u note. "(ii) services which would be physicians' services if furnished by a physician (as defined in subsection (r)(D) and which are performed by a nurse practitioner (as defined in subjection (aaX3)) working in collaboration (as defined in subsection (aaX4)) with a physician (as defined in subsection (r)(D) in a skilled nursing facility or nursing facility (as defined in section 1919(a)) which the nurse practitioner is legally authorized to perform by the State in which the services are performed, and". (b) DETERMINATION OF PAYMENT AMOUNT.—Section 1842(b)(12XA) of such Act (42 U.S.C. 1395u(b)(12XA)) is amended by striking "physi- cian assistant acting under the supervision of a physician and inserting "physician assistants and nurse practitioners. (c) PAYMENT TO EMPLOYER; PAYMENT FOR ROUTINE VISITS BY MEM- BERS OF A TEAM.—Section 1842(b) of such Act (42 U.S.C. 1395u(b)) is amended— (1) in clause (C) of the first sentence of paragraph (6), by inserting "or nurse practitioner" after "physician assistant, and (2) by adding at the end of paragraph (2), the following new subparagraph: "(C) In the case of residents of nursing facilities who receive services described in clause (i) or (ii) of section 1861(s)(2)(K) per- formed by a member of a team, the Secretary shall instruct carriers to develop mechanisms which permit routine payment under this part for up to 1.5 visits per month per resident. In the previous sentence, the term 'team' refers to a physician and includes a physician assistant acting under the supervision of the physician or a nurse practitioner wor^ng in collaboration with that physician, or both. ". (d) DEFINITION OF COLLABORATION.—Section 1861(aa) of such Act (42 U.S.C. 1395x(aa)) is amended by adding at the end the following new paragraph: "(4) The term 'collaboration' means a process in which a nurse practitioner works with a physician to deliver health care services within the scope of the practitioner's professional expertise, with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanisms as defined by the law of the State in which the services are performed.". (e) STATE DEMONSTRATION PROJECTS ON APPLICATION OF LIMITA- TION ON VISITS PER MONTH PER RESIDENT ON AGGREGATE BASIS FOR A TEAM.—The Secretary of Health and Human Services shall pro- vide for at least 1 demonstration project under which, in the app.Uca- tion of section 1842(b)(2)(C) of the l^ial Security Act (as added by subsection (c)(2) of this section) in one or more States, the limitation on the number of visits per month per resident would be applied on an average basis over the aggregate total of residents receiving services from members of the team. (f) EFFECTIVE DATE. — The amendments made by this section shall apply to services furnished on or after April 1, 1990. SEC. 6115. COVERAGE OF SCREENING PAP SMEARS. (a) IN GENERAL.— Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 6003CgX3XA) of this subtitle, is amended— (1) in subsection (s)— (A) by striking "and" at the end of paragraph (12),
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