PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 443 would otherwise be recognized if performed by a physician who is serving as an assistant at surgery; and". (2) CONFORMING AMENDMENTS.—Section 1833(r) (42 U.S.C. 13951(r)) is amended— (A) in paragraph (1), by striking "section 1861(s)(2)(K)(iii) (relating to nurse practitioner or clinical nurse specialist services provided in a rural area)" and inserting "section 1861(s)(2)(K)(ii) (relating to nurse practitioner or clinical nurse specialist services)"; (B) by striking paragraph (2); (C) in paragraph (3), by striking "section 1861(s)(2)(K)(iii)" and inserting "section 1861(s)(2)(K)(ii)"; and (D) by redesignating paragraph (3) as paragraph (2). (c) DIRECT PAYMENT FOR NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS.— Section 1832(a)(2)(B)(iv) (42 U.S.C. 1395k(a)(2)(B)(iv)) is amended by striking "provided in a rural area (as defined in section 1886(d)(2)(D))" and inserting "but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services". (d) DEFINITION OF CLINICAL NURSE SPECIALIST CLARIFIED.— Section 1861(aa)(5) (42 U.S.C. 1395x(aa)(5)) is amended— (1) by inserting "(A)" after "(5)"; (2) by striking "The term 'physician assistant'" and all that follows through "who performs" and inserting "The term 'physician assistsint' and the term 'nurse practitioner' mean, for purposes of this title, a physician assistant or nurse practitioner who performs"; and (3) by adding at the end the following new subparagraph: "(B) The term 'clinical nurse specialist' means, for purposes of this title, an individual who— "(i) is a registered nurse and is licensed to practice nursing in the State in which the Clinical nurse specialist services are performed; and "(ii) holds a master's degree in a defined clinical area of nursing from an accredited educational institution.". (e) EFFECTIVE DATE. —The amendments made by this section 42 USC 1395k shall apply with respect to services furnished and supplies provided ^°^- on and after Jeinuary 1, 1998. SEC. 4512. INCREASED MEDICARE REIMBURSEMENT FOR PHYSICIAN ASSISTANTS. (a) REMOVAL OF RESTRICTION ON SETTINGS.—Section 1861(s)(2)(K)(i) (42 U.S.C. 1395x(s)(2)(K)(i)), as amended by section 4511, is amended— (1) by striking "(I) in a hospital" and all that follows through "shortage area,", and (2) by adding at the end the following: "but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services,". (b) INCREASED PAYMENT.— (1) FEE SCHEDULE AMOUNT.— Section 1833(a)(l)(0) (42 U.S.C. 13951(a)(l)(0)), as amended by section 4511, is further amended— (A) by striking "section 1861(s)(2)(K)(ii)" and inserting " 1861(s)(2)(K)", and
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