Streamlining care delivery in skilled nursing facilities and nursing facilities; authorizing Medicare and Medicaid inpatient hospital patients to be under the care of a nurse practitioner

(a) Medicare (1) Certification of post-hospital extended care services Section 1814(a)(2) of the Social Security Act (42 U.S.C. 1395f(a)(2)) is amended, in the matter preceding subparagraph (A), by striking, or a nurse practitioner, and inserting or a nurse practitioner (in accordance with State law), or. (2) Certification authority for nurse practitioners Section 1814(a)(3) of the Social Security Act (42 U.S.C. 1395f(a)(3)) is amended by inserting or nurse practitioner after physician. (3) Supervision requirement in skilled nursing facility services and resident's rights Section 1819 of the Social Security Act (42 U.S.C. 1395i–3(b)(6)) is amended— (A) in subsection (b)— (i) in paragraph (2)(B), by inserting or nurse practitioner after attending physician; and (ii) in paragraph (6)— (I) in the heading, by striking Physician supervision and inserting Supervision; and (II) in subparagraph (A), by inserting or a nurse practitioner, in accordance with State law after physician; and (B) in subsection (c)— (i) in subparagraph (1)(A)(i), by inserting or nurse practitioner after attending physician; (ii) in the flush matter at the end of subparagraph (2)(A), by inserting or nurse practitioner after physician in each occurrence; and (iii) in subparagraph (3)(A), by inserting or nurse practitioner after physician. (4) Administration of part B Section 1842(b)(2)(C) of the Social Security Act (42 U.S.C. 1395u(b)(2)(C)) is amended, in the second sentence— (A) by inserting or a nurse practitioner after a physician; and (B) by striking or a nurse practitioner working in collaboration with that physician, or both. (5) Provision of medical and other health services Section 1861(s)(2)(K)(ii) of the Social Security Act (42 U.S.C. 1395x(s)(2)(K)(ii)) is amended by striking or clinical nurse specialist (as defined in subsection (aa)(5)) working in collaboration (as defined in subsection (aa)(6)) with a physician (as defined in subsection (r)(1)) and inserting (as defined in subsection (aa)(5)(A)), or by a clinical nurse specialist (as defined in subsection (aa)(5)(B)) working in collaboration with a physician (as defined in subsection (r)(1)),. (6) Privileges for nurse practitioners Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (A) in subsection (e)(4), by inserting (or nurse practitioner, in accordance with State law) after physician; (B) in subsection (f)(1), by inserting or nurse practitioner after physician; and (C) in each of subparagraphs (B) and (F) of subsection (ee)(2), by inserting or nurse practitioner after physician. (b) Medicaid (1) Certification authority for nurse practitioners Section 1902(a)(44) of the Social Security Act (42 U.S.C. 1396a(a)(44)) is amended to read as follows: (44) in each case for which payment for inpatient hospital services, skilled nursing facility services, services in an intermediate care facility described in section 1905(d), or inpatient mental hospital services is made under the State plan— (A) a physician or nurse practitioner (or, in the case of skilled nursing facility services or intermediate care facility services, a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician) certifies at the time of admission, or, if later, the time the individual applies for medical assistance under the State plan (and a physician or nurse practitioner, or a physician assistant under the supervision of a physician, or, in the case of skilled nursing facility services or intermediate care facility services, a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician, recertifies, where such services are furnished over a period of time, in such cases, at least as often as required under section 1903(g)(6) (or, in the case of services that are services provided in an intermediate care facility, every year), and accompanied by such supporting material, appropriate to the case involved, as may be provided in regulations of the Secretary), that such services are or were required to be given on an inpatient basis because the individual needs or needed such services, and (B) such services were furnished under a plan established and periodically reviewed and evaluated by a physician or nurse practitioner, or, in the case of skilled nursing facility services or intermediate care facility services, by a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician;. (2) Nursing facility services supervision and clinical records Section 1919(b)(6)(A) of the Social Security Act (42 U.S.C. 1396r(b)(6)(A)) is amended to read as follows: (A) require that the health care of every resident be provided under the supervision of a physician or nurse practitioner (or, at the option of a State, under the supervision of a clinical nurse specialist or physician assistant who is not an employee of the facility but who is working in collaboration with a physician);.