H.R. 1770 – Reading Mode

118th CONGRESS

1st Session

H. R. 1770

IN THE HOUSE OF REPRESENTATIVES

March 23, 2023

Mr. Smith of Nebraska (for himself, Mr. Schneider, Mr. Bucshon, Ms. Matsui, Mr. Carter of Georgia, Mrs. Harshbarger, Mr. Bilirakis, Mr. Blumenauer, Mr. Fitzpatrick, Mr. Peters, and Ms. Sewell) 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 pharmacy payment of certain services.

Short title

This Act may be cited as the Equitable Community Access to Pharmacist Services Act.

Coverage of pharmacist services under medicare part B

(a)

Coverage

Section 1861(s) of the Social Security Act (42 U.S.C. 1395x(s)) is amended—

(1)

in paragraph (2)—

(A)

in subparagraph (II), by striking and at the end;

(B)

in subparagraph (JJ), by striking the period at the end and inserting ; and; and

(C)

by adding at the end the following new subparagraph:

(KK)

pharmacist services and such services and supplies furnished as an incident to the pharmacist’s service as would otherwise be covered under part B if furnished by a physician or as an incident to a physician’s service that—

(i)

are furnished by a pharmacist—

(I)

as licensed under State law; or

(II)

pursuant to a Federal emergency authority described under section 319F–3 or section 361 of the Public Health Service Act, or other similar Federal law;

(ii)

would otherwise be covered under part B if furnished by a physician; and

(iii)

are services—

(I)

for encounters for the evaluation and management of patients for testing or treatment for COVID–19, influenza, respiratory syncytial virus, or streptococcal pharyngitis; or

(II)

that address a public health need related to a public health emergency under section 319F–3 or section 361 of the Public Health Service Act, or other similar Federal law.

; and

(2)

in paragraph (10), in each of subparagraphs (A) and (B), by inserting , including when furnished by a pharmacist before the semicolon in each such subparagraph.

(b)

Payment

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—

(1)

by striking and (HH) and inserting (HH); and

(2)

by inserting before the semicolon at the end the following: and (II) with respect to pharmacist services described in section 1861(s)(2)(KK), the amounts paid shall be equal to 80 percent of the lesser of (i) the actual charge for the services or (ii) 85 percent (or 100 percent, in the case of such services furnished pursuant to a Federal emergency authority described in clause (i)(II) of such section) of the amount determined under the payment basis under section 1848 for such services..

(c)

Prohibition on balance billing for pharmacist services

Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following:

(ix)

A pharmacist.

(d)

Rule of construction

Nothing in this section shall be construed to restrict the ability of pharmacies and pharmacists to enroll and obtain reimbursement under existing pathways under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) as of the date of the enactment of this Act, including payment as mass immunizers.

(e)

Implementation authority

Notwithstanding any other provision of law, the Secretary of Health and Human Services shall implement the provisions of, and the amendments made by, this section by interim final rule, program instruction, or otherwise not later than the date that is 60 days after the date of the enactment of this Act.