In a previous blog, I discussed some of the basics of provider status as it relates to Medicare. In this blog we will look at more of the details that advocates may need if greater detail is required to respond to questions from policy makers or members of other professions concerning the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S. 314).

The legislation H.R. 592 consists of three parts – Section 2(a), 2(b) and 2(c)

Section 2(a) includes:

Amending Section 1861(s)(2) of the Social Security Act by adding a new subsection “GG” to the law that would authorize Medicare Part B coverage of “pharmacist services.”

Limiting these services to services:

  • Provided by a State licensed pharmacist, individually or on behalf of a pharmacy provider.
  • Defined based on what the pharmacist is legally authorized to perform in the State in which the services are performed.
  • That would otherwise be covered by Medicare Part B if the services were performed by a physician or incident to a physician’s service.
  • Provided in a health professional shortage area, medically underserved area, or medically underserved population (each of which is defined within the Public Health Service Act).

Section 2(b) includes:

Amending  Section 1833(a)(1) of the Social Security Act by adding a new subsection “(AA)” to the law to define payment of “pharmacist services.”

Establishing reimbursement for these services as equal to 80% of the lesser of the actual charge or 85% of the physician fee schedule amount (established in law), if these services had been furnished by a physician.

Section 2(c) includes

Establishing an effective date of January 1, 2016.

Directing the Secretary of Health and Human Services to develop pharmacist specific codes, as necessary, under the physician fee schedule to implement this new section.

These three sections also appear in the Senate version of the Pharmacy and Medically Underserved Areas Enhancement Act  S. 314.

Next, we will look at the challenges associated with passing H.R. 592/S.314

What are the details of pending Provider Status legislation?

Post navigation

Leave a Reply

Your email address will not be published. Required fields are marked *