[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1770 Introduced in House (IH)]
103d CONGRESS
1st Session
H. R. 1770
To provide incentives for physicians to practice in rural areas and in
rural medically underserved areas.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 21, 1993
Mr. Rowland (for himself, Mr. Hall of Texas, Mrs. Vucanovich, Mr.
Thomas of Wyoming, Mr. Emerson, Mr. Lancaster, Mr. Roberts, Mr.
Bereuter, Mr. Slattery, Mr. Stenholm, Mr. Gunderson, Ms. Snowe, and Mr.
Durbin) introduced the following bill; which was referred jointly to
the Committees on Ways and Means, Energy and Commerce, and Education
and Labor
_______________________________________________________________________
A BILL
To provide incentives for physicians to practice in rural areas and in
rural medically underserved areas.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Rural Physicians' Incentives Act of
1993''.
SEC. 2. DEDUCTION FOR MEDICAL SCHOOL EDUCATION LOAN INTEREST INCURRED
BY DOCTORS SERVING IN MEDICALLY UNDERSERVED RURAL AREAS.
(a) In General.--Paragraph (1) of section 163(h) of the Internal
Revenue Code of 1986 (relating to disallowance of deduction for
personal interest) is amended by striking ``and'' at the end of
subparagraph (D), by redesignating subparagraph (E) as subparagraph
(F), and by inserting after subparagraph (D) the following new
subparagraph:
``(E) any qualified medical education loan interest
(within the meaning of paragraph (5)), and''.
(b) Qualified Medical Education Loan Interest Defined.--Subsection
(h) of section 163 of such Code is amended by redesignating paragraph
(5) as paragraph (6) and by inserting after paragraph (4) the following
new paragraph:
``(5) Qualified medical education loan interest.--
``(A) In general.--The term `qualified medical
education loan interest' means interest--
``(i) which is on a medical education loan
of a physician,
``(ii) which is paid or accrued by such
physician, and
``(iii) which accrues during the period--
``(I) such physician is providing
primary care (including internal
medicine, pediatrics, obstetrics/
gynecology, family medicine, and
osteopathy) to residents of a medically
underserved rural area, and
``(II) such physician's principal
place of abode is in such area.
``(B) Medical education loan.--The term `medical
education loan' means indebtedness incurred to pay the
individual's--
``(i) qualified tuition and related
expenses (as defined in section 117(b))
incurred for the medical education of such
individual, or
``(ii) reasonable living expenses while
away from home in order to attend an
educational institution described in section
170(b)(1)(A)(ii) for the medical education of
such individual.
``(C) Physician.--For purposes of subparagraph (A),
the term `physician' has the meaning given such term by
section 1861(r)(1) of the Social Security Act.
``(D) Medically underserved rural area.--The term
`medically underserved rural area' means any rural area
which is a medically underserved area (as defined in
section 330(b) or 1302(7) of the Public Health Service
Act).''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years ending after the date of the enactment of this
Act.
SEC. 3. ELIMINATION OF MEDICARE PAYMENT REDUCTIONS FOR NEW DOCTORS FOR
SERVICES FURNISHED IN ANY RURAL AREA.
(a) In General.--Section 1848(a)(4) of the Social Security Act (42
U.S.C. 1395w-4(a)(4)) is amended--
(1) by striking ``or services'' and inserting ``,
services'', and
(2) by inserting before the period at the end the
following: ``, or services furnished in a rural area (as so
defined) by (or under the supervision, or incidental to
services, of) a physician described in section 1861(r)(1)''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to services furnished after 1993.
SEC. 4. EXTENSION OF DEFERMENTS.
(a) Stafford Loans.--
(1) GSL loans.--Section 428(b)(1)(M) of the Higher
Education Act of 1965 (20 U.S.C. 1078(b)(1)(M)) is amended--
(A) by striking ``or'' at the end of clause (ii);
(B) by inserting ``or'' after the semicolon at the
end of clause (iii); and
(C) by adding at the end thereof the following new
clause:
``(iv) during which the borrower is serving
in an internship or residency program in
preparation for practice in an area of primary
care (including internal medicine, pediatrics,
obstetrics/gynecology, family medicine, and
osteopathy);''.
(2) FISL loans.--Section 427(a)(2)(C) of such Act (20
U.S.C. 1077(a)(2)(C)) is amended--
(A) by striking ``or'' at the end of clause (ii);
(B) by inserting ``or'' after the semicolon at the
end of clause (iii); and
(C) by adding at the end thereof the following new
clause:
``(iv) during which the borrower is serving
in an internship or residency program in
preparation for practice in an area of primary
care (including internal medicine, pediatrics,
obstetrics/gynecology, family medicine, and
osteopathy);''.
(b) Perkins Loans.--Section 464(c)(2)(A) of such Act (20 U.S.C.
1087dd(c)(2)(A)) is amended--
(1) by striking ``or'' at the end of clause (iii);
(2) by inserting ``or'' after the semicolon at the end of
clause (iv); and
(3) by adding at the end thereof the following new clause:
``(v) during which the borrower is serving
in an internship or residency program in
preparation for practice in an area of primary
care (including internal medicine, pediatrics,
obstetrics/gynecology, family medicine, and
osteopathy);''.
(c) Effective Date.--The amendments made by this section shall
apply to on and after the date of the enactment of this Act with
respect to loans made under the Higher Education Act of 1965 before,
on, or after that date.
SEC. 5. CLARIFICATION OF PERMISSIBLE SUBSTITUTE BILLING ARRANGEMENTS
FOR PHYSICIANS' SERVICES UNDER THE MEDICARE AND MEDICAID
PROGRAMS.
(a) Medicare Program.--
(1) In general.--Clause (D) of section 1842(b)(6) of the
Social Security Act (42 U.S.C. 1395u(b)(6)) is amended to read
as follows: ``(D)(i) payment may be made to a physician for
physicians' services (and services incident to such services)
to be provided by a second physician on a reciprocal basis to
individuals who are patients of the first physician if (I) the
first physician is unavailable to provide the services, (II)
the services are not provided by the second physician over a
continuous period of longer than 60 days, and (III) the claim
form submitted to the carrier includes the second physician's
unique identifier (provided under the system established under
subsection (r)) and indicates that the claim meets the
requirements of this clause for payment to the first physician;
and (ii) payment may be made to a physician for physicians'
services (and services incident to such services) which that
physician pays a second physician on a per diem or other fee-
for-time basis to provide to individuals who are patients of
the first physician if (I) the first physician is unavailable
to provide the services, (II) the services are not provided by
the second physician over a continuous period of longer than 90
days (or such longer period as the Secretary may provide), and
(III) the claim form submitted to the carrier includes the
second physician's unique identifier (provided under the system
established under subsection (r)) and indicates that the claim
meets the requirements of this clause for payment to the first
physician''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to services furnished on or after the first day of
the first month beginning more than 60 days after the date of
the enactment of this Act.
(b) Medicaid Program.--
(1) In general.--Section 1902(a)(32)(C) of the Social
Security Act (42 U.S.C. 1396a(a)(32)(C)) is amended to read as
follows:
``(C) payment may be made to a physician for
services furnished by a substitute physician under the
circumstances described in subparagraph (D) of section
1842(b)(6), except that, for purposes of this
subparagraph, any reference in such subparagraph to `a
carrier' or `the system established under subsection
(r)' is deemed a reference to the State (or other
fiscal agent under the State plan) and to the system
established under subsection (x) of this section,
respectively.''.
(2) Effective date.--(A) The amendment made by paragraph
(1) shall apply to services furnished on or after the date of
the enactment of this Act.
(B) Until the first day of the first calendar quarter
beginning more than 60 days after the date the Secretary of
Health and Human Services establishes the physician identifier
system under section 1902(x) of the Social Security Act, the
requirement under section 1902(a)(32)(C) of such Act that a
claim form submitted must include the second physician's unique
identifier is deemed to be satisfied if the claim form
identifies (in a manner specified by the Secretary of Health
and Human Services) the second physician.
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