Rural Physicians' Incentives Act of 1991

Rural Physicians' Incentives Act of 1991 - Amends the Internal Revenue Code to allow a deduction on medical education loan interest of a physician which accrues while the physician is living in and providing primary care to residents of a medically underserved rural area.

Amends title XVIII (Medicare) of the Social Security Act to exempt services furnished in a rural area from a special fee schedule applicable to new physicians.

Amends the Higher Education Act of 1965 to extend beyond the normal two-year limit, for borrowers serving an internship or residency program in preparation for practice in an area of primary care, the deferral of payments on: (1) insured student loans (Stafford Loans), including those eligible for interest subsidies; and (2) low-interest student loans (Perkins Loans).

Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to modify provisions setting forth requirements concerning billing by one physician for services rendered by another physician in specified circumstances.

 
HR 2230 IH
102d CONGRESS
1st Session
 H. R. 2230
To provide incentives for physicians to practice in rural areas and in rural
medically underserved areas.
IN THE HOUSE OF REPRESENTATIVES
May 7, 1991
Mr. ROWLAND (for himself, Mr. STENHOLM, Mr. ROBERTS, Mr. PENNY, Mr. ENGLISH,
Mr. SLATTERY, Mr. POSHARD, Mr. GUNDERSON, Mr. SYNAR, Mr. MCCLOSKEY,
Mr. KLUG, Mr. BRUCE, Mr. JOHNSON of South Dakota, Mr. EVANS, Mrs. VUCANOVICH,
Mr. BOUCHER, Mr. BARRETT, Mr. ORTIZ, Mr. BEREUTER, Mr. EMERSON, Mr. SKELTON,
Mr. WILSON, Mr. KOPETSKI, Mr. SWETT, Mr. ALEXANDER, Mr. HALL of Texas,
Mr. ROGERS, Ms. BYRON, Mr. THOMAS of Wyoming, Mr. DORGAN of North Dakota,
Mr. LANCASTER, Mr. SMITH of Texas, Mr. NUSSLE, Mr. COMBEST, and Mr. WILLIAMS)
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 1991'.
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)), added by section 4106(b)(1) of the Omnibus Budget
  Reconciliation Act of 1990, 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 incidential 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 1991.
SEC. 4. EXTENSION OF DEFERMENTS.
  (a) STAFFORD LOANS-
  (1) GSL LOANS- Section 428(b)(1)(M)(vii) of the Higher Education Act of 1965
  (20 U.S.C. 1078(b)(1)(M)) is amended by inserting before the semicolon at the
  end thereof the following: `, except that the two-year limitation of this
  clause shall not apply in the case of a borrower serving 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)(vii) of such Act (20
  U.S.C. 1077(a)(2)(C)(vii)) is amended by inserting before the semicolon at
  the end thereof the following: `, except that the two-year limitation of this
  clause shall not apply in the case of a borrower serving 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)(vi) of such Act (20
  U.S.C. 1087dd(c)(2)(A)(vi)) is amended by inserting before the semicolon at
  the end thereof the following: `, except that the two-year limitation of this
  clause shall not apply in the case of a borrower serving 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 on and
  after the date of 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)), as inserted by section 4110(a)(2) of the
  Omnibus Budget Reconciliation Act of 1990, 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)), as added by section 4708(a)(3) of the Omnibus
  Budget Reconciliation Act of 1990, 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.