Legislative Summary: H.R. 4190
H.R. 4190 will enable Medicare beneficiaries’ access to pharmacist-provided ambulatory-based patient care services under Medicare Part B by amending section 1861(s)(2) of the Social Security Act. These services would be reimbursable under Medicare Part B if they are provided in medically underserved communities and consistent with state scope of practice laws.
- Who – State-licensed pharmacists who may have additional training or certificates depending on state laws.
- What – Pharmacist services according to state scope of practice.
- Where – Medically underserved communities (i.e., Medically Underserved Areas (MUAs), Medically Underserved Populations (MUPs), or Health Professional Shortage Areas (HPSAs) as designated by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA)).
- Reimbursement – Consistent with Medicare reimbursement for other non-physician practitioners, pharmacist services would typically be reimbursed at 85% of the physician fee schedule.
Key aspects of legislation
The bill seeks to increase access and improve quality by enabling pharmacists to provide patient care services as consistent with their education, training and license. Importantly, the federal legislation would not expand the types of services that pharmacists are permitted to provide. Eligible services would continue to be governed by state laws just as they are for other health professions.
The legislation promotes increased access to care for patients who are otherwise medically underserved. Specifically, the legislation focuses on care for underserved beneficiaries in MUAs, MUPs, and HPSAs, as designated by HRSA. As the shortage of primary care physicians increases, so too will the challenges that patients in underserved communities face, especially those related to access. This legislation can help address provider shortages and access issues in underserved areas.
The bill promotes cost-effective health care by increasing access to care and opportunities for early intervention at cost-effective settings so as to minimize long-term health care costs such as those associated with preventable higher-cost conditions. Consistent with precedent established in the Social Security Act for nurse practitioners and physician assistants, pharmacist services would be reimbursed at 85% of the physician fee schedule, unless they are operating under the direct supervision of a physician, in which case they would be reimbursed at 100% of the physician fee schedule.
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