[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3164 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 3164
To amend title XVIII of the Social Security Act to provide pharmacy
payment of certain services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 1, 2025
Mr. Smith of Nebraska (for himself, Mr. Schneider, Mrs. Harshbarger,
and Ms. Matsui) 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.
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 ``Ensuring Community Access to
Pharmacist Services Act''.
SEC. 2. COVERAGE OF PHARMACIST SERVICES UNDER MEDICARE PART B.
(a) Coverage.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended--
(1) in subsection (s)(2)--
(A) in subparagraph (JJ), by adding ``and'' at the
end; and
(B) by adding at the end the following new
subparagraph:
``(KK) pharmacist services (as defined in subsection
(nnn));''; and
(2) by adding at the end the following new subsection:
``(nnn) Pharmacist Services.--
``(1) In general.--The term `pharmacist services' means
such services furnished by a pharmacist, and such services and
supplies furnished as an incident to the pharmacist's service,
which the pharmacist is legally authorized to perform under
State law as would otherwise be covered if furnished by a
physician or as an incident to a physicians' service which--
``(A) in the case such State law requires such
services to be furnished under the supervision of, or
working in collaboration with, a physician or
practitioner (as defined in section 1842(b)(18)(C)(i)),
are so furnished under the supervision of, or working
in collaboration with, such physician or practitioner
in the manner and to the extent as so required by such
State law; and
``(B) are--
``(i) for visits for the evaluation and
management of individuals for testing or
treatment for COVID-19, influenza, respiratory
syncytial virus, or streptococcal pharyngitis;
or
``(ii) testing or treatment services that
address a public health need related to a
public health emergency declared under section
319 of the Public Health Service Act (as
determined by the Secretary).
``(2) Collaboration.--For purposes of this subsection, the
term `collaboration' means a process in which a pharmacist
works with a physician or practitioner (as defined in section
1842(b)(18)(C)(i)), as applicable, to deliver health care
services within the scope of the pharmacist's professional
expertise, with medical direction and appropriate supervision
as provided for in jointly developed guidelines or other
mechanisms as defined by the law of the State in which the
services are performed.''.
(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 (as
defined in section 1861(nnn)), 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 that address a public health need described in
paragraph (2)(B) 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) of the Social Security Act (42 U.S.C. 1395u(b)(18))
is amended--
(1) in subparagraph (A), by inserting ``or a pharmacist''
after ``a practitioner described in subparagraph (C)''; and
(2) in subparagraph (B)--
(A) in the first sentence, by inserting ``, a
pharmacist,'' after ``a practitioner described in
subparagraph (C)''; and
(B) in the third sentence--
(i) by inserting ``, a pharmacist,'' after
``a practitioner''; and
(ii) by inserting ``, the pharmacist,''
after ``the practitioner''.
(d) Application.--The amendments made by this section shall apply
to items and services furnished on or after January 1, 2026.
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