H.R. 3164

[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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