Enhancing Skilled Nursing Facilities Act

Section 1814(a)(2) of the Social Security Act (42 U.S.C. 1395f(a)(2)) is amended by striking who does not and all that follows through physician,, and inserting working in accordance with State law,.

Section 1819(b)(6)(A) of the Social Security Act (42 U.S.C. 1395i–3(b)(6)(A)) is amended—

(A) in the header, by striking Physician supervision and inserting Supervision; and

(B) by inserting or a nurse practitioner or physician assistant, in accordance with State law after physician.

Section 1842(b)(2)(C) of the Social Security Act (42 U.S.C. 1395u(b)(2)(C)) is amended—

(A) by inserting, a nurse practitioner, or a physician assistant after a physician; and

(B) by striking and includes a physician assistant acting under the supervision of the physician or a nurse practitioner working in collaboration with that physician, or both.

Section 1861(s)(2)(K)(ii) of the Social Security Act (42 U.S.C. 1395x(s)(2)(K)(ii)) is amended by striking or clinical nurse specialist (as defined in subsection (aa)(5)) working in collaboration (as defined in subsection (aa)(6)) with a physician (as defined in subsection (r)(1)) and inserting (as defined in subsection (aa)(5)(A)), or by a clinical nurse specialist (as defined in subsection (aa)(5)(B)) working in collaboration with a physician (as defined in subsection (r)(1)),.

Section 1819(b)(2)(B) of the Social Security Act (42 U.S.C. 1395i–3(b)(2)(B)) is amended by inserting (or a nurse practitioner, physician assistant, or clinical nurse specialist working in accordance with State law) after attending physician.

Section 1819(c) of the Social Security Act (42 U.S.C. 1395i–3(c)) is amended—

(A) in paragraph (1)(A)(i), by inserting nurse practitioner, physician assistant, or clinical nurse specialist working in accordance with State law after attending physician;

(B) in paragraph (2)(A), in the matter following clause (vi)—

(i) by inserting nurse practitioner, physician assistant, or clinical nurse specialist working in accordance with State law after resident’s physician; and

(ii) by inserting, nurse practitioner, physician assistant, or clinical nurse specialist working in accordance with State law after a physician; and

(C) in paragraph (3)(A), by inserting, nurse practitioner, physician assistant, or clinical nurse specialist working in accordance with State law after physician.

Section 1902(a)(44) of the Social Security Act (42 U.S.C. 1396a(a)(44)) is amended—

(A) in subparagraph (A)—

(i) by striking (or, in the case of skilled nursing facility services or intermediate care facility services and inserting (or, in the case of intermediate care facility services;

(ii) by striking physician) certifies and inserting physician, or, in the case of skilled nursing facility services, a physician, or a nurse practitioner, a physician assistant, or a clinical nurse specialist working in accordance with State law) certifies;

(iii) by striking a physician, or, in the case of skilled nursing facility services or and inserting a physician, or, in the case of; and

(iv) by inserting or, in the case of skilled nursing facility services, a physician, or a nurse practitioner, a physician assistant, or a clinical nurse specialist working in accordance with State law, before recertifies; and

(B) in subparagraph (B)—

(i) by striking skilled nursing facility services or; and

(ii) by inserting, or, in the case of skilled nursing facility services, a physician, or a nurse practitioner, a physician assistant, or a clinical nurse specialist working in accordance with State law before the semicolon.

Section 1919(b)(6)(A) of the Social Security Act (42 U.S.C. 1396r(b)(6)(A)) is amended to read as follows:

(A) require that the health care of every resident be provided under the supervision of a physician or nurse practitioner or a physician assistant (or, at the option of a State, under the supervision of a clinical nurse specialist);