Title IV, SEC. 4022. COVERAGE OF SERVICES OF ADVANCED PRACTICE NURSES. 
      (a) Coverage. Section 1861(s)(2)(K) (42 U.S.C. 1395x(s)(2)(K)) is amended 

        (1) by striking ``and'' at the end of clause (iii); 

        (2) in clause (iv), by striking ``(i) or (ii)'' and inserting ``(i), 
      (ii), or (iv)''; 

        (3) by redesignating clause (iv) as clause (v); and 

        (4) by inserting after clause (iii) the following new clause: 

        ``(iv) services which would be physicians' services if furnished by a 
      physician (as defined in subsection (r)(1)) and which are performed by an 
      advanced practice nurse (as defined in subsection (aa)(5)) working in 
      collaboration (as defined in subsection (aa)(6)) with such a physician 
      which the advanced practice nurse is legally authorized to perform by the 
      State in which the services are performed, and''. 

      (b) Application of Payment Rules and Methodology Used for Services of 
    Nurse Practitioners and Clinical Nurse Specialists in Rural Areas. 

        (1) Direct payment. Section 1832(a)(2)(B)(iii) (42 U.S.C. 
      1395k(a)(2)(B)(iii)) is amended by striking ``1861(s)(2)(K)(i),'' and 
      inserting ``1861(s)(2)(K)(i) or section 1861(s)(2)(K)(iv),''. 

        (2) Amount of payment. Section 1833(a)(1)(O) (42 U.S.C. 
      1395l(a)(1)(M)), as amended by section 13544(b)(2)(B) of OBRA	1993, is 
      amended by striking ``rural area),'' and inserting ``rural area) or 
      section 1861(s)(2)(K)(iv) (relating to services of advanced practice 
      nurses),''. 

        (3) Mandatory assignment. The section 1833(r) added by section 
      4155(b)(3) of OBRA	1990 is amended 

        (1) in paragraph (1) 

          (A) by striking ``rural area),'' and inserting ``rural area) or 
        section 1861(s)(2)(K)(iv) (relating to services of advanced practice 
        nurses),'', and 

          (B) by striking ``nurse practitioner or clinical nurse specialist'' 
        each place it appears and inserting ``nurse practitioner, clinical 
        nurse specialist, or advanced practice nurse''; and 

        (2) by inserting ``or section 1861(s)(2)(K)(iv)'' after ``section 
      1861(s)(2)(K)(iii)'' each place it appears. 

      (c) Services Defined. Section 1861(aa)(5) (42 U.S.C. 1395x(aa)(5)) is 
    amended 

        (1) by striking ``and the term `clinical nurse specialist''' and 
      inserting ``, the term `clinical nurse specialist', and the term 
      `advanced practice nurse'''; and 

        (2) by striking ``or clinical nurse specialist'' and inserting 
      ``clinical nurse specialist, or advanced practice nurse''. 

      (d) Effective Date. The amendments made by this section shall apply to 
    services furnished on or after January 1, 1995.