Provides for treatment of outpatient speech-language pathology services separately from outpatient physical therapy services.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 647 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 647
To amend title XVIII of the Social Security Act to authorize physical
therapists to evaluate and treat medicare beneficiaries without a
requirement for a physician referral, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 17, 2005
Mrs. Lincoln (for herself, Mr. Specter, Mr. Ensign, Ms. Landrieu, and
Mr. Dayton) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to authorize physical
therapists to evaluate and treat medicare beneficiaries without a
requirement for a physician referral, and for other purposes.
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 ``Medicare Patient Access to Physical
Therapists Act of 2005''.
SEC. 2. ACCESS TO OUTPATIENT PHYSICAL THERAPY SERVICES FOR MEDICARE
BENEFICIARIES AS AUTHORIZED BY STATE LAW.
(a) In General.--
(1) Elimination of required physician referral.--
(A) Definition of outpatient physical therapy
services.--Section 1861(p) of the Social Security Act
(42 U.S.C. 1395x(p)) is amended--
(i) in the matter preceding paragraph (1),
by striking ``as an outpatient'';
(ii) by amending paragraph (1) to read as
follows:
``(1) who is an outpatient, and'';
(iii) in paragraph (2)--
(I) by striking ``physician (as so
defined) or by a qualified physical
therapist'' and inserting ``physician
(as defined in paragraph (1), (3), or
(4) of subsection (r)) or by a
qualified physical therapist (as
defined in section 1861(bbb))''; and
(II) by inserting ``or a qualified
physical therapist (as so defined)''
after ``physician'' the second place it
appears;
(iv) in paragraph (4)(A)(ii), by striking
``one or more'' and all that follows through
``agency) and''; and
(v) by amending the fifth sentence to read
as follows: ``Nothing in this subsection shall
be construed as authorizing the provision of
services in a State that a qualified physical
therapist is not authorized to provide in the
State in accordance with State law (or the
State regulatory mechanism provided by State
law).
(B) Conforming amendments.--Section 1835(a)(2) of
the Social Security Act (42 U.S.C. 1395n(a)(2)) is
amended--
(i) in the matter preceding subparagraph
(A), by inserting ``, or in the case of
outpatient physical therapy services (as
described in subparagraph (C)) and physical
therapy services furnished as comprehensive
outpatient rehabilitation facility services
(described in subparagraph (E)), a qualified
physical therapist,'' after ``a physician'';
(ii) in subparagraph (C)--
(I) in the matter preceding clause
(i), by striking ``or outpatient
occupational therapy services'';
(II) in clause (i), by striking
``or occupational therapy services,
respectively,'' and inserting ``,
and'';
(III) in clause (ii), by striking
``or qualified occupational therapist,
respectively,''; and
(IV) beginning in clause (ii), by
striking ``by a physician, and (iii)''
and all that follows and inserting ``by
a physician or a qualified physical
therapist;'';
(iii) in subparagraph (D)--
(I) in the matter preceding clause
(i), by striking ``outpatient speech
pathology services'' and inserting
``outpatient occupational therapy
services or outpatient speech-language
pathology services'';
(II) in clause (i), by striking
``needed speech pathology services''
and inserting ``needed occupational
therapy services or speech-language
pathology services, respectively''; and
(III) in clause (ii), by striking
``speech pathologist'' and inserting
``occupational therapist or speech-
language pathologist, respectively,'';
and
(iv) in subparagraph (E)--
(I) in clause (ii), by inserting
``(or, in the case of comprehensive
outpatient rehabilitation facility
services consisting of physical therapy
services, by a qualified physical
therapist)'' after ``physician''; and
(II) in clause (iii), by inserting
``in the case of comprehensive
outpatient rehabilitation facility
services not consisting of physical
therapy services,'' before ``such
services''.
(2) Definition of qualified physical therapist.--Section
1861 of the Social Security Act (42 U.S.C. 1395x) is amended by
adding at the end the following new subsection:
``Qualified Physical Therapist
``(bbb) The term `qualified physical therapist' means an individual
who is licensed as a physical therapist by the State in which such
individual is practicing and who meets the applicable requirements
under paragraph (1) or (2):
``(1) With respect to individuals graduating from a
professional physical therapy education program on or after
January 1, 2003, the individual--
``(A) has received a master's or doctoral degree
from a professional physical therapy education program
that has been accredited by a national physical therapy
education accreditation agency recognized by the
Secretary of Education; or
``(B) has graduated from a professional physical
therapy education program outside the United States
with a curriculum that is substantially equivalent (as
determined by an accreditation agency described in
subparagraph (A)) to the curricula of programs for
professional physical therapy education programs in the
United States that are accredited by such an
accreditation agency.
``(2) With respect to individuals licensed as physical
therapists by a State before 2003, the individual was, or upon
application to the Secretary could have been, qualified under
regulations of the Secretary in effect before such date to
furnish physical therapy services under this title, as
determined by the Secretary.''.
(b) Preserving Existing Law for Outpatient Occupational Therapy
Services.--
(1) Definition.--Section 1861(g) of the Social Security Act
(42 U.S.C. 1395x(g)) is amended to read as follows:
``Outpatient Occupational Therapy Services
``(g) The term `outpatient occupational therapy services' means
occupational therapy services furnished by a provider of services, a
clinic, a rehabilitation agency, or a public health agency, or by
others under an arrangement with, and under the supervision of, such a
provider, clinic, rehabilitation agency, or public health agency to an
individual as an outpatient--
``(1) who is under the care of a physician (as defined in
paragraph (1), (3), or (4) of subsection (r));
``(2) with respect to whom a plan prescribing the type,
amount, and duration of occupational therapy services that are
furnished to such individual has been established by a
physician (as so defined) or by an occupational therapist and
is periodically reviewed by a physician (as so defined);
excluding, however--
``(3) any item or service if it would not be included under
subsection (b) if furnished to an inpatient of a hospital; and
``(4) any such service--
``(A) if furnished by a clinic, rehabilitation
agency, or by others under arrangements with such
clinic or agency, unless such clinic or rehabilitation
agency--
``(i) provides an adequate program of
occupational therapy services for outpatients
and has the facilities and personnel required
for such program or required for the
supervision of such a program, in accordance
with such requirements as the Secretary may
specify;
``(ii) has policies, established by a group
of professional personnel, including one or
more occupational therapists, to govern the
services (referred to in clause (i)) it
provides;
``(iii) maintains clinical records on all
patients;
``(iv) if such clinic or agency is situated
in a State in which State or applicable local
law provides for the licensing of institutions
of this nature--
``(I) is licensed pursuant to such
law, or
``(II) is approved by the agency of
such State or locality responsible for
licensing institutions of this nature,
as meeting the standards established
for such licensing; and
``(v) meets such other conditions relating
to the health and safety of individuals who are
furnished services by such clinic or agency on
an outpatient basis, as the Secretary may find
necessary, and provides the Secretary on a
continuing basis with a surety bond that is not
less than $50,000; or
``(B) if furnished by a public health agency,
unless such agency meets such other conditions relating
to the safety of individuals who are furnished services
by such agency on an outpatient basis, as the Secretary
may find necessary.
The term `outpatient occupational therapy services' also includes
occupational therapy services furnished an individual by an
occupational therapist (in the office of the occupational therapist or
in such individual's home) who meets licensing and other standards
prescribed by the Secretary in regulations, otherwise than under an
arrangement with and under the supervision of a provider of services,
clinic, rehabilitation agency, or public health agency, if the
furnishing of such services meets such conditions relating to health
and safety as the Secretary may find necessary. In addition, such term
includes occupational therapy services that meet the requirements of
the first sentence of this subsection except that they are furnished to
an inpatient of a hospital or extended care facility. Nothing in this
subsection shall be construed as requiring, with respect to outpatients
who are not entitled to benefits under this title, an occupational
therapist to provide outpatient occupational therapy services only to
outpatients who are under the care of a physician or pursuant to a plan
of care established by a physician. The Secretary may waive the
requirement of a surety bond under paragraph (4)(A)(v) in the case of a
clinic or agency that provides a comparable surety bond under State
law.''.
(2) Conforming amendments.--
(A) Scope of benefits.--Section 1832(a)(2)(C) of
the Social Security Act (42 U.S.C. 1395k(a)(2)(C)) is
amended by striking ``such sentence applies through the
operation of section 1861(g))'' and inserting ``the
second sentence of section 1861(g) applies)''.
(B) Payment of benefits.--Section 1833(g)(3) of the
Social Security Act (42 U.S.C. 1395l(g)(3)) is amended
by striking ``section 1861(p)'' and all that follows
through ``section 1861(g)'' and inserting ``section
1861(g) (but not described in subsection (a)(8)(B))''.
(C) Provider claims procedures.--The second
sentence of section 1835(a) of the Social Security Act
(42 U.S.C. 1395n(a)) is amended--
(i) by striking ``section 1861(p)(4)(A) (or
meets the requirements of such section through
the operation of section 1861(g))'' and
inserting ``section 1861(p)(4)(A) or section
1861(g)(4)(A)'';
(ii) by striking ``section 1861(p)(4)(B)
(or meets the requirements of such section
through the operation of section 1861(g))'' and
inserting ``section 1861(p)(4)(B) or section
1861(g)(4)(B)''; and
(iii) by striking ``(as therein defined) or
(through the operation of section 1861(g)) with
respect to the furnishing of outpatient
occupational therapy services'' and inserting
``(as defined in section 1861(p)) or outpatient
occupational therapy services (as defined in
section 1861(g)), respectively''.
(D) Agreements with providers.--Section 1866(e)(1)
of the Social Security Act (42 U.S.C. 1395cc(e)(1)) is
amended--
(i) by striking ``section 1861(p)(4)(A) (or
meets the requirements of such section through
the operation of section 1861(g))'' and
inserting ``section 1861(p)(4)(A) or section
1861(g)(4)(A)'';
(ii) by striking ``section 1861(p)(4)(B)
(or meets the requirements of such section
through the operation of section 1861(g))'' and
inserting ``section 1861(p)(4)(B) or section
1861(g)(4)(B)''; and
(iii) by striking ``(as therein defined) or
(through the operation of section 1861(g)) with
respect to the furnishing of outpatient
occupational therapy services'' and inserting
``(as defined in section 1861(p)) or outpatient
occupational therapy services (as defined in
section 1861(g)), respectively''.
(c) Separate Statutory Treatment for Outpatient Physical Therapy
Services and Outpatient Speech-language Pathology Services.--
(1) Scope of benefits.--Section 1832(a)(2)(C) of the Social
Security Act (42 U.S.C. 1395k(a)(2)(C)), as amended by
subsection (b)(2)(A), is amended--
(A) by striking ``and outpatient'' and inserting
``, outpatient''; and
(B) by inserting before the semicolon the
following: ``, and outpatient speech-language pathology
services''.
(2) Payment of benefits.--Section 1833 of the Social
Security Act (42 U.S.C. 1395l) is amended--
(A) in subparagraphs (A) and (B) of subsection
(a)(8), by striking ``services, (which includes
outpatient speech-language pathology services) and
outpatient occupational therapy services'' each place
it appears and inserting ``services, outpatient
occupational therapy services, and outpatient speech-
language pathology services''; and
(B) in subsection (g)--
(i) in paragraphs (1) and (3), by striking
``paragraph (4)'' each place it appears and
inserting ``paragraph (5)''; and
(ii) by redesignating paragraph (4) as
paragraph (5) and inserting after paragraph (3)
the following new paragraph:
``(4) Subject to paragraph (5), in the case of speech-
language pathology services (of the type described in section
1861(ll)(4) (but not described in subsection (a)(8)(B)) and
speech-language pathology services of such type that are
furnished by a physician or as incident to physicians'
services), with respect to expenses incurred in any calendar
year, no more than the amount specified in paragraph (2) for
the year shall be considered as incurred expenses for purposes
of subsections (a) and (b).''.
(3) Provider claims procedures.--The second sentence of
section 1835(a) of the Social Security Act (42 U.S.C.
1395n(a)), as amended by subsection (b)(2)(C), is amended--
(A) by striking ``or section 1861(g)(4)(A)'' and
inserting ``, section 1861(g)(4)(A), or section
1861(ll)(5)(A)'';
(B) by striking ``or section 1861(g)(4)(B)'' and
inserting ``, section 1861(g)(4)(B), or section
1861(ll)(4)(B)(ii)(II)''; and
(C) by striking ``or outpatient occupational
services (as defined in section 1861(g))'' and
inserting ``, outpatient occupational services (as
defined in section 1861(g)), or outpatient speech-
language pathology services (as defined in section
1861(ll)(4)(A))''.
(4) Agreements with providers.--Section 1866(e)(1) of the
Social Security Act (42 U.S.C. 1395cc(e)(1)), as amended by
subsection (b)(2)(D), is amended--
(A) by striking ``or section 1861(g)(4)(A)'' and
inserting 1861(g)(4)(A), or section 1861(ll)(5)(A)'';
(B) by striking ``or section 1861(g)(4)(B)'' and
inserting ``, section 1861(g)(4)(B), or section
1861(ll)(4)(B)(ii)(II)''; and
(C) by striking ``or outpatient occupational
services (as defined in section 1861(g))'' and
inserting ``, outpatient occupational services (as
defined in section 1861(g)), or outpatient speech-
language pathology services (as defined in section
1861(ll)(4)(A))''.
(5) Definitions.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended--
(A) in subsection (p), by striking the fourth
sentence;
(B) in subsection (s)(2)(D), by striking ``services
and outpatient occupational therapy services'' and
inserting ``services, outpatient occupational therapy
services, and outpatient speech-language pathology
services''; and
(C) in subsection (ll), by adding at the end the
following new paragraphs:
``(4)(A) Subject to subparagraph (B), the term `outpatient speech-
language pathology services' means speech-language pathology services
that are furnished by a provider of services, a clinic, a
rehabilitation agency, or a public health agency, or by others under an
arrangement with, and under the supervision of, such provider, clinic,
rehabilitation agency, or public health agency to an individual as an
outpatient--
``(i) who is under the care of a physician (as defined in
paragraph (1), (3), or (4) of subsection (r)); and
``(ii) with respect to whom a plan prescribing the type,
amount, and duration of speech-language pathology services that
are furnished to such individual has been established by a
physician (as so defined) or by a qualified speech-language
pathologist and is periodically reviewed by a physician (as so
defined).
``(B) Such term does not include--
``(i) any item or service if it would not be included under
subsection (b) if furnished to an inpatient of a hospital; or
``(ii) any item or service--
``(I) if furnished by a clinic, rehabilitation
agency, or by others under arrangements with such
clinic or agency, unless such clinic or rehabilitation
agency meets the requirements of paragraph (5); and
``(II) if furnished by a public health agency,
unless such agency meets such other conditions relating
to the safety of individuals who are furnished services
by such agency on an outpatient basis, as the Secretary
may find necessary.
``(C) Such term also includes speech-language pathology services
that meet the requirements of the preceding sentence except that they
are furnished to an inpatient of a hospital or extended care facility.
Nothing in this subsection shall be construed as requiring, with
respect to outpatients who are not entitled to benefits under this
title, a speech-language pathologist to provide outpatient speech-
language pathology services only to outpatients who are under the care
of a physician or pursuant to a plan of care established by a
physician. The Secretary may waive the requirement of a surety bond
under paragraph (5)(E) in the case of a clinic or agency that provides
a comparable surety bond under State law.
``(5) A clinic or rehabilitation agency meets the requirements of
this paragraph if it--
``(A) provides an adequate program of speech-language
pathology services for outpatients and has the facilities and
personnel required for such program or required for the
supervision of such a program, in accordance with such
requirements as the Secretary may specify;
``(B) has policies, established by a group of professional
personnel, including one or more speech-language pathologists,
to govern the services (referred to in subparagraph (A)) it
provides;
``(C) maintains clinical records on all patients;
``(D) in the case of a clinic or agency that is situated in
a State in which State or applicable local law provides for the
licensing of institutions of this nature--
``(i) is licensed pursuant to such law, or
``(ii) is approved by the agency of such State or
locality responsible for licensing institutions of this
nature, as meeting the standards established for such
licensing; and
``(E) meets such other conditions relating to the health
and safety of individuals who are furnished services by such
clinic or agency on an outpatient basis, as the Secretary may
find necessary, and provides the Secretary on a continuing
basis with a surety bond that is not less than $50,000.''.
(d) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2006.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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