[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 472 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                 S. 472

  To amend title XVIII of the Social Security Act to provide certain 
 medicare beneficiaries with an exemption to the financial limitations 
   imposed on physical, speech-language pathology, and occupational 
 therapy services under part B of the medicare program, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 25, 1999

  Mr. Grassley (for himself, Mr. Reid, Mr. Conrad, Mr. Hollings, Mr. 
    Johnson, Mr. Durbin, Ms. Collins, Mr. Daschle, and Mr. Dorgan) 
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 provide certain 
 medicare beneficiaries with an exemption to the financial limitations 
   imposed on physical, speech-language pathology, and occupational 
 therapy services under part B of the medicare program, 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 Rehabilitation Benefit 
Improvement Act of 1999''.

SEC. 2. PURPOSES.

    The purposes of this Act are as follows:
            (1) To provide certain medicare beneficiaries with an 
        exemption to the financial limitations imposed on physical, 
        speech-language pathology, and occupational therapy services 
        under section 1833(g) of the Social Security Act (42 U.S.C. 
        1395l(g)).
            (2) To direct the Secretary of Health and Human Services to 
        conduct a study on the implementation of such exemption and to 
        submit a report to Congress that includes recommendations 
        regarding alternatives to such financial limitations.

SEC. 3. ESTABLISHMENT OF EXEMPTION TO CAP ON PHYSICAL, SPEECH-LANGUAGE 
              PATHOLOGY, AND OCCUPATIONAL THERAPY SERVICES.

    (a) In General.--Section 1833(g) of the Social Security Act (42 
U.S.C. 1395l(g)) is amended by adding at the end the following:
    ``(4)(A) The limitations in this subsection shall not apply to an 
individual described in subparagraph (B).
    ``(B) An individual described in this subparagraph is an individual 
that meets any of the following criteria:
            ``(i) The individual has received services described in 
        paragraph (1) or (3) in a calendar year and is subsequently 
        diagnosed with an illness, injury, or disability that requires 
        the provision in such year of additional such services that are 
        medically necessary.
            ``(ii) The individual has a diagnosis that requires the 
        provision of services described in paragraph (1) or (3) and an 
        additional diagnosis or incident that exacerbates the 
        individual's condition, thereby requiring the provision of 
        additional such services.
            ``(iii) The individual will require hospitalization if the 
        individual does not receive the services described in paragraph 
        (1) or (3).
            ``(iv) The individual meets other criteria that the 
        Secretary determines are appropriate.
    ``(C) Nothing in this paragraph shall be construed as affecting any 
requirement for, or limitation on, payment under this title (other than 
the financial limitation under this subsection).
    ``(D) Any service that is covered under this title by reason of 
this paragraph shall be subject to the same reasonable and necessary 
requirement under section 1862(a)(1) that is applicable to the services 
described in paragraph (1) or (3) that are covered under this title 
without regard to this paragraph.''.
    (b) Conforming Amendments.--Paragraphs (1) and (3) of section 
1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) are each 
amended by striking ``In the case'' and inserting ``Subject to 
paragraph (4), in the case''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services provided on or after the date of enactment of this 
Act.

SEC. 4. STUDY AND REPORT TO CONGRESS.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study on the amendments to section 1833(g) of the Social 
Security Act (42 U.S.C. 1395l(g)) made by section 3 of this Act, 
including a study of--
            (1) the number of medicare beneficiaries that receive 
        exemptions under paragraph (4) of such section (as added by 
        section 3);
            (2) the diagnoses of such beneficiaries;
            (3) the types of physical, speech-language pathology, and 
        occupational therapy services that are covered under the 
        medicare program because of such exemptions;
            (4) the settings in which such services are provided; and
            (5) the number of medicare beneficiaries that reach the 
        financial limitation under section 1833(g) of the Social 
        Security Act in a year (without regard to the amendments to 
        such section made by section 3 of this Act) and subsequently 
        receive physical, speech-language pathology, or occupational 
        therapy services in such year at an outpatient hospital 
        department.
    (b) Report.--Not later than 2 years after the date of enactment of 
this Act, the Secretary of Health and Human Services shall submit a 
detailed report to Congress on the study conducted pursuant to 
paragraph (1), and shall include in the report recommendations 
regarding alternatives to the financial limitations on physical, 
speech-language pathology, and occupational therapy services under 
section 1833(g) of the Social Security Act and any other 
recommendations determined appropriate by the Secretary. Such report 
shall be included in the report required to be submitted to Congress 
pursuant to section 4541(d)(2) of the Balanced Budget Act of 1997 (42 
U.S.C. 1395l note).
                                 <all>