[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3363 Introduced in House (IH)]







107th CONGRESS
  1st Session
                                H. R. 3363

 To amend title XVIII of the Social Security Act to authorize physical 
  therapists to diagnose, evaluate, and treat Medicare beneficiaries 
without a requirement for a physician referral, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 28, 2001

Mr. Crane  (for himself and Mr. Pomeroy) 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 authorize physical 
  therapists to diagnose, 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 2001''.

SEC. 2. ACCESS TO OUTPATIENT PHYSICAL THERAPY SERVICES FOR MEDICARE 
              BENEFICIARIES.

    (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 inserting ``(as defined in 
                                section 1861(ww))'' after ``qualified 
                                physical therapist''; and
                                    (II) by inserting ``or a qualified 
                                physical therapist'' after 
                                ``physician'' the second place it 
                                appears;
                            (iv) in paragraph (4)(A)(ii), by striking 
                        ``including one or more'' and all that follows 
                        through ``agency) and'' and inserting 
                        ``including''; and
                            (v) in the fifth sentence, by striking 
                        ``with respect to outpatients who are not 
                        entitled to benefits under this title'' and 
                        inserting ``or as authorizing the Secretary to 
                        require''.
                    (B) Conforming amendments.--Section 1835(a)(2) of 
                such 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 outpatient 
                                comprehensive 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 outpatient 
                                comprehensive rehabilitation facility 
                                services not consisting of physical 
                                therapy services,'' before ``such 
                                services''.
            (2) Definition of qualified physical therapist.--Section 
        1861 of such Act (42 U.S.C. 1395x) is amended by adding at the 
        end the following new subsection:
    ``(ww) 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 education and 
training requirements under paragraph (1) or (2):
            ``(1) With respect to years beginning with 2003, except as 
        provided in paragraph (2), the individual has received a 
        master's or doctoral degree from a professional physical 
        therapy education program that has been accredited by a 
        national accreditation agency recognized by the Secretary of 
        Education.
            ``(2) The requirement of paragraph (1) shall not apply to 
        an individual who, before 2003, meets one of the following 
        requirements:
                    ``(A) The individual has graduated from a physical 
                therapy curriculum approved by the American Physical 
                Therapy Association or the Council on Medical Education 
                and Hospitals of the American Medical Association, or 
                both.
                    ``(B) Before 1966, the individual--
                            ``(i) was admitted to membership by the 
                        American Physical Therapy Association;
                            ``(ii) was admitted to registration by the 
                        American Registry of Physical Therapist; or
                            ``(iii) graduated from a physical therapy 
                        curriculum in a 4-year college or university 
                        approved by a State department of education.
                    ``(C) The individual has 2 years of appropriate 
                experience as determined by the Secretary as a physical 
                therapist and, in the case of such an individual who 
                was initially licensed by a State as a physical 
                therapist before December 31, 1977, or seeking 
                qualification as a physical therapist before such date, 
                has achieved a satisfactory grade on a proficiency 
                examination approved by the Secretary.
                    ``(D) The individual--
                            ``(i) was licensed or registered as a 
                        physical therapist before January 1, 1966; and
                            ``(ii) had 15 years of full-time experience 
                        in the treatment of illness or injury through 
                        the practice of physical therapy in which 
                        services were rendered under the order and 
                        direction of an attending or referring 
                        physician (as defined in subsection (r)(1)) 
                        before January 1, 1970.
                    ``(E) In the case of an individual trained outside 
                of the United States, the individual--
                            ``(i) has graduated before January 1, 2003, 
                        from a physical therapy curriculum approved by 
                        the country in which the curriculum was located 
                        and in which there is a member organization of 
                        the World Conference for Physical Therapy;
                            ``(ii) meets the requirements for 
                        membership in a member organization of the 
                        World Conference for Physical Therapy;
                            ``(iii) has 1 year of experience under the 
                        supervision of an active member of the American 
                        Physical Therapy Association; and
                            ``(iv) has successfully completed an 
                        examination prescribed by the American Physical 
                        Therapy Association.''.
    (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:
    ``(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 
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 
                such 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 
                such 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 such 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 defined therein) 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 such 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 defined therein) 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 further 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 such 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:
            ``(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 such Act (42 U.S.C. 1395n(a)), as amended by 
        subsection (b)(2)(C), is further 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 such 
        Act (42 U.S.C. 1395cc(e)(1)), as amended by subsection 
        (b)(2)(D), is further 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 such 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:
            ``(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, 2002.
                                 <all>