[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 493 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                 S. 493

 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

                           February 27, 2003

 Mrs. Lincoln (for herself, Mr. Specter, Mr. Ensign, and Ms. Landrieu) 
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 2003''.

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(ww))''; 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

    ``(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 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, 2003.
                                 <all>