[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1440 Introduced in Senate (IS)]








109th CONGRESS
  1st Session
                                S. 1440

   A bill to amend title XVIII of the Social Security Act to provide 
   coverage for cardiac rehabilitation and pulmonary rehabilitation 
                               services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 21, 2005

Mr. Crapo (for himself and Mrs. Lincoln) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   A bill to amend title XVIII of the Social Security Act to provide 
   coverage for cardiac rehabilitation and pulmonary rehabilitation 
                               services.

    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 ``Pulmonary and Cardiac Rehabilitation 
Act of 2005''.

SEC. 2. COVERAGE OF ITEMS AND SERVICES UNDER A CARDIAC REHABILITATION 
              PROGRAM AND A PULMONARY REHABILITATION PROGRAM.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) in subparagraph (Y), by striking ``and'' at the 
                end;
                    (B) in subparagraph (Z), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(AA) items and services furnished under a cardiac 
                rehabilitation program (as defined in subsection (bbb)) 
                or under a pulmonary rehabilitation program (as defined 
                in subsection (ccc)).''; and
            (2) by adding at the end the following new subsections:

                    ``Cardiac Rehabilitation Program

    ``(bbb)(1) The term `cardiac rehabilitation program' means a 
physician-supervised program (as described in paragraph (2)) that 
furnishes the items and services described in paragraph (3).
    ``(2) A program described in this paragraph is a program under 
which--
            ``(A) items and services under the program are delivered--
                    ``(i) in a physician's office;
                    ``(ii) in a physician-directed clinic; or
                    ``(iii) in a hospital on an outpatient basis;
            ``(B) a physician is immediately available and accessible 
        for medical consultation and medical emergencies at all times 
        items and services are being furnished under the program, 
        except that, in the case of items and services furnished under 
        such a program in a hospital, such availability shall be 
        presumed; and
            ``(C) individualized treatment is furnished under a written 
        plan established, reviewed, and signed by a physician every 30 
        days that describes--
                    ``(i) the patient's diagnosis;
                    ``(ii) the type, amount, frequency, and duration of 
                the items and services furnished under the plan; and
                    ``(iii) the goals set for the patient under the 
                plan.
    ``(3) The items and services described in this paragraph are--
            ``(A) physician-prescribed exercise;
            ``(B) cardiac risk factor modification, including 
        education, counseling, and behavioral intervention (to the 
        extent such education, counseling, and behavioral intervention 
        is closely related to the individual's care and treatment and 
        is tailored to the individual's needs);
            ``(C) psychosocial assessment;
            ``(D) outcomes assessment; and
            ``(E) such other items and services as the Secretary may 
        determine, but only if such items and services are--
                    ``(i) reasonable and necessary for the diagnosis or 
                active treatment of the individual's condition;
                    ``(ii) reasonably expected to improve or maintain 
                the individual's condition and functional level; and
                    ``(iii) furnished under such guidelines relating to 
                the frequency and duration of such items and services 
                as the Secretary shall establish, taking into account 
                accepted norms of medical practice and the reasonable 
                expectation of patient improvement.
    ``(4) The Secretary shall establish standards to ensure that a 
physician with expertise in the management of patients with cardiac 
pathophysiology who is licensed to practice medicine in the State in 
which a cardiac rehabilitation program is offered--
            ``(A) is responsible for such program; and
            ``(B) in consultation with appropriate staff, is involved 
        substantially in directing the progress of individual patients 
        in the program.

                   ``Pulmonary Rehabilitation Program

    ``(ccc)(1) The term `pulmonary rehabilitation program' means a 
physician-supervised program (as described in subsection (bbb)(2) with 
respect to a program under this subsection) that furnishes the items 
and services described in paragraph (2).
    ``(2) The items and services described in this paragraph are--
            ``(A) physician-prescribed exercise;
            ``(B) education or training (to the extent the education or 
        training is closely and clearly related to the individual's 
        care and treatment and is tailored to such individual's needs);
            ``(C) psychosocial assessment;
            ``(D) outcomes assessment; and
            ``(E) such other items and services as the Secretary may 
        determine, but only if such items and services are--
                    ``(i) reasonable and necessary for the diagnosis or 
                active treatment of the individual's condition;
                    ``(ii) reasonably expected to improve or maintain 
                the individual's condition and functional level; and
                    ``(iii) furnished under such guidelines relating to 
                the frequency and duration of such items and services 
                as the Secretary shall establish, taking into account 
                accepted norms of medical practice and the reasonable 
                expectation of patient improvement.
    ``(3) The Secretary shall establish standards to ensure that a 
physician with expertise in the management of patients with respiratory 
pathophysiology who is licensed to practice medicine in the State in 
which a pulmonary rehabilitation program is offered--
            ``(A) is responsible for such program; and
            ``(B) in consultation with appropriate staff, is involved 
        substantially in directing the progress of individual patients 
        in the program.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after the date of enactment 
of this Act.
                                 <all>