1.This Act may be cited as the
Pulmonary and Cardiac Rehabilitation
Act of 2005
.
2.Coverage of items and
services under a cardiac rehabilitation program and a pulmonary rehabilitation
program
(a)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:
(bbb)Cardiac rehabilitation program(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.
(ccc)Pulmonary rehabilitation
program(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)The amendments made by
this section shall apply to items and services furnished on or after the date
of enactment of this Act.