Coverage of certified athletic trainer services and certified lymphedema therapist services under part B of the medicare program

(a)

Coverage of services

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (1)in subsection (s)(2)— (A)in subparagraph (Z), by striking and at the end; (B)in subparagraph (AA), by adding and at the end; and (C)by adding at the end the following new subparagraph:

(BB)certified athletic trainer services (as defined in subsection (ccc)(1)) and lymphedema therapist services (as defined in subsection (ccc)(3)).

; and

(2)by adding at the end the following new subsection:

(ccc)

Athletic trainer services and lymphedema therapist services

(1)The term athletic trainer services means services performed by a certified athletic trainer (as defined in paragraph (2)) under the supervision of a physician (as defined in section 1861(r)), which the athletic trainer is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician (as so defined) or as an incident to a physician's professional service, to an individual— (A)who is under the care of a physician (as so defined); and (B)with respect to whom a plan prescribing the type, amount, and duration of services that are to be furnished to such individual has been established by a physician (as so defined).

Such term does not include any services for which a facility or other provider charges or is paid any amounts with respect to the furnishing of such services.

(2)The term certified athletic trainer means an individual who— (A)possesses a bachelor’s, master's, or doctoral degree which qualifies for licensure or certification as an athletic trainer; and (B)in the case of an individual performing services in a State that provides for licensure or certification of athletic trainers, is licensed or certified as an athletic trainer in such State. (3)The term certified lymphedema therapist services means services performed by a certified lymphedema therapist (as defined in paragraph (4)) under the supervision of a physician (as defined by paragraph (1) or (3) of section 1861(r)) which the lymphedema therapist is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician (as so defined) or as incident to a physicians professional service, to an individual— (A)who is under the care of a physician (as so defined); and (B)with respect to whom a plan prescribing the type, amount, and duration of services that are to be furnished to such individual has been established by a physician (as so defined).

Such term does not include any services for which a facility or other provider charges or is paid any amounts with respect to the furnishing of such services

(4)The term certified lymphedema therapist means an individual who— (A)possesses a current unrestricted license as a health professional in the State in which he or she practices; (B)after obtaining such a license, has successfully completed 135 hours of Complete Decongestive Therapy coursework which consists of theoretical instruction and practical laboratory work utilizing teaching methods directly aimed at the treatment of lymphatic and vascular disease from a lymphedema training program recognized by the Secretary for purposes of certifying lymphedema therapists; and (C)in the case of an individual performing services in a State that provides for licensure or certification of lymphedema therapists, is licensed or certified as a lymphedema therapist in such State.

(b)

Payment

(1)

In general

Section 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)) is amended by adding at the end the following new clause:

(v)athletic trainer services and lymphedema therapist services; and

(2)

Amount

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— (A)by striking and (V) and inserting (V); and (B)by inserting before the semicolon at the end the following: , and (W) with respect to athletic trainer services and lymphedema therapist services under section 1861(s)(2)(BB), the amounts paid shall be 80 percent of the lesser of the actual charge for the service or the fee schedule amount under section 1848 for the same service performed by a physician. (c)

Inclusion of services in the therapy cap

Services provided by a certified athletic trainer or a certified lymphedema therapist (as those terms are defined in section 1861(ccc) of the Social Security Act, as added by subsection (a)) shall be subject to the limitation on payments described in section 1833(g) of such Act (42 U.S.C. 1395l(g)) in the same manner those services would be subject to limitation if the service had been provided by a physician personally. (d)

Inclusion of athletic trainers and lymphedema therapists as practitioners for assignment of claims

Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C.1395u(b)(18)(C)) is amended by adding at the end the following new clauses:

(vii)A certified athletic trainer (as defined in section 1861(ccc)(1)). (viii)A certified lymphedema therapist (as defined in section 1861(ccc)(2)).

(e)

Coverage of certain physical medicine and rehabilitation services provided in rural health clinics and federally qualified health centers

Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking or by a clinical social worker (as defined in subsection (hh)(1)) and inserting , by a clinical social worker (as defined in subsection (hh)(1)), by a certified athletic trainer (as defined in subsection (ccc)(2)), or by a certified lymphedema therapist (as defined in subsection (ccc)(4)). (f)

Effective date

The amendments made by this section shall apply with respect to services furnished on or after January 1, 2007.