1.This Act may be cited as the
Medicare Patient Access to Physical
Therapists Act of 2005
.
2.Access to
outpatient physical therapy services for medicare beneficiaries as authorized
by State law
(a)
(1)Elimination of
required physician referral
(A)Definition of
outpatient physical therapy servicesSection 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(bbb))
; 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)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 therapistSection 1861 of the
Social Security Act (42 U.S.C. 1395x)
is amended by adding at the end the following new subsection:
(bbb)Qualified physical therapistThe 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)Section
1861(g) of the Social Security Act (42
U.S.C. 1395x(g)) is amended to read as follows:
(g)Outpatient occupational therapy servicesThe 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)
(A)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)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
proceduresThe 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
providersSection 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)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)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
proceduresThe 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
providersSection 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)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)The amendments made by this section shall apply to items and
services furnished on or after January 1, 2006.