1.This Act may be cited as the
Medicare Patient Access to Physical
Therapists Act of 2007
.
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(ccc))
;
and
(II)by inserting or a qualified physical
therapist (as so defined)
after physician (as so
defined)
;
(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:
(ccc)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), by adding at the end the
following new paragraph:
(6)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,
2008.