[Congressional Record Volume 149, Number 76 (Wednesday, May 21, 2003)]
[Senate]
[Pages S6858-S6859]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SUNUNU (for himself, Mr. Kerry, Mr. Stevens, Mr. McCain, 
        Mrs. Lincoln, Ms. Collins, Mr. Bunning, Mr. Miller, Mr. 
        Specter, Mr. Rockefeller, Ms. Cantwell, Mr. Kennedy, Ms. 
        Landrieu, Mr. Burns, and Mr. Allen):
  S. 1095. A bill to amend title XVIII of the Social Security Act to 
improve outpatient vision services under part B of the medicare 
program; to the Committee on Finance.
  Mr. SUNUNU. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1095

       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 ``Medicare Vision 
     Rehabilitation Services Act of 2003''.

     SEC. 2. IMPROVEMENT OF OUTPATIENT VISION SERVICES UNDER PART 
                   B.

       (a) Coverage Under Part B.--Section 1861(s)(2) of the 
     Social Security Act (42 U.S.C. 1395x(s)(2)) is amended--
       (1) in subparagraph (U), by striking ``and'' after the 
     semicolon at the end;
       (2) in subparagraph (V)(iii), by adding ``and'' after the 
     semicolon at the end; and
       (3) by adding at the end the following new subparagraph:
       ``(W) vision rehabilitation services (as defined in 
     subsection (ww)(1));''.
       (b) Services Described.--Section 1861 of the Social 
     Security Act (42 U.S.C. 1395x) is amended by adding at the 
     end the following new subsection:

  ``Vision Rehabilitation Services: Vision Rehabilitation Professional

       ``(ww)(1)(A) The term `vision rehabilitation services' 
     means rehabilitative services (as determined by the Secretary 
     in regulations) furnished--
       ``(i) to an individual diagnosed with a vision impairment 
     (as defined in paragraph (6));
       ``(ii) pursuant to a plan of care established by a 
     qualified physician (as defined in subparagraph (C)) or by a 
     qualified occupational therapist that is periodically 
     reviewed by a qualified physician;
       ``(iii) in an appropriate setting (including the home of 
     the individual receiving such services if specified in the 
     plan of care); and
       ``(iv) by any of the following individuals:
       ``(I) A qualified physician.
       ``(II) A qualified occupational therapist.
       ``(III) A vision rehabilitation professional (as defined in 
     paragraph (2)) while under the general supervision (as 
     defined in subparagraph (D)) of a qualified physician.
       ``(B) In the case of vision rehabilitation services 
     furnished by a vision rehabilitation professional, the plan 
     of care may only be established and reviewed by a qualified 
     physician.
       ``(C) The term `qualified physician' means--
       ``(i) a physician (as defined in subsection (r)(1)) who is 
     an ophthalmologist; or
       ``(ii) a physician (as defined in subsection (r)(4) 
     (relating to a doctor of optometry)).
       ``(D) The term `general supervision' means, with respect to 
     a vision rehabilitation professional, overall direction and 
     control of that professional by the qualified physician who 
     established the plan of care for the individual, but the 
     presence of the qualified physician is not required during 
     the furnishing of vision rehabilitation services by that 
     professional to the individual.
       ``(2) The term `vision rehabilitation professional' means 
     any of the following individuals:
       ``(A) An orientation and mobility specialist (as defined in 
     paragraph (3)).
       ``(B) A rehabilitation teacher (as defined in paragraph 
     (4)).
       ``(C) A low vision therapist (as defined in paragraph (5)).
       ``(3) The term `orientation and mobility specialist' means 
     an individual who--
       ``(A) if a State requires licensure or certification of 
     orientation and mobility specialists, is licensed or 
     certified by that State as an orientation and mobility 
     specialist;
       ``(B)(i) holds a baccalaureate or higher degree from an 
     accredited college or university in the United States (or an 
     equivalent foreign degree) with a concentration in 
     orientation and mobility; and
       ``(ii) has successfully completed 350 hours of clinical 
     practicum under the supervision of an orientation and 
     mobility specialist and has furnished not less than 9 months 
     of supervised full-time orientation and mobility services;
       ``(C) has successfully completed the national examination 
     in orientation and mobility administered by the Academy for 
     Certification of Vision Rehabilitation and Education 
     Professionals; and
       ``(D) meets such other criteria as the Secretary 
     establishes.
       ``(4) The term `rehabilitation teacher' means an individual 
     who--
       ``(A) if a State requires licensure or certification of 
     rehabilitation teachers, is licensed or certified by the 
     State as a rehabilitation teacher;
       ``(B)(i) holds a baccalaureate or higher degree from an 
     accredited college or university in the United States (or an 
     equivalent foreign degree) with a concentration in 
     rehabilitation teaching, or holds such a degree in a 
     health field; and
       ``(ii) has successfully completed 350 hours of clinical 
     practicum under the supervision of a rehabilitation teacher 
     and has furnished not less than 9 months of supervised full-
     time rehabilitation teaching services;
       ``(C) has successfully completed the national examination 
     in rehabilitation teaching administered by the Academy for 
     Certification of Vision Rehabilitation and Education 
     Professionals; and
       ``(D) meets such other criteria as the Secretary 
     establishes.
       ``(5) The term `low vision therapist' means an individual 
     who--
       ``(A) if a State requires licensure or certification of low 
     vision therapists, is licensed or certified by the State as a 
     low vision therapist;
       ``(B)(i) holds a baccalaureate or higher degree from an 
     accredited college or university in the United States (or an 
     equivalent foreign degree) with a concentration in low vision 
     therapy, or holds such a degree in a health field; and
       ``(ii) has successfully completed 350 hours of clinical 
     practicum under the supervision of a physician, and has 
     furnished not less than 9 months of supervised full-time low 
     vision therapy services;
       ``(C) has successfully completed the national examination 
     in low vision therapy administered by the Academy for 
     Certification of Vision Rehabilitation and Education 
     Professionals; and
       ``(D) meets such other criteria as the Secretary 
     establishes.
       ``(6) The term `vision impairment' means vision loss that 
     constitutes a significant limitation of visual capability 
     resulting from

[[Page S6859]]

     disease, trauma, or a congenital or degenerative condition 
     that cannot be corrected by conventional means, including 
     refractive correction, medication, or surgery, and that is 
     manifested by 1 or more of the following:
       ``(A) Best corrected visual acuity of less than 20/60, or 
     significant central field defect.
       ``(B) Significant peripheral field defect including 
     homonymous or heteronymous bilateral visual field defect or 
     generalized contraction or constriction of field.
       ``(C) Reduced peak contrast sensitivity in conjunction with 
     a condition described in subparagraph (A) or (B).
       ``(D) Such other diagnoses, indications, or other 
     manifestations as the Secretary may determine to be 
     appropriate.''.
       (c) Payment Under Part B.--
       (1) Physician fee schedule.--Section 1848(j)(3) of the 
     Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by 
     inserting ``(2)(W),'' after ``(2)(S),''.
       (2) Carve out from hospital outpatient department 
     prospective payment system.--Section 1833(t)(1)(B)(iv) of the 
     Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended 
     by inserting ``vision rehabilitation services (as defined in 
     section 1861(ww)(1)) or'' after ``does not include''.
        (3) Clarification of billing requirements.--The first 
     sentence of section 1842(b)(6) of such Act (42 U.S.C. 
     1395u(b)(6)) is amended--
       (A) by striking ``and'' before ``(G)''; and
       (B) by inserting before the period the following: ``, and 
     (H) in the case of vision rehabilitation services (as defined 
     in section 1861(ww)(1)) furnished by a vision rehabilitation 
     professional (as defined in section 1861(ww)(2)) while under 
     the general supervision (as defined in section 
     1861(ww)(1)(D)) of a qualified physician (as defined in 
     section 1861(ww)(1)(C)), payment shall be made to (i) the 
     qualified physician or (ii) the facility (such as a 
     rehabilitation agency, a clinic, or other facility) through 
     which such services are furnished under the plan of care if 
     there is a contractual arrangement between the vision 
     rehabilitation professional and the facility under which the 
     facility submits the bill for such services''.
       (d) Plan of Care.--Section 1835(a)(2) of the Social 
     Security Act (42 U.S.C. 1395n(a)(2)) is amended--
       (1) in subparagraph (E), by striking ``and'' after the 
     semicolon at the end;
       (2) in subparagraph (F), by striking the period at the end 
     and inserting ``; and''; and
       (3) by inserting after subparagraph (F) the following new 
     subparagraph:
       ``(G) in the case of vision rehabilitation services, (i) 
     such services are or were required because the individual 
     needed vision rehabilitation services, (ii) an 
     individualized, written plan for furnishing such services has 
     been established (I) by a qualified physician (as defined in 
     section 1861(ww)(1)(C)), (II) by a qualified occupational 
     therapist, or (III) in the case of such services furnished by 
     a vision rehabilitation professional, by a qualified 
     physician, (iii) the plan is periodically reviewed by the 
     qualified physician, and (iv) such services are or were 
     furnished while the individual is or was under the care of 
     the qualified physician.''.
       (e) Relationship to Rehabilitation Act of 1973.--The 
     provision of vision rehabilitation services under the 
     medicare program under title XVIII of the Social Security Act 
     (42 U.S.C. 1395 et seq.) shall not be taken into account for 
     any purpose under the Rehabilitation Act of 1973 (29 U.S.C. 
     701 et seq.).
       (f) Effective Date.--
       (1) Interim, final regulations.--The Secretary of Health 
     and Human Services shall publish a rule under this section in 
     the Federal Register by not later than 180 days after the 
     date of enactment of this Act to carry out the provisions of 
     this section. Such rule shall be effective and final 
     immediately on an interim basis, but is subject to change and 
     revision after public notice and opportunity for a period (of 
     not less than 60 days) for public comment.
       (2) Consultation.--The Secretary of Health and Human 
     Services shall consult with the National Vision 
     Rehabilitation Cooperative, the Association for Education and 
     Rehabilitation of the Blind and Visually Impaired, the 
     Academy for Certification of Vision Rehabilitation and 
     Education Professionals, the American Academy of 
     Ophthalmology, the American Occupational Therapy Association, 
     the American Optometric Association, and such other qualified 
     professional and consumer organizations as the Secretary 
     determines appropriate in promulgating regulations to carry 
     out this Act.
                                 ______