S 950 ISCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to authorize physical therapists to evaluate and treat Medicare beneficiaries without a requirement for a physician referral, and for other purposes.CommentsClose CommentsPermalink

April 30, 2009CommentsClose CommentsPermalink

Mrs. LINCOLN (for herself, Mr. GRAHAM, and Mr. SPECTER) introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to authorize physical therapists to evaluate and treat Medicare beneficiaries without a requirement for a physician referral, and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Medicare Patient Access to Physical Therapists Act of 2009’.CommentsClose CommentsPermalink

SEC. 2. ACCESS TO OUTPATIENT PHYSICAL THERAPY SERVICES FOR MEDICARE BENEFICIARIES AS AUTHORIZED BY STATE LAW.

(a) In General-CommentsClose CommentsPermalink





(1) ELIMINATION OF REQUIRED PHYSICIAN REFERRAL-CommentsClose CommentsPermalink





(A) DEFINITION OF OUTPATIENT PHYSICAL THERAPY SERVICES- Section 1861(p) of the Social Security Act (42 U.S.C. 1395x(p)) is amended--CommentsClose CommentsPermalink





(i) in the matter preceding paragraph (1), by striking ‘as an outpatient’;CommentsClose CommentsPermalink





(ii) by amending paragraph (1) to read as follows:CommentsClose CommentsPermalink





‘(1) who is an outpatient, and’;CommentsClose CommentsPermalink





(iii) in paragraph (2)--CommentsClose CommentsPermalink





(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 subsection (hhh))’; andCommentsClose CommentsPermalink





(II) by inserting ‘or a qualified physical therapist (as so defined)’ after ‘physician’ the second place it appears;CommentsClose CommentsPermalink





(iv) in paragraph (4)(A)(ii), by striking ‘one or more physicians’ and all that follows through ‘agency) and’; andCommentsClose CommentsPermalink





(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).’CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENTS- Section 1835(a)(2) of the Social Security Act (42 U.S.C. 1395n(a)(2)) is amended--CommentsClose CommentsPermalink





(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’;CommentsClose CommentsPermalink





(ii) in subparagraph (C)--CommentsClose CommentsPermalink





(I) in the matter preceding clause (i), by striking ‘or outpatient occupational therapy services’;CommentsClose CommentsPermalink





(II) in clause (i), by striking ‘or occupational therapy services, respectively,’ and inserting ‘, and’;CommentsClose CommentsPermalink





(III) in clause (ii), by striking ‘or qualified occupational therapist, respectively,’; andCommentsClose CommentsPermalink





(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;’;CommentsClose CommentsPermalink





(iii) in subparagraph (D)--CommentsClose CommentsPermalink





(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’;CommentsClose CommentsPermalink





(II) in clause (i), by striking ‘needed speech pathology services’ and inserting ‘needed occupational therapy services or speech-language pathology services, respectively’; andCommentsClose CommentsPermalink





(III) in clause (ii), by striking ‘speech pathologist’ and inserting ‘occupational therapist or speech-language pathologist, respectively,’; andCommentsClose CommentsPermalink





(iv) in subparagraph (E)--CommentsClose CommentsPermalink





(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’; andCommentsClose CommentsPermalink





(II) in clause (iii), by inserting ‘in the case of comprehensive outpatient rehabilitation facility services not consisting of physical therapy services,’ before ‘such services’.CommentsClose CommentsPermalink





(2) DEFINITION OF QUALIFIED PHYSICAL THERAPIST- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink

‘Qualified Physical Therapist

‘(hhh) The 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):CommentsClose CommentsPermalink





‘(1) With respect to individuals graduating from a professional physical therapy education program on or after January 1, 2005, the individual--CommentsClose CommentsPermalink





‘(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; orCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(2) With respect to individuals licensed as physical therapists by a State before 2005, 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.’.CommentsClose CommentsPermalink





(b) Preserving Existing Law for Outpatient Occupational Therapy Services-CommentsClose CommentsPermalink





(1) DEFINITION- Section 1861(g) of the Social Security Act (42 U.S.C. 1395x(g)) is amended to read as follows:CommentsClose CommentsPermalink

‘Outpatient Occupational Therapy Services

‘(g) The 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--CommentsClose CommentsPermalink





‘(1) who is under the care of a physician (as defined in paragraph (1), (3), or (4) of subsection (r));CommentsClose CommentsPermalink





‘(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);CommentsClose CommentsPermalink





excluding, however--CommentsClose CommentsPermalink





‘(3) any item or service if it would not be included under subsection (b) if furnished to an inpatient of a hospital; andCommentsClose CommentsPermalink





‘(4) any such service--CommentsClose CommentsPermalink





‘(A) if furnished by a clinic, rehabilitation agency, or by others under arrangements with such clinic or agency, unless such clinic or rehabilitation agency--CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(iii) maintains clinical records on all patients;CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(I) is licensed pursuant to such law, orCommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(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; orCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





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.’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(A) SCOPE OF BENEFITS- 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)’.CommentsClose CommentsPermalink





(B) PAYMENT OF BENEFITS- 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))’.CommentsClose CommentsPermalink





(C) PROVIDER CLAIMS PROCEDURES- The second sentence of section 1835(a) of the Social Security Act (42 U.S.C. 1395n(a)) is amended--CommentsClose CommentsPermalink





(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)’;CommentsClose CommentsPermalink





(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)’; andCommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink





(D) AGREEMENTS WITH PROVIDERS- Section 1866(e)(1) of the Social Security Act (42 U.S.C. 1395cc(e)(1)) is amended--CommentsClose CommentsPermalink





(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)’;CommentsClose CommentsPermalink





(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)’; andCommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink





(c) Separate Statutory Treatment for Outpatient Physical Therapy Services and Outpatient Speech-Language Pathology Services-CommentsClose CommentsPermalink





(1) SCOPE OF BENEFITS- 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--CommentsClose CommentsPermalink





(A) by striking ‘and outpatient’ and inserting ‘, outpatient’; andCommentsClose CommentsPermalink





(B) by inserting before the semicolon the following: ‘, and outpatient speech-language pathology services’.CommentsClose CommentsPermalink





(2) PAYMENT OF BENEFITS- Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended--CommentsClose CommentsPermalink





(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’; andCommentsClose CommentsPermalink





(B) in subsection (g)--CommentsClose CommentsPermalink





(i) in paragraphs (1) and (3), by striking ‘paragraphs (4) and (5)’ and inserting ‘paragraphs (5) and (6)’ each place it appears;CommentsClose CommentsPermalink





(ii) by redesignating paragraphs (4) and (5) as paragraphs (5) and (6), respectively, and inserting after paragraph (3) the following new paragraph:CommentsClose CommentsPermalink





‘(4) Subject to paragraphs (5) and (6), in the case of speech-language pathology services (of the type described in section 1861(ll)(5) (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).’; andCommentsClose CommentsPermalink





(iii) in paragraph (5), by striking ‘paragraphs (1) and (3)’ and inserting ‘paragraphs (1), (3), and (4)’.CommentsClose CommentsPermalink





(3) PROVIDER CLAIMS PROCEDURES- The 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--CommentsClose CommentsPermalink





(A) by striking ‘or section 1861(g)(4)(A)’ and inserting ‘, section 1861(g)(4)(A), or section 1861(ll)(6)(A)’;CommentsClose CommentsPermalink





(B) by striking ‘or section 1861(g)(4)(B)’ and inserting ‘, section 1861(g)(4)(B), or section 1861(ll)(5)(B)(ii)(II)’; andCommentsClose CommentsPermalink





(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)(5)(A))’.CommentsClose CommentsPermalink





(4) AGREEMENTS WITH PROVIDERS- Section 1866(e)(1) of the Social Security Act (42 U.S.C. 1395cc(e)(1)), as amended by subsection (b)(2)(D), is amended--CommentsClose CommentsPermalink





(A) by striking ‘or section 1861(g)(4)(A)’ and inserting ‘, section 1861(g)(4)(A), or section 1861(ll)(6)(A)’;CommentsClose CommentsPermalink





(B) by striking ‘or section 1861(g)(4)(B)’ and inserting ‘, section 1861(g)(4)(B), or section 1861(ll)(5)(B)(ii)(II)’; andCommentsClose CommentsPermalink





(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)(5)(A))’.CommentsClose CommentsPermalink





(5) DEFINITIONS- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--CommentsClose CommentsPermalink





(A) in subsection (p), by striking the fourth sentence;CommentsClose CommentsPermalink





(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’; andCommentsClose CommentsPermalink





(C) in subsection (ll), by adding at the end the following new paragraphs:CommentsClose CommentsPermalink





‘(5)(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--CommentsClose CommentsPermalink





‘(i) who is under the care of a physician (as defined in paragraph (1), (3), or (4) of subsection (r)); andCommentsClose CommentsPermalink





‘(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).CommentsClose CommentsPermalink





‘(B) Such term does not include--CommentsClose CommentsPermalink





‘(i) any item or service if it would not be included under subsection (b) if furnished to an inpatient of a hospital; orCommentsClose CommentsPermalink





‘(ii) any item or service--CommentsClose CommentsPermalink





‘(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 (6); andCommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(6) A clinic or rehabilitation agency meets the requirements of this paragraph if it--CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(C) maintains clinical records on all patients;CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(i) is licensed pursuant to such law, orCommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(d) Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2010.CommentsClose CommentsPermalink