I 

108TH CONGRESS 

1ST SESSION H. R. 1902

To amend title XVIII of the Social Security Act to improve outpatient 

vision services under part B of the Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 1, 2003

Mr. FOLEY (for himself, Mr. CAPUANO, Mr. ENGLISH, Mr. CAMP, Mr. ISRAEL, 

Mr. FOSSELLA, Mr. PAYNE, Mr. GOODLATTE, Mr. WAXMAN, Mr. UPTON, 

Mr. HINCHEY, Mr. ABERCROMBIE, Mr. MCNULTY, Mr. WATT, Mr. 

ENGEL, Mr. WELDON of Florida, Mr. MICHAUD, Mr. SERRANO, Mrs. 

CHRISTENSEN, Mr. KENNEDY of Rhode Island, Mr. HOEFFEL, Mr. 

TOWNS, Mr. FROST, Mr. ALLEN, Mr. LYNCH, Mr. DOYLE, Ms. CORRINE

BROWN of Florida, and Mr. SIMMONS) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL

To amend title XVIII of the Social Security Act to improve 

outpatient vision services under part B of the Medicare 

Program.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Vision Reha5 bilitation Services Act of 2003’’. 
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1 SEC. 2. IMPROVEMENT OF OUTPATIENT VISION SERVICES 

2 UNDER PART B. 

3 (a) COVERAGE UNDER PART B.—Section 1861(s)(2) 

4 of the Social Security Act (42 U.S.C. 1395x(s)(2)) is 

5 amended—

6 (1) in subparagraph (U), by striking ‘‘and’’ at 

7 the end; 

8 (2) in subparagraph (V), by inserting ‘‘and’’ at 

9 the end; and; and 

10 (3) by adding at the end the following new sub11 paragraph: 

12 ‘‘(W) vision rehabilitation services (as defined 

13 in subsection (ww)(1));’’. 

14 (b) SERVICES DESCRIBED.—Section 1861 of the So15 cial Security Act (42 U.S.C. 1395x) is amended by adding 

16 at the end the following new subsection: 

17 ‘‘Vision Rehabilitation Services: Vision Rehabilitation 

18 Professional 

19 ‘‘(ww)(1)(A) The term ‘vision rehabilitation services’ 

20 means rehabilitative services (as determined by the Sec21 retary in regulations) furnished—

22 ‘‘(i) to an individual diagnosed with a vision im23 pairment (as defined in paragraph (6)), 

24 ‘‘(ii) pursuant to a plan of care established by 

25 a qualified physician (as defined in subparagraph 
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1 (C)), or by a qualified occupational therapist, and is 

2 periodically reviewed by the qualified physician, 

3 ‘‘(iii) in an appropriate setting (including the 

4 home of the individual receiving such services if 

5 specified in the plan of care), and 

6 ‘‘(iv) by any of the following individuals: 

7 ‘‘(I) A qualified physician. 

8 ‘‘(II) A qualified occupational therapist. 

9 ‘‘(III) A vision rehabilitation professional 

10 (as defined in paragraph (2)) while under the 

11 general supervision (as defined in subparagraph 

12 (D)) of a qualified physician. 

13 ‘‘(B) In the case of vision rehabilitation services fur14 nished by a vision rehabilitation professional, the plan of 

15 care may only be established and reviewed by a qualified 

16 physician. 

17 ‘‘(C) The term ‘qualified physician’ means—

18 ‘‘(i) a physician (as defined in subsection 

19 (r)(1)) who is an ophthalmologist; or 

20 ‘‘(ii) a physician (as defined in subsection (r)(4) 

21 (relating to a doctor of optometry)). 

22 ‘‘(D) The term ‘general supervision’ means, with re23 spect to a vision rehabilitation professional, overall direc24 tion and control of that professional by the qualified physi25 cian who established the plan of care for the individual,
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1 but the presence of the qualified physician is not required 

2 during the furnishing of vision rehabilitation services by 

3 that professional to the individual. 

4 ‘‘(2) The term ‘vision rehabilitation professional’ 

5 means any of the following individuals: 

6 ‘‘(A) An orientation and mobility specialist (as 

7 defined in paragraph (3)). 

8 ‘‘(B) A rehabilitation teacher (as defined in 

9 paragraph (4)). 

10 ‘‘(C) A low vision therapist (as defined in para11 graph (5)). 

12 ‘‘(3) The term ‘orientation and mobility specialist’ 

13 means an individual who—

14 ‘‘(A) if a State requires licensure or certifi15 cation of orientation and mobility specialists, is li16 censed or certified by that State as an orientation 

17 and mobility specialist; 

18 ‘‘(B)(i) holds a baccalaureate or higher degree 

19 from an accredited college or university in the 

20 United States (or an equivalent foreign degree) with 

21 a concentration in orientation and mobility; and 

22 ‘‘(ii) has successfully completed 350 hours of 

23 clinical practicum under the supervision of an ori24 entation and mobility specialist and has furnished 
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1 not less than 9 months of supervised full-time ori2 entation and mobility services; 

3 ‘‘(C) has successfully completed the national ex4 amination in orientation and mobility administered 

5 by the Academy for Certification of Vision Rehabili6 tation and Education Professionals; and 

7 ‘‘(D) meets such other criteria as the Secretary 

8 establishes. 

9 ‘‘(4) The term ‘rehabilitation teacher’ means an indi10 vidual who—

11 ‘‘(A) if a State requires licensure or certifi12 cation of rehabilitation teachers, is licensed or cer13 tified by the State as a rehabilitation teacher; 

14 ‘‘(B)(i) holds a baccalaureate or higher degree 

15 from an accredited college or university in the 

16 United States (or an equivalent foreign degree) with

17 a concentration in rehabilitation teaching, or holds 

18 such a degree in a health field; and 

19 ‘‘(ii) has successfully completed 350 hours of 

20 clinical practicum under the supervision of a reha21 bilitation teacher and has furnished not less than 9 

22 months of supervised full-time rehabilitation teach23 ing services; 

24 ‘‘(C) has successfully completed the national ex25 amination in rehabilitation teaching administered by 
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1 the Academy for Certification of Vision Rehabilita2 tion and Education Professionals; and 

3 ‘‘(D) meets such other criteria as the Secretary 

4 establishes. 

5 ‘‘(5) The term ‘low vision therapist’ means an indi6 vidual who—

7 ‘‘(A) if a State requires licensure or certifi8 cation of low vision therapists, is licensed or certified 

9 by the State as a low vision therapist; 

10 ‘‘(B)(i) holds a baccalaureate or higher degree 

11 from an accredited college or university in the 

12 United States (or an equivalent foreign degree) with 

13 a concentration in low vision therapy, or holds such 

14 a degree in a health field; and 

15 ‘‘(ii) has successfully completed 350 hours of 

16 clinical practicum under the supervision of a physi17 cian, and has furnished not less than 9 months of 

18 supervised full-time low vision therapy services; 

19 ‘‘(C) has successfully completed the national ex20 amination in low vision therapy administered by the 

21 Academy for Certification of Vision Rehabilitation 

22 and Education Professionals; and 

23 ‘‘(D) meets such other criteria as the Secretary 

24 establishes. 
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1 ‘‘(6) The term ‘vision impairment’ means vision loss 

2 that constitutes a significant limitation of visual capability 

3 resulting from disease, trauma, or a congenital or degen4 erative condition that cannot be corrected by conventional 

5 means, including refractive correction, medication, or sur6 gery, and that is manifested by one or more of the fol7 lowing: 

8 ‘‘(A) Best corrected visual acuity of less than 

9 20/60, or significant central field defect. 

10 ‘‘(B) Significant peripheral field defect includ11 ing homonymous or heteronymous bilateral visual 

12 field defect or generalized contraction or constriction 

13 of field. 

14 ‘‘(C) Reduced peak contrast sensitivity in con15 junction with a condition described in subparagraph 

16 (A) or (B). 

17 ‘‘(D) Such other diagnoses, indications, or other 

18 manifestations as the Secretary may determine to be 

19 appropriate.’’. 

20 (c) PAYMENT UNDER PART B.—

21 (1) PHYSICIAN FEE SCHEDULE.—Section 

22 1848(j)(3) of the Social Security Act (42 U.S.C. 

23 1395w–4(j)(3)) is amended by inserting ‘‘(2)(W),’’ 

24 after ‘‘(2)(S),’’.
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1 (2) CARVE OUT FROM HOSPITAL OUTPATIENT

2 DEPARTMENT PROSPECTIVE PAYMENT SYSTEM.—

3 Section 1833(t)(1)(B)(iv) of such Act (42 U.S.C. 

4 1395l(t)(1)(B)(iv)), as redesignated by section 

5 201(e)(1)(B) of the Medicare, Medicaid, and SCHIP 

6 Balanced Budget Refinement Act of 1999 (as en7 acted into law by section 1000(a)(6) of Public Law 

8 106–113), is amended by inserting ‘‘vision rehabili9 tation services (as defined in section 1861(ww)(1)), 

10 or’’ after ‘‘does not include’’. 

11 (3) CLARIFICATION OF BILLING REQUIRE12 MENTS.—The first sentence of section 1842(b)(6) of 

13 such Act (42 U.S.C. 1395u(b)(6)) is amended—

14 (A) by striking ‘‘and’’ before ‘‘(G)’’; and 

15 (B) by inserting before the period the fol16 lowing: ‘‘, and (H) in the case of vision rehabili17 tation services (as defined in section

18 1861(ww)(1)) furnished by a vision rehabilita19 tion professional (as defined in section 

20 1861(ww)(2)) while under the general super21 vision (as defined in section 1861(ww)(1)(D)) 

22 of a qualified physician (as defined in section 

23 1861(ww)(1)(C)), payment shall be made to (i) 

24 the qualified physician or (ii) the facility (such 

25 as a rehabilitation agency, a clinic, or other fa-
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1 cility) through which such services are fur2 nished under the plan of care if there is a con3 tractual arrangement between the vision reha4 bilitation professional and the facility under 

5 which the facility submits the bill for such serv6 ices’’. 

7 (d) PLAN OF CARE.—Section 1835(a)(2) of the So8 cial Security Act (42 U.S.C. 1395n(a)(2)) is amended—

9 (1) in subparagraph (E), by striking ‘‘and’’ at 

10 the end; 

11 (2) in subparagraph (F), by striking the period 

12 and inserting ‘‘; and’’; and 

13 (3) by inserting after subparagraph (F) the fol14 lowing new subparagraph: 

15 ‘‘(G) in the case of vision rehabilitation 

16 services, that (i) such services are or were re17 quired because the individual needed vision re18 habilitation services, (ii) an individualized, writ19 ten plan for furnishing such services has been 

20 established (I) by a qualified physician (as de21 fined in section 1861(ww)(1)(C)), (II) by a 

22 qualified occupational therapist, or (III) in the 

23 case of such services furnished by a vision reha24 bilitation professional, by a qualified physician, 

25 (iii) the plan is periodically reviewed by the 
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1 qualified physician, and (iv) such services are or 

2 were furnished while the individual is or was 

3 under the care of the qualified physician.’’. 

4 (e) RELATIONSHIP TO REHABILITATION ACT OF

5 1973.—The provision of vision rehabilitation services 

6 under the medicare program under title XVIII of the So7 cial Security Act (42 U.S.C. 1395 et seq.) shall not be 

8 taken into account for any purpose under the Rehabilita9 tion Act of 1973 (29 U.S.C. 701 et seq.). 

10 (f) EFFECTIVE DATE.—

11 (1) INTERIM, FINAL REGULATIONS.—The Sec12 retary shall publish a rule under this section in the 

13 Federal Register by not later than 180 days after 

14 the date of the enactment of this section to carry 

15 out the provisions of this section. Such rule shall be 

16 effective and final immediately on an interim basis, 

17 but is subject to change and revision after public no18 tice and opportunity for a period (of not less than 

19 60 days) for public comment. 

20 (2) CONSULTATION.—The Secretary shall con21 sult with the National Vision Rehabilitation Cooper22 ative, the Association for Education and Rehabilita23 tion of the Blind and Visually Impaired, the Acad24 emy for Certification of Vision Rehabilitation and 

25 Education Professionals, the American Academy of 
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1 Ophthalmology, the American Occupational Therapy 

2 Association, the American Optometric Association, 

3 and such other qualified professional and consumer 

4 organizations as the Secretary determines appro5 priate in promulgating regulations to carry out this 

6 Act.

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