I 

110TH CONGRESS 

1ST SESSION H. R. 1846 

To amend title XVIII of the Social Security Act to provide improved access 

to physical medicine and rehabilitation services under part B of the 

Medicare Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 29, 2007 

Mr. TOWNS 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 provide 

improved access to physical medicine and rehabilitation 

services under part B of the Medicare Program, and 

for other purposes. 

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 Access to 

5 Physical Medicine and Rehabilitation Services Improve6 ment Act of 2007’’. 


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1 SEC. 2. ACCESS TO PHYSICAL MEDICINE AND REHABILITA2 TION SERVICES PROVIDED INCIDENT TO A 

3 PHYSICIAN . 

4 Section 1862(a)(20) of the Social Security Act (42 

5 U.S.C. 1395y(a)(20)) is amended by striking ‘‘(other than 

6 any licensing requirement specified by the Secretary)’’ and 

7 inserting ‘‘(other than any licensing, education, or 

8 credentialing requirements specified by the Secretary)’’. 

9 SEC. 3. COVERAGE OF CERTIFIED ATHLETIC TRAINER 

10 SERVICES AND CERTIFIED LYMPHEDEMA 

11 THERAPIST SERVICES UNDER PART B OF THE 

12 MEDICARE PROGRAM. 

13 (a) COVERAGE OF SERVICES.—Section 1861 of the 

14 Social Security Act (42 U.S.C. 1395x) is amended— 

15 (1) in subsection (s)(2)— 

16 (A) in subparagraph (Z), by striking 

17 ‘‘and’’ at the end; 

18 (B) in subparagraph (AA), by adding 

19 ‘‘and’’ at the end; and 

20 (C) by adding at the end the following new 

21 subparagraph: 

22 ‘‘(BB) certified athletic trainer services (as 

23 defined in subsection (ccc)(1)) and lymphedema 

24 therapist services (as defined in subsection 

25 (ccc)(3));’’; and 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘Certified Athletic Trainer Services and Lymphedema 

4 Therapist Services 

5 ‘‘(ccc)(1) The term ‘certified athletic trainer services’ 

6 means services performed by a certified athletic trainer (as 

7 defined in paragraph (2)) under the supervision of a physi8 cian (as defined in subsection (r)), which the athletic 

9 trainer is legally authorized to perform under State law 

10 (or the State regulatory mechanism provided by State law) 

11 of the State in which such services are performed, as 

12 would otherwise be covered if furnished by a physician (as 

13 so defined) or as an incident to a physician’s professional 

14 service, to an individual— 

15 ‘‘(A) who is under the care of a physician (as 

16 so defined); and 

17 ‘‘(B) with respect to whom a plan prescribing 

18 the type, amount, and duration of services that are 

19 to be furnished to such individual has been estab20 lished by a physician (as so defined). 

21 Such term does not include any services for which a facil22 ity or other provider charges or is paid any amounts with 

23 respect to the furnishing of such services. 

24 ‘‘(2) The term ‘certified athletic trainer’ means an 

25 individual who— 


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1 ‘‘(A) in the case of an individual performing 

2 services in a State that provides for licensure or cer3 tification of athletic trainers, is licensed or certified 

4 as an athletic trainer in such State; or 

5 ‘‘(B) in the case of an individual performing 

6 services in a State that does not provide for licen7 sure or certification of athletic trainers, possesses a 

8 bachelors, master’s or doctoral degree which quali9 fies for certification as an athletic trainer, and, has 

10 successfully passed a national certification examina11 tion for Athletic Trainers recognized by the Sec12 retary. 

13 ‘‘(3) The term ‘certified lymphedema therapist serv14 ices’ means services performed by a certified lymphedema 

15 therapist (as defined in paragraph (4)) under the super16 vision of a physician (as defined by paragraph (1) or (3) 

17 of subsection (r)) which the lymphedema therapist is le18 gally authorized to perform under State law (or the State 

19 regulatory mechanism provided by the State law) of the 

20 State in which such services are performed, as would oth21 erwise be covered if furnished by a physician (as so de22 fined) or as incident to a physicians professional service, 

23 to an individual— 

24 ‘‘(A) who is under the care of a physician (as 

25 so defined); and 


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1 ‘‘(B) with respect to whom a plan prescribing 

2 the type, amount, and duration of services that are 

3 to be furnished to such individual has been estab4 lished by a physician (as so defined). 

5 Such term does not include any services for which a facil6 ity or other provider charges or is paid any amounts with 

7 respect to the furnishing of such services. 

8 ‘‘(4) The term ‘certified lymphedema therapist’ 

9 means an individual who— 

10 ‘‘(A) possesses a current unrestricted license as 

11 a health professional in the State in which the indi12 vidual practices; 

13 ‘‘(B) after obtaining such a license, has success14 fully completed 135 hours of Complete Decongestive 

15 Therapy coursework which consists of theoretical in16 struction and practical laboratory work utilizing 

17 teaching methods directly aimed at the treatment of 

18 lymphatic and vascular disease from a lymphedema 

19 training program recognized by the Secretary for 

20 purposes of certifying lymphedema therapists; and 

21 ‘‘(C) in the case of an individual performing 

22 services in a State that provides for licensure or cer23 tification of lymphedema therapists, is licensed or 

24 certified as a lymphedema therapist in such State.’’. 

25 (b) PAYMENT.— 


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1 (1) IN GENERAL.—Section 1832(a)(2)(B) of 

2 such Act (42 U.S.C. 1395k(a)(2)(B)) is amended by 

3 adding at the end the following new clause: 

4 ‘‘(v) certified athletic trainer services 

5 and lymphedema therapist services;’’. 

6 (2) AMOUNT.—Section 1833(a)(1) of such Act 

7 (42 U.S.C. 1395l(a)(1)) is amended— 

8 (A) by striking ‘‘and (V)’’ and inserting 

9 ‘‘(V)’’; and 

10 (B) by inserting before the semicolon at 

11 the end the following: ‘‘, and (W) with respect 

12 to certified athletic trainer services and certified 

13 lymphedema therapist services under section 

14 1861(s)(2)(BB), the amounts paid shall be 80 

15 percent of the lesser of the actual charge for 

16 the service or the fee schedule amount under 

17 section 1848 for the same service performed by 

18 a physician’’. 

19 (3) PAYMENT TO EMPLOYER.—The first sen20 tence of section 1842(b)(6) of such Act (42 U.S.C. 

21 1395u(b)(6)) is amended— 

22 (A) by striking ‘‘and’’ before ‘‘(H)’’; and 

23 (B) by inserting before ‘‘; but nothing’’ the 

24 following: ‘‘, and (H) in the case of certified 

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1 pist services, payment shall be made to the phy2 sician, clinic, or hospital that employs the ath3 letic trainer or lymphedema therapist involved’’. 

4 (c) INCLUSION OF SERVICES IN THE THERAPY

5 CAP.—Section 1833(g)(1) of such Act (42 U.S.C. 

6 1395l(g)(1)) is amended— 

7 (1) by striking ‘‘and’’ before ‘‘physical ther8 apy’’; and 

9 (2) by inserting after ‘‘or as incident to physi10 cians’ services,’’ the following: ‘‘and certified athletic 

11 trainer services and certified lymphedema therapist 

12 services’’. 

13 (d) INCLUSION OF ATHLETIC TRAINERS AND

14 LYMPHEDEMA THERAPISTS AS PRACTITIONERS FOR AS15 SIGNMENT OF CLAIMS.—Section 1842(b)(18)(C) of such 

16 Act (42 U.S.C.1395u(b)(18)(C)) is amended by adding at 

17 the end the following new clauses: 

18 ‘‘(vii) A certified athletic trainer (as defined in 

19 section 1861(ccc)(1)). 

20 ‘‘(viii) A certified lymphedema therapist (as de21 fined in section 1861(ccc)(2)).’’. 

22 (e) COVERAGE OF CERTAIN PHYSICAL MEDICINE

23 AND REHABILITATION SERVICES PROVIDED IN RURAL

24 HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH


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1 CENTERS.—Section 1861(aa)(1)(B) of such Act (42 

2 U.S.C. 1395x(aa)(1)(B)) is amended— 

3 (1) by striking ‘‘or’’ before ‘‘by a clinical social 

4 worker’’; and 

5 (2) by inserting after ‘‘subsection (hh)(1)),’’ the 

6 following: ‘‘by a certified athletic trainer (as defined 

7 in subsection (ccc)(2)), or by a certified lymphedema 

8 therapist (as defined in subsection (ccc)(4))’’. 

9 (f) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply with respect to services furnished 

11 on or after January 1, 2008. 

Æ 


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