I 

111TH CONGRESS 

1ST SESSION H. R. 1829 

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. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 31, 2009 

Mr. POMEROY (for himself, Mr. TIM MURPHY of Pennsylvania, Ms. BALDWIN, 

Ms. DELAURO, Mr. RUPPERSBERGER, Mr. ROSS, Mr. OLVER, Mr. TURNER, Mr. FARR, Mr. KIRK, Mr. PITTS, Mr. GERLACH, Mr. HIGGINS, Mr. 

CHANDLER, Mr. MORAN of Kansas, Mr. ROGERS of Kentucky, Mr. INSLEE, Mr. GRAVES, Mr. SHUSTER, Mr. CONAWAY, Mr. MICHAUD, Mr. 

PAUL, Mr. LANGEVIN, Mr. HINCHEY, Mr. BISHOP of Utah, Mr. PLATTS, 

Mrs. EMERSON, Mr. BLUMENAUER, Mr. MEEK of Florida, Mr. SESTAK, 

Mr. NEAL of Massachusetts, Mr. SHIMKUS, Mr. WILSON of South Carolina, Mr. PUTNAM, Mr. MCGOVERN, Mr. BUTTERFIELD, Mr. LINCOLN

DIAZ-BALART of Florida, Mr. DEFAZIO, Mr. ISRAEL, Mr. BISHOP of 

Georgia, Mr. TIERNEY, Mr. ROHRABACHER, Mrs. CAPPS, Mr. LOEBSACK, 

Mr. GRIJALVA, Mr. ROGERS of Alabama, Mr. ELLISON, Mr. OBERSTAR, 

Mr. WU, Mr. FRANKS of Arizona, Mrs. MALONEY, Mr. JONES, Mr. GARY

G. MILLER of California, Mr. YOUNG of Alaska, Mr. GENE GREEN of 

Texas, Mr. KILDEE, and Mr. ALTMIRE) 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 authorize 

physical therapists to evaluate and treat Medicare beneficiaries without a requirement for a physician referral, 

and for other purposes. 


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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 Patient Ac5 cess to Physical Therapists Act of 2009’’. 

6 SEC. 2. ACCESS TO OUTPATIENT PHYSICAL THERAPY SERV7 ICES FOR MEDICARE BENEFICIARIES AS AU8 THORIZED BY STATE LAW. 

9 (a) IN GENERAL.— 

10 (1) ELIMINATION OF REQUIRED PHYSICIAN RE11 FERRAL.— 

12 (A) DEFINITION OF OUTPATIENT PHYS13 ICAL THERAPY SERVICES.—Section 1861(p) of 

14 the Social Security Act (42 U.S.C. 1395x(p)) is 

15 amended— 

16 (i) in the matter preceding paragraph 

17 (1), by striking ‘‘as an outpatient’’; 

18 (ii) by amending paragraph (1) to 

19 read as follows: 

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

21 (iii) in paragraph (2)— 

22 (I) by striking ‘‘physician (as so 

23 defined) or by a qualified physical 

24 therapist’’ and inserting ‘‘physician 

25 (as defined in paragraph (1), (3), or 


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1 (4) of subsection (r)) or by a qualified 

2 physical therapist (as defined in sub3 section (hhh))’’; and 

4 (II) by inserting ‘‘or a qualified 

5 physical therapist (as so defined)’’ 

6 after ‘‘physician’’ the second place it 

7 appears; 

8 (iv) in paragraph (4)(A)(ii), by strik9 ing ‘‘one or more physicians’’ and all that 

10 follows through ‘‘agency) and’’; and 

11 (v) by amending the fifth sentence to 

12 read as follows: ‘‘Nothing in this sub13 section shall be construed as authorizing 

14 the provision of services in a State that a 

15 qualified physical therapist is not author16 ized to provide in the State in accordance 

17 with State law (or the State regulatory 

18 mechanism provided by State law).’’ 

19 (B) CONFORMING AMENDMENTS.—Section 

20 1835(a)(2) of the Social Security Act (42 

21 U.S.C. 1395n(a)(2)) is amended— 

22 (i) in the matter preceding subpara23 graph (A), by inserting ‘‘, or in the case of 

24 outpatient physical therapy services (as de25 scribed in subparagraph (C)) and physical 


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1 therapy services furnished as comprehen2 sive outpatient rehabilitation facility serv3 ices (described in subparagraph (E)), a 

4 qualified physical therapist,’’ after ‘‘a phy5 sician’’; 

6 (ii) in subparagraph (C)— 

7 (I) in the matter preceding clause 

8 (i), by striking ‘‘or outpatient occupa9 tional therapy services’’; 

10 (II) in clause (i), by striking ‘‘or 

11 occupational therapy services, respec12 tively,’’ and inserting ‘‘, and’’; 

13 (III) in clause (ii), by striking 

14 ‘‘or qualified occupational therapist, 

15 respectively,’’; and 

16 (IV) beginning in clause (ii), by 

17 striking ‘‘by a physician, and (iii)’’ 

18 and all that follows and inserting ‘‘by 

19 a physician or a qualified physical 

20 therapist;’’; 

21 (iii) in subparagraph (D)— 

22 (I) in the matter preceding clause 

23 (i), by striking ‘‘outpatient speech pa24 thology services’’ and inserting ‘‘out25 patient occupational therapy services 


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1 or outpatient speech-language pathol2 ogy services’’; 

3 (II) in clause (i), by striking 

4 ‘‘needed speech pathology services’’ 

5 and inserting ‘‘needed occupational 

6 therapy services or speech-language 

7 pathology services, respectively’’; and 

8 (III) in clause (ii), by striking 

9 ‘‘speech pathologist’’ and inserting 

10 ‘‘occupational therapist or speech-lan11 guage pathologist, respectively,’’; and 

12 (iv) in subparagraph (E)— 

13 (I) in clause (ii), by inserting 

14 ‘‘(or, in the case of comprehensive 

15 outpatient rehabilitation facility serv16 ices consisting of physical therapy 

17 services, by a qualified physical thera18 pist)’’ after ‘‘physician’’; and 

19 (II) in clause (iii), by inserting 

20 ‘‘in the case of comprehensive out21 patient rehabilitation facility services 

22 not consisting of physical therapy 

23 services,’’ before ‘‘such services’’. 

24 (2) DEFINITION OF QUALIFIED PHYSICAL

25 THERAPIST.—Section 1861 of the Social Security 


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1 Act (42 U.S.C. 1395x) is amended by adding at the 

2 end the following new subsection: 

3 ‘‘Qualified Physical Therapist 

4 ‘‘(hhh) The term ‘qualified physical therapist’ means 

5 an individual who is licensed as a physical therapist by 

6 the State in which such individual is practicing and who 

7 meets the applicable requirements under paragraph (1) or 

8 (2): 

9 ‘‘(1) With respect to individuals graduating 

10 from a professional physical therapy education pro11 gram on or after January 1, 2005, the individual— 

12 ‘‘(A) has received a master’s or doctoral 

13 degree from a professional physical therapy 

14 education program that has been accredited by 

15 a national physical therapy education accredita16 tion agency recognized by the Secretary of Edu17 cation; or 

18 ‘‘(B) has graduated from a professional 

19 physical therapy education program outside the 

20 United States with a curriculum that is sub21 stantially equivalent (as determined by an ac22 creditation agency described in subparagraph 

23 (A)) to the curricula of programs for profes24 sional physical therapy education programs in 


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1 the United States that are accredited by such 

2 an accreditation agency. 

3 ‘‘(2) With respect to individuals licensed as 

4 physical therapists by a State before 2005, the indi5 vidual was, or upon application to the Secretary 

6 could have been, qualified under regulations of the 

7 Secretary in effect before such date to furnish phys8 ical therapy services under this title, as determined 

9 by the Secretary.’’. 

10 (b) PRESERVING EXISTING LAW FOR OUTPATIENT

11 OCCUPATIONAL THERAPY SERVICES.— 

12 (1) DEFINITION.—Section 1861(g) of the Social 

13 Security Act (42 U.S.C. 1395x(g)) is amended to 

14 read as follows: 

15 ‘‘Outpatient Occupational Therapy Services 

16 ‘‘(g) The term ‘outpatient occupational therapy serv17 ices’ means occupational therapy services furnished by a 

18 provider of services, a clinic, a rehabilitation agency, or 

19 a public health agency, or by others under an arrangement 

20 with, and under the supervision of, such a provider, clinic, 

21 rehabilitation agency, or public health agency to an indi22 vidual as an outpatient— 

23 ‘‘(1) who is under the care of a physician (as 

24 defined in paragraph (1), (3), or (4) of subsection 

25 (r)); 


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

2 the type, amount, and duration of occupational ther3 apy services that are furnished to such individual 

4 has been established by a physician (as so defined) 

5 or by an occupational therapist and is periodically 

6 reviewed by a physician (as so defined); 

7 excluding, however— 

8 ‘‘(3) any item or service if it would not be in9 cluded under subsection (b) if furnished to an inpa10 tient of a hospital; and 

11 ‘‘(4) any such service— 

12 ‘‘(A) if furnished by a clinic, rehabilitation 

13 agency, or by others under arrangements with 

14 such clinic or agency, unless such clinic or reha15 bilitation agency— 

16 ‘‘(i) provides an adequate program of 

17 occupational therapy services for out18 patients and has the facilities and per19 sonnel required for such program or re20 quired for the supervision of such a pro21 gram, in accordance with such require22 ments as the Secretary may specify; 

23 ‘‘(ii) has policies, established by a 

24 group of professional personnel, including 

25 one or more occupational therapists, to 


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1 govern the services (referred to in clause 

2 (i)) it provides; 

3 ‘‘(iii) maintains clinical records on all 

4 patients; 

5 ‘‘(iv) if such clinic or agency is situ6 ated in a State in which State or applica7 ble local law provides for the licensing of 

8 institutions of this nature— 

9 ‘‘(I) is licensed pursuant to such 

10 law, or 

11 ‘‘(II) is approved by the agency 

12 of such State or locality responsible 

13 for licensing institutions of this na14 ture, as meeting the standards estab15 lished for such licensing; and 

16 ‘‘(v) meets such other conditions relat17 ing to the health and safety of individuals 

18 who are furnished services by such clinic or 

19 agency on an outpatient basis, as the Sec20 retary may find necessary, and provides 

21 the Secretary on a continuing basis with a 

22 surety bond that is not less than $50,000; 

23 or 

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1 tions relating to the safety of individuals who 

2 are furnished services by such agency on an 

3 outpatient basis, as the Secretary may find nec4 essary. 

5 The term ‘outpatient occupational therapy services’ also 

6 includes occupational therapy services furnished an indi7 vidual by an occupational therapist (in the office of the 

8 occupational therapist or in such individual’s home) who 

9 meets licensing and other standards prescribed by the Sec10 retary in regulations, otherwise than under an arrange11 ment with and under the supervision of a provider of serv12 ices, clinic, rehabilitation agency, or public health agency, 

13 if the furnishing of such services meets such conditions 

14 relating to health and safety as the Secretary may find 

15 necessary. In addition, such term includes occupational 

16 therapy services that meet the requirements of the first 

17 sentence of this subsection except that they are furnished 

18 to an inpatient of a hospital or extended care facility. 

19 Nothing in this subsection shall be construed as requiring, 

20 with respect to outpatients who are not entitled to benefits 

21 under this title, an occupational therapist to provide out22 patient occupational therapy services only to outpatients 

23 who are under the care of a physician or pursuant to a 

24 plan of care established by a physician. The Secretary may 

25 waive the requirement of a surety bond under paragraph 


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1 (4)(A)(v) in the case of a clinic or agency that provides 

2 a comparable surety bond under State law.’’. 

3 (2) CONFORMING AMENDMENTS.— 

4 (A) SCOPE OF BENEFITS.—Section 

5 1832(a)(2)(C) of the Social Security Act (42 

6 U.S.C. 1395k(a)(2)(C)) is amended by striking 

7 ‘‘such sentence applies through the operation of 

8 section 1861(g))’’ and inserting ‘‘the second 

9 sentence of section 1861(g) applies)’’. 

10 (B) PAYMENT OF BENEFITS.—Section 

11 1833(g)(3) of the Social Security Act (42 

12 U.S.C. 1395l(g)(3)) is amended by striking 

13 ‘‘section 1861(p)’’ and all that follows through 

14 ‘‘section 1861(g)’’ and inserting ‘‘section 

15 1861(g) (but not described in subsection 

16 (a)(8)(B))’’. 

17 (C) PROVIDER CLAIMS PROCEDURES.—The 

18 second sentence of section 1835(a) of the Social 

19 Security Act (42 U.S.C. 1395n(a)) is amend20 ed— 

21 (i) by striking ‘‘section 1861(p)(4)(A) 

22 (or meets the requirements of such section 

23 through the operation of section 1861(g))’’ 

24 and inserting ‘‘section 1861(p)(4)(A) or 

25 section 1861(g)(4)(A)’’; 


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1 (ii) by striking ‘‘section 1861(p)(4)(B) 

2 (or meets the requirements of such section 

3 through the operation of section 1861(g))’’ 

4 and inserting ‘‘section 1861(p)(4)(B) or 

5 section 1861(g)(4)(B)’’; and 

6 (iii) by striking ‘‘(as therein defined) 

7 or (through the operation of section 

8 1861(g)) with respect to the furnishing of 

9 outpatient occupational therapy services’’ 

10 and inserting ‘‘(as defined in section 

11 1861(p)) or outpatient occupational ther12 apy services (as defined in section 

13 1861(g)), respectively’’. 

14 (D) AGREEMENTS WITH PROVIDERS.—Sec15 tion 1866(e)(1) of the Social Security Act (42 

16 U.S.C. 1395cc(e)(1)) is amended— 

17 (i) by striking ‘‘section 1861(p)(4)(A) 

18 (or meets the requirements of such section 

19 through the operation of section 1861(g))’’ 

20 and inserting ‘‘section 1861(p)(4)(A) or 

21 section 1861(g)(4)(A)’’; 

22 (ii) by striking ‘‘section 1861(p)(4)(B) 

23 (or meets the requirements of such section 

24 through the operation of section 1861(g))’’ 


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1 and inserting ‘‘section 1861(p)(4)(B) or 

2 section 1861(g)(4)(B)’’; and 

3 (iii) by striking ‘‘(as therein defined) 

4 or (through the operation of section 

5 1861(g)) with respect to the furnishing of 

6 outpatient occupational therapy services’’ 

7 and inserting ‘‘(as defined in section 

8 1861(p)) or outpatient occupational ther9 apy services (as defined in section 

10 1861(g)), respectively’’. 

11 (c) SEPARATE STATUTORY TREATMENT FOR OUT12 PATIENT PHYSICAL THERAPY SERVICES AND OUT13 PATIENT SPEECH-LANGUAGE PATHOLOGY SERVICES.— 

14 (1) SCOPE OF BENEFITS.—Section 

15 1832(a)(2)(C) of the Social Security Act (42 U.S.C. 

16 1395k(a)(2)(C)), as amended by subsection 

17 (b)(2)(A), is amended— 

18 (A) by striking ‘‘and outpatient’’ and in19 serting ‘‘, outpatient’’; and 

20 (B) by inserting before the semicolon the 

21 following: ‘‘, and outpatient speech-language pa22 thology services’’. 

23 (2) PAYMENT OF BENEFITS.—Section 1833 of 

24 the Social Security Act (42 U.S.C. 1395l) is amend25 ed— 


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1 (A) in subparagraphs (A) and (B) of sub2 section (a)(8), by striking ‘‘services, (which in3 cludes outpatient speech-language pathology 

4 services) and outpatient occupational therapy 

5 services’’ each place it appears and inserting 

6 ‘‘services, outpatient occupational therapy serv7 ices, and outpatient speech-language pathology 

8 services’’; and 

9 (B) in subsection (g)— 

10 (i) in paragraphs (1) and (3), by 

11 striking ‘‘paragraphs (4) and (5)’’ and in12 serting ‘‘paragraphs (5) and (6)’’ each 

13 place it appears; 

14 (ii) by redesignating paragraphs (4) 

15 and (5) as paragraphs (5) and (6), respec16 tively, and inserting after paragraph (3) 

17 the following new paragraph: 

18 ‘‘(4) Subject to paragraphs (5) and (6), in the 

19 case of speech-language pathology services (of the 

20 type described in section 1861(ll)(5) (but not de21 scribed in subsection (a)(8)(B)) and speech-language 

22 pathology services of such type that are furnished by 

23 a physician or as incident to physicians’ services), 

24 with respect to expenses incurred in any calendar 

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1 graph (2) for the year shall be considered as in2 curred expenses for purposes of subsections (a) and 

3 (b).’’; and 

4 (iii) in paragraph (5), by striking 

5 ‘‘paragraphs (1) and (3)’’ and inserting 

6 ‘‘paragraphs (1), (3), and (4)’’. 

7 (3) PROVIDER CLAIMS PROCEDURES.—The sec8 ond sentence of section 1835(a) of the Social Secu9 rity Act (42 U.S.C. 1395n(a)), as amended by sub10 section (b)(2)(C), is amended— 

11 (A) by striking ‘‘or section 1861(g)(4)(A)’’ 

12 and inserting ‘‘, section 1861(g)(4)(A), or sec13 tion 1861(ll)(6)(A)’’; 

14 (B) by striking ‘‘or section 1861(g)(4)(B)’’ 

15 and inserting ‘‘, section 1861(g)(4)(B), or sec16 tion 1861(ll)(5)(B)(ii)(II)’’; and 

17 (C) by striking ‘‘or outpatient occupational 

18 services (as defined in section 1861(g))’’ and 

19 inserting ‘‘, outpatient occupational services (as 

20 defined in section 1861(g)), or outpatient 

21 speech-language pathology services (as defined 

22 in section 1861(ll)(5)(A))’’. 

23 (4) AGREEMENTS WITH PROVIDERS.—Section 

24 1866(e)(1) of the Social Security Act (42 U.S.C. 


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1 1395cc(e)(1)), as amended by subsection (b)(2)(D), 

2 is amended— 

3 (A) by striking ‘‘or section 1861(g)(4)(A)’’ 

4 and inserting 1861(g)(4)(A), or section 

5 1861(ll)(6)(A)’’; 

6 (B) by striking ‘‘or section 1861(g)(4)(B)’’ 

7 and inserting ‘‘, section 1861(g)(4)(B), or sec8 tion 1861(ll)(5)(B)(ii)(II)’’; and 

9 (C) by striking ‘‘or outpatient occupational 

10 services (as defined in section 1861(g))’’ and 

11 inserting ‘‘, outpatient occupational services (as 

12 defined in section 1861(g)), or outpatient 

13 speech-language pathology services (as defined 

14 in section 1861(ll)(5)(A))’’. 

15 (5) DEFINITIONS.—Section 1861 of the Social 

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

17 (A) in subsection (p), by striking the 

18 fourth sentence; 

19 (B) in subsection (s)(2)(D), by striking 

20 ‘‘services and outpatient occupational therapy 

21 services’’ and inserting ‘‘services, outpatient oc22 cupational therapy services, and outpatient 

23 speech-language pathology services’’; and 

24 (C) in subsection (ll), by adding at the end 

25 the following new paragraphs: 


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1 ‘‘(5)(A) Subject to subparagraph (B), the term ‘out2 patient speech-language pathology services’ means speech3 language pathology services that are furnished by a pro4 vider of services, a clinic, a rehabilitation agency, or a pub5 lic health agency, or by others under an arrangement with, 

6 and under the supervision of, such provider, clinic, reha7 bilitation agency, or public health agency to an individual 

8 as an outpatient— 

9 ‘‘(i) who is under the care of a physician (as de10 fined in paragraph (1), (3), or (4) of subsection (r)); 

11 and 

12 ‘‘(ii) with respect to whom a plan prescribing 

13 the type, amount, and duration of speech-language 

14 pathology services that are furnished to such indi15 vidual has been established by a physician (as so de16 fined) or by a qualified speech-language pathologist 

17 and is periodically reviewed by a physician (as so de18 fined). 

19 ‘‘(B) Such term does not include— 

20 ‘‘(i) any item or service if it would not be in21 cluded under subsection (b) if furnished to an inpa22 tient of a hospital; or 

23 ‘‘(ii) any item or service— 

24 ‘‘(I) if furnished by a clinic, rehabilitation 

25 agency, or by others under arrangements with 


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1 such clinic or agency, unless such clinic or reha2 bilitation agency meets the requirements of 

3 paragraph (6); and 

4 ‘‘(II) if furnished by a public health agen5 cy, unless such agency meets such other condi6 tions relating to the safety of individuals who 

7 are furnished services by such agency on an 

8 outpatient basis, as the Secretary may find nec9 essary. 

10 ‘‘(C) Such term also includes speech-language pathol11 ogy services that meet the requirements of the preceding 

12 sentence except that they are furnished to an inpatient 

13 of a hospital or extended care facility. Nothing in this sub14 section shall be construed as requiring, with respect to 

15 outpatients who are not entitled to benefits under this 

16 title, a speech-language pathologist to provide outpatient 

17 speech-language pathology services only to outpatients 

18 who are under the care of a physician or pursuant to a 

19 plan of care established by a physician. The Secretary may 

20 waive the requirement of a surety bond under paragraph 

21 (5)(E) in the case of a clinic or agency that provides a 

22 comparable surety bond under State law. 

23 ‘‘(6) A clinic or rehabilitation agency meets the re24 quirements of this paragraph if it— 


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1 ‘‘(A) provides an adequate program of speech2 language pathology services for outpatients and has 

3 the facilities and personnel required for such pro4 gram or required for the supervision of such a pro5 gram, in accordance with such requirements as the 

6 Secretary may specify; 

7 ‘‘(B) has policies, established by a group of pro8 fessional personnel, including one or more speech9 language pathologists, to govern the services (re10 ferred to in subparagraph (A)) it provides; 

11 ‘‘(C) maintains clinical records on all patients; 

12 ‘‘(D) in the case of a clinic or agency that is 

13 situated in a State in which State or applicable local 

14 law provides for the licensing of institutions of this 

15 nature— 

16 ‘‘(i) is licensed pursuant to such law, or 

17 ‘‘(ii) is approved by the agency of such 

18 State or locality responsible for licensing insti19 tutions of this nature, as meeting the standards 

20 established for such licensing; and 

21 ‘‘(E) meets such other conditions relating to the 

22 health and safety of individuals who are furnished 

23 services by such clinic or agency on an outpatient 

24 basis, as the Secretary may find necessary, and proVerDate Nov 24 2008 02:32 Apr 02, 2009 Jkt 079200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H1829.IH H1829

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1 vides the Secretary on a continuing basis with a sur2 ety bond that is not less than $50,000.’’. 

3 (d) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply to items and services furnished on 

5 or after January 1, 2010. 

Æ 


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