II 

109TH CONGRESS 

1ST SESSION S. 1440 

A bill to amend title XVIII of the Social Security Act to provide coverage 

for cardiac rehabilitation and pulmonary rehabilitation services. 

IN THE SENATE OF THE UNITED STATES 

JULY 21, 2005 

Mr. CRAPO (for himself and Mrs. LINCOLN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

A bill to amend title XVIII of the Social Security Act to 

provide coverage for cardiac rehabilitation and pulmonary 

rehabilitation services. 

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 ‘‘Pulmonary and Car5 diac Rehabilitation Act of 2005’’. 

6 SEC. 2. COVERAGE OF ITEMS AND SERVICES UNDER A CAR7 DIAC REHABILITATION PROGRAM AND A PUL8 MONARY REHABILITATION PROGRAM. 

9 (a) IN GENERAL.—Section 1861 of the Social Secu10 rity Act (42 U.S.C. 1395x) is amended— 
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1 (1) in subsection (s)(2)— 

2 (A) in subparagraph (Y), by striking 

3 ‘‘and’’ at the end; 

4 (B) in subparagraph (Z), by striking the 

5 period at the end and inserting ‘‘; and’’; and 

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

7 subparagraph: 

8 ‘‘(AA) items and services furnished under 

9 a cardiac rehabilitation program (as defined in 

10 subsection (bbb)) or under a pulmonary reha11 bilitation program (as defined in subsection 

12 (ccc)).’’; and 

13 (2) by adding at the end the following new sub14 sections: 

15 ‘‘Cardiac Rehabilitation Program 

16 ‘‘(bbb)(1) The term ‘cardiac rehabilitation program’ 

17 means a physician-supervised program (as described in 

18 paragraph (2)) that furnishes the items and services de19 scribed in paragraph (3). 

20 ‘‘(2) A program described in this paragraph is a pro21 gram under which— 

22 ‘‘(A) items and services under the program are 

23 delivered— 

24 ‘‘(i) in a physician’s office; 

25 ‘‘(ii) in a physician-directed clinic; or 
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1 ‘‘(iii) in a hospital on an outpatient basis; 

2 ‘‘(B) a physician is immediately available and 

3 accessible for medical consultation and medical 

4 emergencies at all times items and services are being 

5 furnished under the program, except that, in the 

6 case of items and services furnished under such a 

7 program in a hospital, such availability shall be pre8 sumed; and 

9 ‘‘(C) individualized treatment is furnished 

10 under a written plan established, reviewed, and 

11 signed by a physician every 30 days that describes— 

12 ‘‘(i) the patient’s diagnosis; 

13 ‘‘(ii) the type, amount, frequency, and du14 ration of the items and services furnished under 

15 the plan; and 

16 ‘‘(iii) the goals set for the patient under 

17 the plan. 

18 ‘‘(3) The items and services described in this para19 graph are— 

20 ‘‘(A) physician-prescribed exercise; 

21 ‘‘(B) cardiac risk factor modification, including 

22 education, counseling, and behavioral intervention 

23 (to the extent such education, counseling, and behav24 ioral intervention is closely related to the individual’s 
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1 care and treatment and is tailored to the individual’s 

2 needs); 

3 ‘‘(C) psychosocial assessment; 

4 ‘‘(D) outcomes assessment; and 

5 ‘‘(E) such other items and services as the Sec6 retary may determine, but only if such items and 

7 services are— 

8 ‘‘(i) reasonable and necessary for the diag9 nosis or active treatment of the individual’s 

10 condition; 

11 ‘‘(ii) reasonably expected to improve or 

12 maintain the individual’s condition and func13 tional level; and 

14 ‘‘(iii) furnished under such guidelines re15 lating to the frequency and duration of such 

16 items and services as the Secretary shall estab17 lish, taking into account accepted norms of 

18 medical practice and the reasonable expectation 

19 of patient improvement. 

20 ‘‘(4) The Secretary shall establish standards to en21 sure that a physician with expertise in the management 

22 of patients with cardiac pathophysiology who is licensed 

23 to practice medicine in the State in which a cardiac reha24 bilitation program is offered— 

25 ‘‘(A) is responsible for such program; and 
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1 ‘‘(B) in consultation with appropriate staff, is 

2 involved substantially in directing the progress of in3 dividual patients in the program. 

4 ‘‘Pulmonary Rehabilitation Program 

5 ‘‘(ccc)(1) The term ‘pulmonary rehabilitation pro6 gram’ means a physician-supervised program (as de7 scribed in subsection (bbb)(2) with respect to a program 

8 under this subsection) that furnishes the items and serv9 ices described in paragraph (2). 

10 ‘‘(2) The items and services described in this para11 graph are— 

12 ‘‘(A) physician-prescribed exercise; 

13 ‘‘(B) education or training (to the extent the 

14 education or training is closely and clearly related to 

15 the individual’s care and treatment and is tailored to 

16 such individual’s needs); 

17 ‘‘(C) psychosocial assessment; 

18 ‘‘(D) outcomes assessment; and 

19 ‘‘(E) such other items and services as the Sec20 retary may determine, but only if such items and 

21 services are— 

22 ‘‘(i) reasonable and necessary for the diag23 nosis or active treatment of the individual’s 

24 condition; 
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1 ‘‘(ii) reasonably expected to improve or 

2 maintain the individual’s condition and func3 tional level; and 

4 ‘‘(iii) furnished under such guidelines re5 lating to the frequency and duration of such 

6 items and services as the Secretary shall estab7 lish, taking into account accepted norms of 

8 medical practice and the reasonable expectation 

9 of patient improvement. 

10 ‘‘(3) The Secretary shall establish standards to en11 sure that a physician with expertise in the management 

12 of patients with respiratory pathophysiology who is li13 censed to practice medicine in the State in which a pul14 monary rehabilitation program is offered— 

15 ‘‘(A) is responsible for such program; and 

16 ‘‘(B) in consultation with appropriate staff, is 

17 involved substantially in directing the progress of in18 dividual patients in the program.’’. 

19 (b) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply to items and services furnished on 

21 or after the date of enactment of this Act. 

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