II

106TH CONGRESS

1ST SESSION S. 472

To amend title XVIII of the Social Security Act to provide certain medicare

beneficiaries with an exemption to the financial limitations imposed on

physical, speech-language pathology, and occupational therapy services

under part B of the medicare program, and for other purposes.

IN THE SENATE OF THE UNITED STATES

FEBRUARY 25, 1999

Mr. GRASSLEY (for himself, Mr. REID, Mr. CONRAD, Mr. HOLLINGS, Mr.

JOHNSON, Mr. DURBIN, Ms. COLLINS, Mr. DASCHLE, and Mr. DORGAN)

introduced the following bill; which was read twice and referred to the

Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to provide

certain medicare beneficiaries with an exemption to the

financial limitations imposed on physical, speech-language pathology, and occupational therapy 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 Rehabilita5 tion Benefit Improvement Act of 1999’’.
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1 SEC. 2. PURPOSES.

2 The purposes of this Act are as follows:

3 (1) To provide certain medicare beneficiaries

4 with an exemption to the financial limitations im5 posed on physical, speech-language pathology, and

6 occupational therapy services under section 1833(g)

7 of the Social Security Act (42 U.S.C. 1395l(g)).

8 (2) To direct the Secretary of Health and

9 Human Services to conduct a study on the imple10 mentation of such exemption and to submit a report

11 to Congress that includes recommendations regard12 ing alternatives to such financial limitations.

13 SEC. 3. ESTABLISHMENT OF EXEMPTION TO CAP ON PHYS14 ICAL, SPEECH-LANGUAGE PATHOLOGY, AND

15 OCCUPATIONAL THERAPY SERVICES.

16 (a) IN GENERAL.—Section 1833(g) of the Social Se17 curity Act (42 U.S.C. 1395l(g)) is amended by adding at

18 the end the following:

19 ‘‘(4)(A) The limitations in this subsection shall not

20 apply to an individual described in subparagraph (B).

21 ‘‘(B) An individual described in this subparagraph is

22 an individual that meets any of the following criteria:

23 ‘‘(i) The individual has received services de24 scribed in paragraph (1) or (3) in a calendar year

25 and is subsequently diagnosed with an illness, in26 jury, or disability that requires the provision in such
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1 year of additional such services that are medically

2 necessary.

3 ‘‘(ii) The individual has a diagnosis that re4 quires the provision of services described in para5 graph (1) or (3) and an additional diagnosis or inci6 dent that exacerbates the individual’s condition,

7 thereby requiring the provision of additional such

8 services.

9 ‘‘(iii) The individual will require hospitalization

10 if the individual does not receive the services de11 scribed in paragraph (1) or (3).

12 ‘‘(iv) The individual meets other criteria that

13 the Secretary determines are appropriate.

14 ‘‘(C) Nothing in this paragraph shall be construed as

15 affecting any requirement for, or limitation on, payment

16 under this title (other than the financial limitation under

17 this subsection).

18 ‘‘(D) Any service that is covered under this title by

19 reason of this paragraph shall be subject to the same rea20 sonable and necessary requirement under section

21 1862(a)(1) that is applicable to the services described in

22 paragraph (1) or (3) that are covered under this title with23 out regard to this paragraph.’’.

24 (b) CONFORMING AMENDMENTS.—Paragraphs (1)

25 and (3) of section 1833(g) of the Social Security Act (42
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1 U.S.C. 1395l(g)) are each amended by striking ‘‘In the

2 case’’ and inserting ‘‘Subject to paragraph (4), in the

3 case’’.

4 (c) EFFECTIVE DATE.—The amendments made by

5 this section shall apply to services provided on or after

6 the date of enactment of this Act.

7 SEC. 4. STUDY AND REPORT TO CONGRESS.

8 (a) STUDY.—The Secretary of Health and Human

9 Services shall conduct a study on the amendments to sec10 tion 1833(g) of the Social Security Act (42 U.S.C.

11 1395l(g)) made by section 3 of this Act, including a study

12 of—

13 (1) the number of medicare beneficiaries that

14 receive exemptions under paragraph (4) of such sec15 tion (as added by section 3);

16 (2) the diagnoses of such beneficiaries;

17 (3) the types of physical, speech-language pa18 thology, and occupational therapy services that are

19 covered under the medicare program because of such

20 exemptions;

21 (4) the settings in which such services are pro22 vided; and

23 (5) the number of medicare beneficiaries that

24 reach the financial limitation under section 1833(g)

25 of the Social Security Act in a year (without regard
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1 to the amendments to such section made by section

2 3 of this Act) and subsequently receive physical,

3 speech-language pathology, or occupational therapy

4 services in such year at an outpatient hospital de5 partment.

6 (b) REPORT.—Not later than 2 years after the date

7 of enactment of this Act, the Secretary of Health and

8 Human Services shall submit a detailed report to Congress

9 on the study conducted pursuant to paragraph (1), and

10 shall include in the report recommendations regarding al11 ternatives to the financial limitations on physical, speech12 language pathology, and occupational therapy services

13 under section 1833(g) of the Social Security Act and any

14 other recommendations determined appropriate by the

15 Secretary. Such report shall be included in the report re16 quired to be submitted to Congress pursuant to section

17 4541(d)(2) of the Balanced Budget Act of 1997 (42

18 U.S.C. 1395l note).

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