I 

109TH CONGRESS 

2D SESSION H. R. 4824 

To amend title XVIII of the Social Security Act to provide coverage for 

cardiac rehabilitation and pulmonary rehabilitation services. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 1, 2006 

Mr. PICKERING (for himself and Mr. LEWIS of Georgia) 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 

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 2006’’. 


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1 SEC. 2. COVERAGE OF ITEMS AND SERVICES UNDER A CAR2 DIAC REHABILITATION PROGRAM AND A PUL3 MONARY REHABILITATION PROGRAM. 

4 (a) IN GENERAL.—Section 1861 of the Social Secu5 rity Act (42 U.S.C. 1395x), as amended by section 

6 5112(a) of the Deficit Reduction Act of 2005, is amend7 ed— 

8 (1) in subsection (s)(2)— 

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

10 ‘‘and’’ at the end; 

11 (B) in subparagraph (AA), by adding at 

12 the end ‘‘; and’’; and 

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

14 subparagraph: 

15 ‘‘(BB) items and services furnished under 

16 a cardiac rehabilitation program (as defined in 

17 subsection (ccc)) or under a pulmonary rehabili18 tation program (as defined in subsection 

19 (ddd)).’’; and 

20 (2) by adding at the end the following new sub21 sections: 

22 ‘‘Cardiac Rehabilitation Program 

23 ‘‘(ccc)(1) The term ‘cardiac rehabilitation program’ 

24 means a physician-supervised program (as described in 

25 paragraph (2)) that furnishes the items and services de26 scribed in paragraph (3). 


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1 ‘‘(2) A program described in this paragraph is a pro2 gram under which— 

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

4 delivered— 

5 ‘‘(i) in a physician’s office; 

6 ‘‘(ii) in a physician-directed clinic; or 

7 ‘‘(iii) in a hospital on an outpatient basis; 

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

9 accessible for medical consultation and medical 

10 emergencies at all times items and services are being 

11 furnished under the program, except that, in the 

12 case of items and services furnished under such a 

13 program in a hospital, such availability shall be pre14 sumed; and 

15 ‘‘(C) individualized treatment is furnished 

16 under a written plan established, reviewed, and 

17 signed by a physician every 30 days that describes— 

18 ‘‘(i) the patient’s diagnosis; 

19 ‘‘(ii) the type, amount, frequency, and du20 ration of the items and services furnished under 

21 the plan; and 

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

23 the plan. 

24 ‘‘(3) The items and services described in this 

25 paragraph are— 


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1 ‘‘(A) physician-prescribed exercise; 

2 ‘‘(B) cardiac risk factor modification, in3 cluding education, counseling, and behavioral 

4 intervention (to the extent such education, 

5 counseling, and behavioral intervention is close6 ly related to the individual’s care and treatment 

7 and is tailored to the individual’s needs); 

8 ‘‘(C) psychosocial assessment; 

9 ‘‘(D) outcomes assessment; and 

10 ‘‘(E) such other items and services as the 

11 Secretary may determine, but only if such items 

12 and services are— 

13 ‘‘(i) reasonable and necessary for the 

14 diagnosis or active treatment of the indi15 vidual’s condition; 

16 ‘‘(ii) reasonably expected to improve 

17 or maintain the individual’s condition and 

18 functional level; and 

19 ‘‘(iii) furnished under such guidelines 

20 relating to the frequency and duration of 

21 such items and services as the Secretary 

22 shall establish, taking into account accept23 ed norms of medical practice and the rea24 sonable expectation of patient improve25 ment. 


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1 ‘‘(4) The Secretary shall establish standards to 

2 ensure that a physician with expertise in the man3 agement of patients with cardiac pathophysiology 

4 who is licensed to practice medicine in the State in 

5 which a cardiac rehabilitation program is offered— 

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

7 ‘‘(B) in consultation with appropriate staff, 

8 is involved substantially in directing the 

9 progress of individual patients in the program. 

10 ‘‘Pulmonary Rehabilitation Program 

11 ‘‘(ddd)(1) The term ‘pulmonary rehabilitation pro12 gram’ means a physician-supervised program (as de13 scribed in subsection (ccc)(2) with respect to a program 

14 under this subsection) that furnishes the items and serv15 ices described in paragraph (2). 

16 ‘‘(2) The items and services described in this para17 graph are— 

18 ‘‘(A) physician-prescribed exercise; 

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

20 education or training is closely and clearly related to 

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

22 such individual’s needs); 

23 ‘‘(C) psychosocial assessment; 

24 ‘‘(D) outcomes assessment; and 


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1 ‘‘(E) such other items and services as the Sec2 retary may determine, but only if such items and 

3 services are— 

4 ‘‘(i) reasonable and necessary for the diag5 nosis or active treatment of the individual’s 

6 condition; 

7 ‘‘(ii) reasonably expected to improve or 

8 maintain the individual’s condition and func9 tional level; and 

10 ‘‘(iii) furnished under such guidelines re11 lating to the frequency and duration of such 

12 items and services as the Secretary shall estab13 lish, taking into account accepted norms of 

14 medical practice and the reasonable expectation 

15 of patient improvement. 

16 ‘‘(3) The Secretary shall establish standards to en17 sure that a physician with expertise in the management 

18 of patients with respiratory pathophysiology who is li19 censed to practice medicine in the State in which a pul20 monary rehabilitation program is offered— 

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

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

23 involved substantially in directing the progress of in24 dividual patients in the program.’’. 


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

2 this section shall apply to items and services furnished on 

3 or after the date of the enactment of this Act. 

Æ 


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