I 

110TH CONGRESS 

1ST SESSION H. R. 552 

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

cardiac rehabilitation and pulmonary rehabilitation services. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 18, 2007 

Mr. LEWIS of Georgia (for himself and Mr. PICKERING) 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 2007’’. 


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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) is amended— 

6 (1) in subsection (s)(2)— 

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

8 ‘‘and’’ at the end; 

9 (B) in subparagraph (AA), by striking the 

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

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

12 subparagraph: 

13 ‘‘(BB) items and services furnished under 

14 a cardiac rehabilitation program (as defined in 

15 subsection (ccc)) or under a pulmonary rehabili16 tation program (as defined in subsection 

17 (ddd)).’’; and 

18 (2) by adding at the end the following new sub19 sections: 

20 ‘‘Cardiac Rehabilitation Program 

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

22 means a physician-supervised program (as described in 

23 paragraph (2)) that furnishes the items and services de24 scribed in paragraph (3). 

25 ‘‘(2) A program described in this paragraph is a pro26 gram under which— 


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

2 delivered— 

3 ‘‘(i) in a physician’s office; 

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

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

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

7 accessible for medical consultation and medical 

8 emergencies at all times items and services are being 

9 furnished under the program, except that, in the 

10 case of items and services furnished under such a 

11 program in a hospital, such availability shall be pre12 sumed; and 

13 ‘‘(C) individualized treatment is furnished 

14 under a written plan established, reviewed, and 

15 signed by a physician every 30 days that describes— 

16 ‘‘(i) the patient’s diagnosis; 

17 ‘‘(ii) the type, amount, frequency, and du18 ration of the items and services furnished under 

19 the plan; and 

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

21 the plan. 

22 ‘‘(3) The items and services described in this para23 graph are— 

24 ‘‘(A) physician-prescribed exercise; 


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

2 education, counseling, and behavioral intervention 

3 (to the extent such education, counseling, and behav4 ioral intervention is closely related to the individual’s 

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

6 needs); 

7 ‘‘(C) psychosocial assessment; 

8 ‘‘(D) outcomes assessment; and 

9 ‘‘(E) such other items and services as the Sec10 retary may determine, but only if such items and 

11 services are— 

12 ‘‘(i) reasonable and necessary for the diag13 nosis or active treatment of the individual’s 

14 condition; 

15 ‘‘(ii) reasonably expected to improve or 

16 maintain the individual’s condition and func17 tional level; and 

18 ‘‘(iii) furnished under such guidelines re19 lating to the frequency and duration of such 

20 items and services as the Secretary shall estab21 lish, taking into account accepted norms of 

22 medical practice and the reasonable expectation 

23 of patient improvement. 

24 ‘‘(4) The Secretary shall establish standards to en25 sure that a physician with expertise in the management 


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1 of patients with cardiac pathophysiology who is licensed 

2 to practice medicine in the State in which a cardiac reha3 bilitation program is offered— 

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

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

6 involved substantially in directing the progress of in7 dividual patients in the program. 

8 ‘‘Pulmonary Rehabilitation Program 

9 ‘‘(ddd)(1) The term ‘pulmonary rehabilitation pro10 gram’ means a physician-supervised program (as de11 scribed in subsection (ccc)(2) with respect to a program 

12 under this subsection) that furnishes the items and serv13 ices described in paragraph (2). 

14 ‘‘(2) The items and services described in this para15 graph are— 

16 ‘‘(A) physician-prescribed exercise; 

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

18 education or training is closely and clearly related to 

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

20 such individual’s needs); 

21 ‘‘(C) psychosocial assessment; 

22 ‘‘(D) outcomes assessment; and 

23 ‘‘(E) such other items and services as the Sec24 retary may determine, but only if such items and 

25 services are— 


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1 ‘‘(i) reasonable and necessary for the diag2 nosis or active treatment of the individual’s 

3 condition; 

4 ‘‘(ii) reasonably expected to improve or 

5 maintain the individual’s condition and func6 tional level; and 

7 ‘‘(iii) furnished under such guidelines re8 lating to the frequency and duration of such 

9 items and services as the Secretary shall estab10 lish, taking into account accepted norms of 

11 medical practice and the reasonable expectation 

12 of patient improvement. 

13 ‘‘(3) The Secretary shall establish standards to en14 sure that a physician with expertise in the management 

15 of patients with respiratory pathophysiology who is li16 censed to practice medicine in the State in which a pul17 monary rehabilitation program is offered— 

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

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

20 involved substantially in directing the progress of in21 dividual patients in the program.’’. 

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

23 this section shall apply to items and services furnished on 

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

Æ 


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