II 

109TH CONGRESS 

2D SESSION S. 3963 

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

access to cost-effective, quality physical medicine and rehabilitation services under part B of the Medicare program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 28, 2006 

Mr. THOMAS (for himself and Mr. SPECTER) 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 

for improved access to cost-effective, quality physical 

medicine and rehabilitation 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 ‘‘Access to Physical 

5 Medicine and Rehabilitation Services Improvement Act of 

6 2006’’. 


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1 SEC. 2. ACCESS TO PHYSICAL MEDICINE AND REHABILITA2 TION SERVICES PROVIDED INCIDENT TO A 

3 PHYSICIAN. 

4 Section 1862(a)(20) of the Social Security Act (42 

5 U.S.C. 1395y(a)(20)) is amended by striking ‘‘(other than 

6 any licensing requirement specified by the Secretary)’’ and 

7 inserting ‘‘(other than any licensing, education, or 

8 credentialing requirements specified by the Secretary)’’. 

9 SEC. 3. COVERAGE OF CERTIFIED ATHLETIC TRAINER 

10 SERVICES AND CERTIFIED LYMPHEDEMA 

11 THERAPIST SERVICES UNDER PART B OF THE 

12 MEDICARE PROGRAM. 

13 (a) COVERAGE OF SERVICES.—Section 1861 of the 

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

15 (1) in subsection (s)(2)— 

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

17 ‘‘and’’ at the end; 

18 (B) in subparagraph (AA), by adding 

19 ‘‘and’’ at the end; and 

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

21 subparagraph: 

22 ‘‘(BB) certified athletic trainer services (as de23 fined in subsection (ccc)(1)) and lymphedema thera24 pist services (as defined in subsection (ccc)(3)).’’; 

25 and 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘Athletic Trainer Services and Lymphedema Therapist 

4 Services 

5 ‘‘(ccc)(1) The term ‘athletic trainer services’ means 

6 services performed by a certified athletic trainer (as de7 fined in paragraph (2)) under the supervision of a physi8 cian (as defined in section 1861(r)), which the athletic 

9 trainer is legally authorized to perform under State law 

10 (or the State regulatory mechanism provided by State law) 

11 of the State in which such services are performed, as 

12 would otherwise be covered if furnished by a physician (as 

13 so defined) or as an incident to a physician’s professional 

14 service, to an individual— 

15 ‘‘(A) who is under the care of a physician (as 

16 so defined); and 

17 ‘‘(B) with respect to whom a plan prescribing 

18 the type, amount, and duration of services that are 

19 to be furnished to such individual has been estab20 lished by a physician (as so defined). 

21 Such term does not include any services for which a facil22 ity or other provider charges or is paid any amounts with 

23 respect to the furnishing of such services. 

24 ‘‘(2) The term ‘certified athletic trainer’ means an 

25 individual who— 


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1 ‘‘(A) possesses a bachelor’s, master’s, or doc2 toral degree which qualifies for licensure or certifi3 cation as an athletic trainer; and 

4 ‘‘(B) in the case of an individual performing 

5 services in a State that provides for licensure or cer6 tification of athletic trainers, is licensed or certified 

7 as an athletic trainer in such State. 

8 ‘‘(3) The term ‘certified lymphedema therapist serv9 ices’ means services performed by a certified lymphedema 

10 therapist (as defined in paragraph (4)) under the super11 vision of a physician (as defined by paragraph (1) or (3) 

12 of section 1861(r)) which the lymphedema therapist is le13 gally authorized to perform under State law (or the State 

14 regulatory mechanism provided by the State law) of the 

15 State in which such services are performed, as would oth16 erwise be covered if furnished by a physician (as so de17 fined) or as incident to a physicians professional service, 

18 to an individual— 

19 ‘‘(A) who is under the care of a physician (as 

20 so defined); and 

21 ‘‘(B) with respect to whom a plan prescribing 

22 the type, amount, and duration of services that are 

23 to be furnished to such individual has been estab24 lished by a physician (as so defined). 


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1 Such term does not include any services for which a facil2 ity or other provider charges or is paid any amounts with 

3 respect to the furnishing of such services 

4 ‘‘(4) The term ‘certified lymphedema therapist’ 

5 means an individual who— 

6 ‘‘(A) possesses a current unrestricted license as 

7 a health professional in the State in which he or she 

8 practices; 

9 ‘‘(B) after obtaining such a license, has success10 fully completed 135 hours of Complete Decongestive 

11 Therapy coursework which consists of theoretical in12 struction and practical laboratory work utilizing 

13 teaching methods directly aimed at the treatment of 

14 lymphatic and vascular disease from a lymphedema 

15 training program recognized by the Secretary for 

16 purposes of certifying lymphedema therapists; and 

17 ‘‘(C) in the case of an individual performing 

18 services in a State that provides for licensure or cer19 tification of lymphedema therapists, is licensed or 

20 certified as a lymphedema therapist in such State.’’. 

21 (b) PAYMENT.— 

22 (1) IN GENERAL.—Section 1832(a)(2)(B) of the 

23 Social Security Act (42 U.S.C. 1395k(a)(2)(B)) is 

24 amended by adding at the end the following new 

25 clause: 


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1 ‘‘(v) athletic trainer services and 

2 lymphedema therapist services; and’’. 

3 (2) AMOUNT.—Section 1833(a)(1) of the Social 

4 Security Act (42 U.S.C. 1395l(a)(1)) is amended— 

5 (A) by striking ‘‘and (V)’’ and inserting 

6 ‘‘(V)’’; and 

7 (B) by inserting before the semicolon at 

8 the end the following: ‘‘, and (W) with respect 

9 to athletic trainer services and lymphedema 

10 therapist services under section 

11 1861(s)(2)(BB), the amounts paid shall be 80 

12 percent of the lesser of the actual charge for 

13 the service or the fee schedule amount under 

14 section 1848 for the same service performed by 

15 a physician’’. 

16 (c) INCLUSION OF SERVICES IN THE THERAPY

17 CAP.—Services provided by a certified athletic trainer or 

18 a certified lymphedema therapist (as those terms are de19 fined in section 1861(ccc) of the Social Security Act, as 

20 added by subsection (a)) shall be subject to the limitation 

21 on payments described in section 1833(g) of such Act (42 

22 U.S.C. 1395l(g)) in the same manner those services would 

23 be subject to limitation if the service had been provided 

24 by a physician personally. 


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1 (d) INCLUSION OF ATHLETIC TRAINERS AND

2 LYMPHEDEMA THERAPISTS AS PRACTITIONERS FOR AS3 SIGNMENT OF CLAIMS.—Section 1842(b)(18)(C) of the 

4 Social Security Act (42 U.S.C.1395u(b)(18)(C)) is amend5 ed by adding at the end the following new clauses: 

6 ‘‘(vii) A certified athletic trainer (as defined in 

7 section 1861(ccc)(1)). 

8 ‘‘(viii) A certified lymphedema therapist (as de9 fined in section 1861(ccc)(2)).’’. 

10 (e) COVERAGE OF CERTAIN PHYSICAL MEDICINE

11 AND REHABILITATION SERVICES PROVIDED IN RURAL

12 HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH

13 CENTERS.— 

14 Section 1861(aa)(1)(B) of the Social Security Act 

15 (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

16 by a clinical social worker (as defined in subsection 

17 (hh)(1))’’ and inserting ‘‘, by a clinical social worker (as 

18 defined in subsection (hh)(1)), by a certified athletic train19 er (as defined in subsection (ccc)(2)), or by a certified 

20 lymphedema therapist (as defined in subsection (ccc)(4))’’. 

21 (f) EFFECTIVE DATE.—The amendments made by 

22 this section shall apply with respect to services furnished 

23 on or after January 1, 2007. 

Æ 


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