I 

108TH CONGRESS 

1ST SESSION H. R. 792

To amend title XVIII of the Social Security Act to authorize physical therapists to evaluate and treat medicare beneficiaries without a requirement 

for a physician referral, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 13, 2003

Mr. CRANE (for himself, Mr. POMEROY, Mr. ABERCROMBIE, Mr. BOEHNER, 

Mrs. CAPPS, Mr. LINCOLN DIAZ-BALART of Florida, Mr. ENGLISH, Mrs. 

EMERSON, Mr. ETHERIDGE, Mr. FARR, Mr. GRAVES, Mr. LATHAM, Mr. 

LEACH, Mr. LYNCH, Mr. MARKEY, Mr. GARY G. MILLER of California, 

Mr. MCNULTY, Mr. PAUL, Mr. TOWNS, Mr. YOUNG of Alaska, Mr. KILDEE, and Mr. FROST) 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 authorize 

physical therapists to evaluate and treat medicare beneficiaries without a requirement for a physician referral, 

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,
2

•HR 792 IH 

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Medicare Patient Ac3 cess to Physical Therapists Act of 2003’’. 

4 SEC. 2. ACCESS TO OUTPATIENT PHYSICAL THERAPY SERV5 ICES FOR MEDICARE BENEFICIARIES AS AU6 THORIZED BY STATE LAW. 

7 (a) IN GENERAL.—

8 (1) ELIMINATION OF REQUIRED PHYSICIAN RE9 FERRAL.—

10 (A) DEFINITION OF OUTPATIENT PHYS11 ICAL THERAPY SERVICES.—Section 1861(p) of 

12 the Social Security Act (42 U.S.C. 1395x(p)) is 

13 amended—

14 (i) in the matter preceding paragraph 

15 (1), by striking ‘‘as an outpatient’’; 

16 (ii) by amending paragraph (1) to 

17 read as follows: 

18 ‘‘(1) who is an outpatient, and’’; 

19 (iii) in paragraph (2)—

20 (I) by striking ‘‘physician (as so 

21 defined) or by a qualified physical 

22 therapist’’ and inserting ‘‘physician 

23 (as defined in paragraph (1), (3), or 

24 (4) of subsection (r)) or by a qualified 

25 physical therapist (as defined in sec26 tion 1861(ww))’’; and 
3

•HR 792 IH 

1 (II) by inserting ‘‘or a qualified 

2 physical therapist (as so defined)’’ 

3 after ‘‘physician’’ the second place it 

4 appears; 

5 (iv) in paragraph (4)(A)(ii), by strik6 ing ‘‘one or more’’ and all that follows 

7 through ‘‘agency) and’’; and 

8 (v) by amending the fifth sentence to 

9 read as follows: ‘‘Nothing in this sub10 section shall be construed as authorizing 

11 the provision of services in a State that a 

12 qualified physical therapist is not author13 ized to provide in the State in accordance 

14 with State law (or the State regulatory 

15 mechanism provided by State law). 

16 (B) CONFORMING AMENDMENTS.—Section 

17 1835(a)(2) of the Social Security Act (42 

18 U.S.C. 1395n(a)(2)) is amended—

19 (i) in the matter preceding subpara20 graph (A), by inserting ‘‘, or in the case of 

21 outpatient physical therapy services (as de22 scribed in subparagraph (C)) and physical 

23 therapy services furnished as comprehen24 sive outpatient rehabilitation facility serv25 ices (described in subparagraph (E)), a 
4

•HR 792 IH 

1 qualified physical therapist,’’ after ‘‘a phy2 sician’’; 

3 (ii) in subparagraph (C)—

4 (I) in the matter preceding clause 

5 (i), by striking ‘‘or outpatient occupa6 tional therapy services’’; 

7 (II) in clause (i), by striking ‘‘or 

8 occupational therapy services, respec9 tively,’’ and inserting ‘‘, and’’; 

10 (III) in clause (ii), by striking 

11 ‘‘or qualified occupational therapist, 

12 respectively,’’; and

13 (IV) beginning in clause (ii), by 

14 striking ‘‘by a physician, and (iii)’’ 

15 and all that follows and inserting ‘‘by 

16 a physician or a qualified physical 

17 therapist;’’; 

18 (iii) in subparagraph (D)—

19 (I) in the matter preceding clause 

20 (i), by striking ‘‘outpatient speech pa21 thology services’’ and inserting ‘‘out22 patient occupational therapy services 

23 or outpatient speech-language pathol24 ogy services’’; 
5

•HR 792 IH 

1 (II) in clause (i), by striking 

2 ‘‘needed speech pathology services’’ 

3 and inserting ‘‘needed occupational 

4 therapy services or speech-language 

5 pathology services, respectively’’; and 

6 (III) in clause (ii), by striking 

7 ‘‘speech pathologist’’ and inserting 

8 ‘‘occupational therapist or speech-lan9 guage pathologist, respectively,’’; and 

10 (iv) in subparagraph (E)—

11 (I) in clause (ii), by inserting 

12 ‘‘(or, in the case of comprehensive 

13 outpatient rehabilitation facility serv14 ices consisting of physical therapy 

15 services, by a qualified physical thera16 pist)’’ after ‘‘physician’’; and 

17 (II) in clause (iii), by inserting 

18 ‘‘in the case of comprehensive out19 patient rehabilitation facility services 

20 not consisting of physical therapy 

21 services,’’ before ‘‘such services’’. 

22 (2) DEFINITION OF QUALIFIED PHYSICAL

23 THERAPIST.—Section 1861 of the Social Security 

24 Act (42 U.S.C. 1395x) is amended by adding at the 

25 end the following new subsection: 
6

•HR 792 IH 

1 ‘‘Qualified Physical Therapist 

2 ‘‘(ww) The term ‘qualified physical therapist’ means 

3 an individual who is licensed as a physical therapist by

4 the State in which such individual is practicing and who 

5 meets the applicable requirements under paragraph (1) or 

6 (2): 

7 ‘‘(1) With respect to individuals graduating 

8 from a professional physical therapy education pro9 gram on or after January 1, 2003, the individual—

10 ‘‘(A) has received a master’s or doctoral 

11 degree from a professional physical therapy 

12 education program that has been accredited by 

13 a national physicial therapy education accredi14 tation agency recognized by the Secretary of 

15 Education; or 

16 ‘‘(B) has graduated from a professional 

17 physical therapy education program outside the 

18 United States with a curriculum that is sub19 stantially equivalent (as determined by an ac20 creditation agency described in subparagraph 

21 (A)) to the curricula of programs for profes22 sional physical therapy education programs in 

23 the United States that are accredited by such 

24 an accreditation agency. 
7

•HR 792 IH 

1 ‘‘(2) With respect to individuals licensed as 

2 physical therapists by a State before 2003, the indi3 vidual was, or upon application to the Secretary 

4 could have been, qualified under regulations of the 

5 Secretary in effect before such date to furnish 

6 physicial therapy services under this title, as deter7 mined by the Secretary.’’. 

8 (b) PRESERVING EXISTING LAW FOR OUTPATIENT

9 OCCUPATIONAL THERAPY SERVICES.—

10 (1) DEFINITION.—Section 1861(g) of the Social 

11 Security Act (42 U.S.C. 1395x(g)) is amended to 

12 read as follows: 

13 ‘‘Outpatient Occupational Therapy Services 

14 ‘‘(g) The term ‘outpatient occupational therapy serv15 ices’ means occupational therapy services furnished by a 

16 provider of services, a clinic, a rehabilitation agency, or 

17 a public health agency, or by others under an arrangement 

18 with, and under the supervision of, such a provider, clinic, 

19 rehabilitation agency, or public health agency to an indi20 vidual as an outpatient—

21 ‘‘(1) who is under the care of a physician (as 

22 defined in paragraph (1), (3), or (4) of subsection 

23 (r)); 

24 ‘‘(2) with respect to whom a plan prescribing 

25 the type, amount, and duration of occupational ther-
8

•HR 792 IH 

1 apy services that are furnished to such individual 

2 has been established by a physician (as so defined)

3 or by an occupational therapist and is periodically 

4 reviewed by a physician (as so defined); 

5 excluding, however—

6 ‘‘(3) any item or service if it would not be in7 cluded under subsection (b) if furnished to an inpa8 tient of a hospital; and 

9 ‘‘(4) any such service—

10 ‘‘(A) if furnished by a clinic, rehabilitation 

11 agency, or by others under arrangements with 

12 such clinic or agency, unless such clinic or reha13 bilitation agency—

14 ‘‘(i) provides an adequate program of 

15 occupational therapy services for out16 patients and has the facilities and per17 sonnel required for such program or re18 quired for the supervision of such a pro19 gram, in accordance with such require20 ments as the Secretary may specify; 

21 ‘‘(ii) has policies, established by a 

22 group of professional personnel, including 

23 one or more occupational therapists, to 

24 govern the services (referred to in clause 

25 (i)) it provides; 
9

•HR 792 IH 

1 ‘‘(iii) maintains clinical records on all 

2 patients; 

3 ‘‘(iv) if such clinic or agency is situ4 ated in a State in which State or applica5 ble local law provides for the licensing of 

6 institutions of this nature—

7 ‘‘(I) is licensed pursuant to such 

8 law, or 

9 ‘‘(II) is approved by the agency 

10 of such State or locality responsible 

11 for licensing institutions of this na12 ture, as meeting the standards estab13 lished for such licensing; and 

14 ‘‘(v) meets such other conditions relat15 ing to the health and safety of individuals 

16 who are furnished services by such clinic or 

17 agency on an outpatient basis, as the Sec18 retary may find necessary, and provides 

19 the Secretary on a continuing basis with 

20 a surety bond that is not less than 

21 $50,000; or 

22 ‘‘(B) if furnished by a public health agen23 cy, unless such agency meets such other condi24 tions relating to the safety of individuals who 

25 are furnished services by such agency on an 
10

•HR 792 IH 

1 outpatient basis, as the Secretary may find nec2 essary. 

3 The term ‘outpatient occupational therapy services’ also 

4 includes occupational therapy services furnished an indi5 vidual by an occupational therapist (in the office of the 

6 occupational therapist or in such individual’s home) who 

7 meets licensing and other standards prescribed by the Sec8 retary in regulations, otherwise than under an arrange9 ment with and under the supervision of a provider of serv10 ices, clinic, rehabilitation agency, or public health agency, 

11 if the furnishing of such services meets such conditions 

12 relating to health and safety as the Secretary may find 

13 necessary. In addition, such term includes occupational 

14 therapy services that meet the requirements of the first 

15 sentence of this subsection except that they are furnished 

16 to an inpatient of a hospital or extended care facility. 

17 Nothing in this subsection shall be construed as requiring, 

18 with respect to outpatients who are not entitled to benefits 

19 under this title, an occupational therapist to provide out20 patient occupational therapy services only to outpatients 

21 who are under the care of a physician or pursuant to a 

22 plan of care established by a physician. The Secretary may 

23 waive the requirement of a surety bond under paragraph 

24 (4)(A)(v) in the case of a clinic or agency that provides 

25 a comparable surety bond under State law.’’. 
11

•HR 792 IH 

1 (2) CONFORMING AMENDMENTS.—

2 (A) SCOPE OF BENEFITS.—Section 

3 1832(a)(2)(C) of the Social Security Act (42 

4 U.S.C. 1395k(a)(2)(C)) is amended by striking

5 ‘‘such sentence applies through the operation of 

6 section 1861(g))’’ and inserting ‘‘the second 

7 sentence of section 1861(g) applies)’’. 

8 (B) PAYMENT OF BENEFITS.—Section 

9 1833(g)(3) of the Social Security Act (42 

10 U.S.C. 1395l(g)(3)) is amended by striking 

11 ‘‘section 1861(p)’’ and all that follows through 

12 ‘‘section 1861(g)’’ and inserting ‘‘section 

13 1861(g) (but not described in subsection 

14 (a)(8)(B))’’. 

15 (C) PROVIDER CLAIMS PROCEDURES.—The 

16 second sentence of section 1835(a) of the Social 

17 Security Act (42 U.S.C. 1395n(a)) is amend18 ed—

19 (i) by striking ‘‘section 1861(p)(4)(A) 

20 (or meets the requirements of such section 

21 through the operation of section 1861(g))’’ 

22 and inserting ‘‘section 1861(p)(4)(A) or 

23 section 1861(g)(4)(A)’’; 

24 (ii) by striking ‘‘section 1861(p)(4)(B) 

25 (or meets the requirements of such section 
12

•HR 792 IH 

1 through the operation of section 1861(g))’’ 

2 and inserting ‘‘section 1861(p)(4)(B) or 

3 section 1861(g)(4)(B)’’; and 

4 (iii) by striking ‘‘(as therein defined) 

5 or (through the operation of section 

6 1861(g)) with respect to the furnishing of 

7 outpatient occupational therapy services’’ 

8 and inserting ‘‘(as defined in section 

9 1861(p)) or outpatient occupational ther10 apy services (as defined in section 

11 1861(g)), respectively’’. 

12 (D) AGREEMENTS WITH PROVIDERS.—Sec13 tion 1866(e)(1) of the Social Security Act (42 

14 U.S.C. 1395cc(e)(1)) is amended—

15 (i) by striking ‘‘section 1861(p)(4)(A) 

16 (or meets the requirements of such section 

17 through the operation of section 1861(g))’’ 

18 and inserting ‘‘section 1861(p)(4)(A) or 

19 section 1861(g)(4)(A)’’; 

20 (ii) by striking ‘‘section 1861(p)(4)(B) 

21 (or meets the requirements of such section 

22 through the operation of section 1861(g))’’ 

23 and inserting ‘‘section 1861(p)(4)(B) or 

24 section 1861(g)(4)(B)’’; and 
13

•HR 792 IH 

1 (iii) by striking ‘‘(as therein defined) 

2 or (through the operation of section 

3 1861(g)) with respect to the furnishing of 

4 outpatient occupational therapy services’’

5 and inserting ‘‘(as defined in section 

6 1861(p)) or outpatient occupational ther7 apy services (as defined in section 

8 1861(g)), respectively’’. 

9 (c) SEPARATE STATUTORY TREATMENT FOR OUT10 PATIENT PHYSICAL THERAPY SERVICES AND OUT11 PATIENT SPEECH-LANGUAGE PATHOLOGY SERVICES.—

12 (1) SCOPE OF BENEFITS.—Section 

13 1832(a)(2)(C) of the Social Security Act (42 U.S.C. 

14 1395k(a)(2)(C)), as amended by subsection 

15 (b)(2)(A), is amended—

16 (A) by striking ‘‘and outpatient’’ and in17 serting ‘‘, outpatient’’; and 

18 (B) by inserting before the semicolon the 

19 following: ‘‘, and outpatient speech-language pa20 thology services’’. 

21 (2) PAYMENT OF BENEFITS.—Section 1833 of 

22 the Social Security Act (42 U.S.C. 1395l) is amend23 ed—

24 (A) in subparagraphs (A) and (B) of sub25 section (a)(8), by striking ‘‘services, (which in-
14

•HR 792 IH 

1 cludes outpatient speech-language pathology 

2 services) and outpatient occupational therapy 

3 services’’ each place it appears and inserting 

4 ‘‘services, outpatient occupational therapy serv5 ices, and outpatient speech-language pathology 

6 services’’; and 

7 (B) in subsection (g)—

8 (i) in paragraphs (1) and (3), by 

9 striking ‘‘paragraph (4)’’ each place it ap10 pears and inserting ‘‘paragraph (5)’’; and 

11 (ii) by redesignating paragraph (4) as 

12 paragraph (5) and inserting after para13 graph (3) the following new paragraph: 

14 ‘‘(4) Subject to paragraph (5), in the case of 

15 speech-language pathology services (of the type de16 scribed in section 1861(ll)(4) (but not described in 

17 subsection (a)(8)(B)) and speech-language pathology

18 services of such type that are furnished by a physi19 cian or as incident to physicians’ services), with re20 spect to expenses incurred in any calendar year, no 

21 more than the amount specified in paragraph (2) for 

22 the year shall be considered as incurred expenses for 

23 purposes of subsections (a) and (b).’’. 

24 (3) PROVIDER CLAIMS PROCEDURES.—The sec25 ond sentence of section 1835(a) of the Social Secu-
15

•HR 792 IH 

1 rity Act (42 U.S.C. 1395n(a)), as amended by sub2 section (b)(2)(C), is amended—

3 (A) by striking ‘‘or section 1861(g)(4)(A)’’ 

4 and inserting ‘‘, section 1861(g)(4)(A), or sec5 tion 1861(ll)(5)(A)’’; 

6 (B) by striking ‘‘or section 1861(g)(4)(B)’’ 

7 and inserting ‘‘, section 1861(g)(4)(B), or sec8 tion 1861(ll)(4)(B)(ii)(II)’’; and 

9 (C) by striking ‘‘or outpatient occupational 

10 services (as defined in section 1861(g))’’ and 

11 inserting ‘‘, outpatient occupational services (as 

12 defined in section 1861(g)), or outpatient 

13 speech-language pathology services (as defined 

14 in section 1861(ll)(4)(A))’’. 

15 (4) AGREEMENTS WITH PROVIDERS.—Section 

16 1866(e)(1) of the Social Security Act (42 U.S.C. 

17 1395cc(e)(1)), as amended by subsection (b)(2)(D), 

18 is amended—

19 (A) by striking ‘‘or section 1861(g)(4)(A)’’ 

20 and inserting 1861(g)(4)(A), or section 

21 1861(ll)(5)(A)’’; 

22 (B) by striking ‘‘or section 1861(g)(4)(B)’’ 

23 and inserting ‘‘, section 1861(g)(4)(B), or sec24 tion 1861(ll)(4)(B)(ii)(II)’’; and 
16

•HR 792 IH 

1 (C) by striking ‘‘or outpatient occupational 

2 services (as defined in section 1861(g))’’ and 

3 inserting ‘‘, outpatient occupational services (as 

4 defined in section 1861(g)), or outpatient 

5 speech-language pathology services (as defined 

6 in section 1861(ll)(4)(A))’’. 

7 (5) DEFINITIONS.—Section 1861 of the Social 

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

9 (A) in subsection (p), by striking the 

10 fourth sentence; 

11 (B) in subsection (s)(2)(D), by striking 

12 ‘‘services and outpatient occupational therapy 

13 services’’ and inserting ‘‘services, outpatient oc14 cupational therapy services, and outpatient 

15 speech-language pathology services’’; and 

16 (C) in subsection (ll), by adding at the end 

17 the following new paragraphs: 

18 ‘‘(4)(A) Subject to subparagraph (B), the term ‘out19 patient speech-language pathology services’ means speech20 language pathology services that are furnished by a pro21 vider of services, a clinic, a rehabilitation agency, or a pub22 lic health agency, or by others under an arrangement with, 

23 and under the supervision of, such provider, clinic, reha24 bilitation agency, or public health agency to an individual 

25 as an outpatient—
17

•HR 792 IH 

1 ‘‘(i) who is under the care of a physician (as de2 fined in paragraph (1), (3), or (4) of subsection (r)); 

3 and 

4 ‘‘(ii) with respect to whom a plan prescribing 

5 the type, amount, and duration of speech-language 

6 pathology services that are furnished to such indi7 vidual has been established by a physician (as so de8 fined) or by a qualified speech-language pathologist 

9 and is periodically reviewed by a physician (as so de10 fined). 

11 ‘‘(B) Such term does not include—

12 ‘‘(i) any item or service if it would not be in13 cluded under subsection (b) if furnished to an inpa14 tient of a hospital; or 

15 ‘‘(ii) any item or service—

16 ‘‘(I) if furnished by a clinic, rehabilitation 

17 agency, or by others under arrangements with 

18 such clinic or agency, unless such clinic or reha19 bilitation agency meets the requirements of 

20 paragraph (5); and 

21 ‘‘(II) if furnished by a public health agen22 cy, unless such agency meets such other condi23 tions relating to the safety of individuals who 

24 are furnished services by such agency on an 
18

•HR 792 IH 

1 outpatient basis, as the Secretary may find nec2 essary. 

3 ‘‘(C) Such term also includes speech-language pathol4 ogy services that meet the requirements of the preceding 

5 sentence except that they are furnished to an inpatient 

6 of a hospital or extended care facility. Nothing in this sub7 section shall be construed as requiring, with respect to 

8 outpatients who are not entitled to benefits under this 

9 title, a speech-language pathologist to provide outpatient 

10 speech-language pathology services only to outpatients 

11 who are under the care of a physician or pursuant to a 

12 plan of care established by a physician. The Secretary may 

13 waive the requirement of a surety bond under paragraph 

14 (5)(E) in the case of a clinic or agency that provides a 

15 comparable surety bond under State law. 

16 ‘‘(5) A clinic or rehabilitation agency meets the re17 quirements of this paragraph if it—

18 ‘‘(A) provides an adequate program of speech19 language pathology services for outpatients and has 

20 the facilities and personnel required for such pro21 gram or required for the supervision of such a pro22 gram, in accordance with such requirements as the 

23 Secretary may specify; 

24 ‘‘(B) has policies, established by a group of pro25 fessional personnel, including one or more speech-
19

•HR 792 IH 

1 language pathologists, to govern the services (re2 ferred to in subparagraph (A)) it provides; 

3 ‘‘(C) maintains clinical records on all patients; 

4 ‘‘(D) in the case of a clinic or agency that is 

5 situated in a State in which State or applicable local 

6 law provides for the licensing of institutions of this 

7 nature—

8 ‘‘(i) is licensed pursuant to such law, or 

9 ‘‘(ii) is approved by the agency of such 

10 State or locality responsible for licensing insti11 tutions of this nature, as meeting the standards 

12 established for such licensing; and 

13 ‘‘(E) meets such other conditions relating to the 

14 health and safety of individuals who are furnished 

15 services by such clinic or agency on an outpatient 

16 basis, as the Secretary may find necessary, and pro17 vides the Secretary on a continuing basis with a sur18 ety bond that is not less than $50,000.’’. 

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

20 this section shall apply to items and services furnished on 

21 or after January 1, 2003.

Æ