(ii) by striking ‘‘section 1861(p)(4)(B) 
(or meets the requirements of such section 
through the operation of section 1861(g))’’ 
and inserting ‘‘section 1861(p)(4)(B) or 
section 1861(g)(4)(B)’’; and 
(iii) by striking ‘‘(as therein defined) 
or (through the operation of section 
1861(g)) with respect to the furnishing of 
outpatient occupational therapy services’’ 
and inserting ‘‘(as defined in section 
1861(p)) or outpatient occupational ther-
apy 
services 
(as 
defined 
in 
section 
1861(g)), respectively’’. 
(D) AGREEMENTS WITH PROVIDERS.—Sec-
tion 1866(e)(1) of the Social Security Act (42 
U.S.C. 1395cc(e)(1)) is amended— 
(i) by striking ‘‘section 1861(p)(4)(A) 
(or meets the requirements of such section 
through the operation of section 1861(g))’’ 
and inserting ‘‘section 1861(p)(4)(A) or 
section 1861(g)(4)(A)’’; 
(ii) by striking ‘‘section 1861(p)(4)(B) 
(or meets the requirements of such section 
through the operation of section 1861(g))’’ 
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and inserting ‘‘section 1861(p)(4)(B) or 
section 1861(g)(4)(B)’’; and 
(iii) by striking ‘‘(as therein defined) 
or (through the operation of section 
1861(g)) with respect to the furnishing of 
outpatient occupational therapy services’’ 
and inserting ‘‘(as defined in section 
1861(p)) or outpatient occupational ther-
apy 
services 
(as 
defined 
in 
section 
1861(g)), respectively’’. 
(c) SEPARATE STATUTORY TREATMENT FOR OUT-
PATIENT
PHYSICAL
THERAPY
SERVICES
AND
OUT-
PATIENT SPEECH-LANGUAGE PATHOLOGY SERVICES.— 
(1) 
SCOPE
OF
BENEFITS.—Section 
1832(a)(2)(C) of the Social Security Act (42 U.S.C. 
1395k(a)(2)(C)), 
as 
amended 
by 
subsection 
(b)(2)(A), is amended— 
(A) by striking ‘‘and outpatient’’ and in-
serting ‘‘, outpatient’’; and 
(B) by inserting before the semicolon the 
following: ‘‘, and outpatient speech-language pa-
thology services’’. 
(2) PAYMENT OF BENEFITS.—Section 1833 of 
the Social Security Act (42 U.S.C. 1395l) is amend-
ed— 
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(A) in subparagraphs (A) and (B) of sub-
section (a)(8), by striking ‘‘services, (which in-
cludes outpatient speech-language pathology 
services) and outpatient occupational therapy 
services’’ each place it appears and inserting 
‘‘services, outpatient occupational therapy serv-
ices, and outpatient speech-language pathology 
services’’; and 
(B) in subsection (g)— 
(i) in paragraphs (1) and (3), by 
striking ‘‘paragraphs (4) and (5)’’ and in-
serting ‘‘paragraphs (5) and (6)’’ each 
place it appears; 
(ii) by redesignating paragraphs (4) 
and (5) as paragraphs (5) and (6), respec-
tively, and inserting after paragraph (3) 
the following new paragraph: 
‘‘(4) Subject to paragraphs (5) and (6), in the 
case of speech-language pathology services (of the 
type described in section 1861(ll)(5) (but not de-
scribed in subsection (a)(8)(B)) and speech-language 
pathology services of such type that are furnished by 
a physician or as incident to physicians’ services), 
with respect to expenses incurred in any calendar 
year, no more than the amount specified in para-
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graph (2) for the year shall be considered as in-
curred expenses for purposes of subsections (a) and 
(b).’’; and 
(iii) in paragraph (5), by striking 
‘‘paragraphs (1) and (3)’’ and inserting 
‘‘paragraphs (1), (3), and (4)’’. 
(3) PROVIDER CLAIMS PROCEDURES.—The sec-
ond sentence of section 1835(a) of the Social Secu-
rity Act (42 U.S.C. 1395n(a)), as amended by sub-
section (b)(2)(C), is amended— 
(A) by striking ‘‘or section 1861(g)(4)(A)’’ 
and inserting ‘‘, section 1861(g)(4)(A), or sec-
tion 1861(ll)(6)(A)’’; 
(B) by striking ‘‘or section 1861(g)(4)(B)’’ 
and inserting ‘‘, section 1861(g)(4)(B), or sec-
tion 1861(ll)(5)(B)(ii)(II)’’; and 
(C) by striking ‘‘or outpatient occupational 
services (as defined in section 1861(g))’’ and 
inserting ‘‘, outpatient occupational services (as 
defined in section 1861(g)), or outpatient 
speech-language pathology services (as defined 
in section 1861(ll)(5)(A))’’. 
(4) AGREEMENTS
WITH
PROVIDERS.—Section 
1866(e)(1) of the Social Security Act (42 U.S.C. 
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1395cc(e)(1)), as amended by subsection (b)(2)(D), 
is amended— 
(A) by striking ‘‘or section 1861(g)(4)(A)’’ 
and 
inserting 
1861(g)(4)(A), 
or 
section 
1861(ll)(6)(A)’’; 
(B) by striking ‘‘or section 1861(g)(4)(B)’’ 
and inserting ‘‘, section 1861(g)(4)(B), or sec-
tion 1861(ll)(5)(B)(ii)(II)’’; and 
(C) by striking ‘‘or outpatient occupational 
services (as defined in section 1861(g))’’ and 
inserting ‘‘, outpatient occupational services (as 
defined in section 1861(g)), or outpatient 
speech-language pathology services (as defined 
in section 1861(ll)(5)(A))’’. 
(5) DEFINITIONS.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended— 
(A) in subsection (p), by striking the 
fourth sentence; 
(B) in subsection (s)(2)(D), by striking 
‘‘services and outpatient occupational therapy 
services’’ and inserting ‘‘services, outpatient oc-
cupational therapy services, and outpatient 
speech-language pathology services’’; and 
(C) in subsection (ll), by adding at the end 
the following new paragraphs: 
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‘‘(5)(A) Subject to subparagraph (B), the term ‘out-
patient speech-language pathology services’ means speech- 
language pathology services that are furnished by a pro-
vider of services, a clinic, a rehabilitation agency, or a pub-
lic health agency, or by others under an arrangement with, 
and under the supervision of, such provider, clinic, reha-
bilitation agency, or public health agency to an individual 
as an outpatient— 
‘‘(i) who is under the care of a physician (as de-
fined in paragraph (1), (3), or (4) of subsection (r)); 
and 
‘‘(ii) with respect to whom a plan prescribing 
the type, amount, and duration of speech-language 
pathology services that are furnished to such indi-
vidual has been established by a physician (as so de-
fined) or by a qualified speech-language pathologist 
and is periodically reviewed by a physician (as so de-
fined). 
‘‘(B) Such term does not include— 
‘‘(i) any item or service if it would not be in-
cluded under subsection (b) if furnished to an inpa-
tient of a hospital; or 
‘‘(ii) any item or service— 
‘‘(I) if furnished by a clinic, rehabilitation 
agency, or by others under arrangements with 
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such clinic or agency, unless such clinic or reha-
bilitation agency meets the requirements of 
paragraph (6); and 
‘‘(II) if furnished by a public health agen-
cy, unless such agency meets such other condi-
tions relating to the safety of individuals who 
are furnished services by such agency on an 
outpatient basis, as the Secretary may find nec-
essary. 
‘‘(C) Such term also includes speech-language pathol-
ogy services that meet the requirements of the preceding 
sentence except that they are furnished to an inpatient 
of a hospital or extended care facility. Nothing in this sub-
section shall be construed as requiring, with respect to 
outpatients who are not entitled to benefits under this 
title, a speech-language pathologist to provide outpatient 
speech-language pathology services only to outpatients 
who are under the care of a physician or pursuant to a 
plan of care established by a physician. The Secretary may 
waive the requirement of a surety bond under paragraph 
(5)(E) in the case of a clinic or agency that provides a 
comparable surety bond under State law. 
‘‘(6) A clinic or rehabilitation agency meets the re-
quirements of this paragraph if it— 
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