I 
109TH CONGRESS 
1ST SESSION H. R. 1333 
To amend title XVIII of the Social Security Act to authorize physical thera-
pists to evaluate and treat Medicare beneficiaries without a requirement 
for a physician referral, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 16, 2005 
Ms. HART (for herself, Mr. POMEROY, Mr. BISHOP of Utah, Mr. PLATTS, Mr. 
SHIMKUS, Mr. MCCOTTER, Mr. ROHRABACHER, Mr. SHUSTER, Mr. NOR-
WOOD, Mr. PAUL, Mr. GARY G. MILLER of California, Mr. BOEHNER, 
Mr. GERLACH, Mr. YOUNG of Alaska, Mr. ETHERIDGE, Mr. WU, Mr. 
ROSS, Mr. DICKS, Mr. FORD, Mrs. JO ANN DAVIS of Virginia, Mr. 
GRIJALVA, Mr. FARR, Mr. KILDEE, Mr. TOWNS, Mr. COOPER, Mr. HIN-
CHEY, Mr. JEFFERSON, Mr. MCNULTY, Ms. ROS-LEHTINEN, Mr. 
WEINER, Mr. TURNER, Mr. WILSON of South Carolina, Mr. ROGERS of 
Kentucky, Mr. ALEXANDER, Ms. WOOLSEY, Mr. MARIO DIAZ-BALART of 
Florida, Ms. KILPATRICK of Michigan, Mr. SOUDER, Mr. BRADLEY of 
New Hampshire, Mr. LINCOLN DIAZ-BALART of Florida, Mr. ROGERS of 
Alabama, Mr. LANGEVIN, Mr. HOSTETTLER, Mr. MILLER of North Caro-
lina, Mr. GENE GREEN of Texas, Mr. SCHIFF, Mr. BECERRA, and Mr. 
PITTS) 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 juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to authorize 
physical therapists to evaluate and treat Medicare bene-
ficiaries without a requirement for a physician referral, 
and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Patient Ac-
cess to Physical Therapists Act of 2005’’. 
SEC. 2. ACCESS TO OUTPATIENT PHYSICAL THERAPY SERV-
ICES FOR MEDICARE BENEFICIARIES AS AU-
THORIZED BY STATE LAW. 
(a) IN GENERAL.— 
(1) ELIMINATION OF REQUIRED PHYSICIAN RE-
FERRAL.— 
(A) DEFINITION
OF
OUTPATIENT
PHYS-
ICAL THERAPY SERVICES.—Section 1861(p) of 
the Social Security Act (42 U.S.C. 1395x(p)) is 
amended— 
(i) in the matter preceding paragraph 
(1), by striking ‘‘as an outpatient’’; 
(ii) by amending paragraph (1) to 
read as follows: 
‘‘(1) who is an outpatient, and’’; 
(iii) in paragraph (2)— 
(I) by striking ‘‘physician (as so 
defined) or by a qualified physical 
therapist’’ and inserting ‘‘physician 
(as defined in paragraph (1), (3), or
(4) of subsection (r)) or by a qualified 
physical therapist (as defined in sec-
tion 1861(bbb))’’; and 
(II) by inserting ‘‘or a qualified 
physical therapist (as so defined)’’ 
after ‘‘physician’’ the second place it 
appears; 
(iv) in paragraph (4)(A)(ii), by strik-
ing ‘‘one or more’’ and all that follows 
through ‘‘agency) and’’; and 
(v) by amending the fifth sentence to 
read as follows: ‘‘Nothing in this sub-
section shall be construed as authorizing 
the provision of services in a State that a 
qualified physical therapist is not author-
ized to provide in the State in accordance 
with State law (or the State regulatory 
mechanism provided by State law). 
(B) CONFORMING AMENDMENTS.—Section 
1835(a)(2) of the Social Security Act (42 
U.S.C. 1395n(a)(2)) is amended— 
(i) in the matter preceding subpara-
graph (A), by inserting ‘‘, or in the case of 
outpatient physical therapy services (as de-
scribed in subparagraph (C)) and physical
therapy services furnished as comprehen-
sive outpatient rehabilitation facility serv-
ices (described in subparagraph (E)), a 
qualified physical therapist,’’ after ‘‘a phy-
sician’’; 
(ii) in subparagraph (C)— 
(I) in the matter preceding clause 
(i), by striking ‘‘or outpatient occupa-
tional therapy services’’; 
(II) in clause (i), by striking ‘‘or 
occupational therapy services, respec-
tively,’’ and inserting ‘‘, and’’; 
(III) in clause (ii), by striking 
‘‘or qualified occupational therapist, 
respectively,’’; and 
(IV) beginning in clause (ii), by 
striking ‘‘by a physician, and (iii)’’ 
and all that follows and inserting ‘‘by 
a physician or a qualified physical 
therapist;’’; 
(iii) in subparagraph (D)— 
(I) in the matter preceding clause 
(i), by striking ‘‘outpatient speech pa-
thology services’’ and inserting ‘‘out-
patient occupational therapy services
or outpatient speech-language pathol-
ogy services’’; 
(II) in clause (i), by striking 
‘‘needed speech pathology services’’ 
and inserting ‘‘needed occupational 
therapy services or speech-language 
pathology services, respectively’’; and 
(III) in clause (ii), by striking 
‘‘speech pathologist’’ and inserting 
‘‘occupational therapist or speech-lan-
guage pathologist, respectively,’’; and 
(iv) in subparagraph (E)— 
(I) in clause (ii), by inserting 
‘‘(or, in the case of comprehensive 
outpatient rehabilitation facility serv-
ices consisting of physical therapy 
services, by a qualified physical thera-
pist)’’ after ‘‘physician’’; and 
(II) in clause (iii), by inserting 
‘‘in the case of comprehensive out-
patient rehabilitation facility services 
not consisting of physical therapy 
services,’’ before ‘‘such services’’. 
(2) DEFINITION
OF
QUALIFIED
PHYSICAL 
THERAPIST.—Section 1861 of the Social Security
Act (42 U.S.C. 1395x) is amended by adding at the 
end the following new subsection: 
‘‘Qualified Physical Therapist 
‘‘(bbb) The term ‘qualified physical therapist’ means 
an individual who is licensed as a physical therapist by 
the State in which such individual is practicing and who 
meets the applicable requirements under paragraph (1) or 
(2): 
‘‘(1) With respect to individuals graduating 
from a professional physical therapy education pro-
gram on or after January 1, 2003, the individual— 
‘‘(A) has received a master’s or doctoral 
degree from a professional physical therapy 
education program that has been accredited by 
a national physical therapy education accredita-
tion agency recognized by the Secretary of Edu-
cation; or 
‘‘(B) has graduated from a professional 
physical therapy education program outside the 
United States with a curriculum that is sub-
stantially equivalent (as determined by an ac-
creditation agency described in subparagraph 
(A)) to the curricula of programs for profes-
sional physical therapy education programs in
the United States that are accredited by such 
an accreditation agency. 
‘‘(2) With respect to individuals licensed as 
physical therapists by a State before 2003, the indi-
vidual was, or upon application to the Secretary 
could have been, qualified under regulations of the 
Secretary in effect before such date to furnish phys-
ical therapy services under this title, as determined 
by the Secretary.’’. 
(b) PRESERVING EXISTING LAW FOR OUTPATIENT 
OCCUPATIONAL THERAPY SERVICES.— 
(1) DEFINITION.—Section 1861(g) of the Social 
Security Act (42 U.S.C. 1395x(g)) is amended to 
read as follows: 
‘‘Outpatient Occupational Therapy Services 
‘‘(g) The term ‘outpatient occupational therapy serv-
ices’ means occupational therapy services furnished by a 
provider of services, a clinic, a rehabilitation agency, or 
a public health agency, or by others under an arrangement 
with, and under the supervision of, such a provider, clinic, 
rehabilitation agency, or public health agency to an indi-
vidual as an outpatient— 
‘‘(1) who is under the care of a physician (as 
defined in paragraph (1), (3), or (4) of subsection 
(r));
‘‘(2) with respect to whom a plan prescribing 
the type, amount, and duration of occupational ther-
apy services that are furnished to such individual 
has been established by a physician (as so defined) 
or by an occupational therapist and is periodically 
reviewed by a physician (as so defined); 
excluding, however— 
‘‘(3) any item or service if it would not be in-
cluded under subsection (b) if furnished to an inpa-
tient of a hospital; and 
‘‘(4) any such service— 
‘‘(A) if furnished by a clinic, rehabilitation 
agency, or by others under arrangements with 
such clinic or agency, unless such clinic or reha-
bilitation agency— 
‘‘(i) provides an adequate program of 
occupational therapy services for out-
patients and has the facilities and per-
sonnel required for such program or re-
quired for the supervision of such a pro-
gram, in accordance with such require-
ments as the Secretary may specify; 
‘‘(ii) has policies, established by a 
group of professional personnel, including 
one or more occupational therapists, to
govern the services (referred to in clause 
(i)) it provides; 
‘‘(iii) maintains clinical records on all 
patients; 
‘‘(iv) if such clinic or agency is situ-
ated in a State in which State or applica-
ble local law provides for the licensing of 
institutions of this nature— 
‘‘(I) is licensed pursuant to such 
law, or 
‘‘(II) is approved by the agency 
of such State or locality responsible 
for licensing institutions of this na-
ture, as meeting the standards estab-
lished for such licensing; and 
‘‘(v) meets such other conditions relat-
ing to the health and safety of individuals 
who are furnished services by such clinic or 
agency on an outpatient basis, as the Sec-
retary may find necessary, and provides 
the Secretary on a continuing basis with a 
surety bond that is not less than $50,000; 
or 
‘‘(B) 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. 
The term ‘outpatient occupational therapy services’ also 
includes occupational therapy services furnished an indi-
vidual by an occupational therapist (in the office of the 
occupational therapist or in such individual’s home) who 
meets licensing and other standards prescribed by the Sec-
retary in regulations, otherwise than under an arrange-
ment with and under the supervision of a provider of serv-
ices, clinic, rehabilitation agency, or public health agency, 
if the furnishing of such services meets such conditions 
relating to health and safety as the Secretary may find 
necessary. In addition, such term includes occupational 
therapy services that meet the requirements of the first 
sentence of this subsection except that they are furnished 
to an inpatient of a hospital or extended care facility. 
Nothing in this subsection shall be construed as requiring, 
with respect to outpatients who are not entitled to benefits 
under this title, an occupational therapist to provide out-
patient occupational therapy 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
(4)(A)(v) in the case of a clinic or agency that provides 
a comparable surety bond under State law.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) 
SCOPE
OF
BENEFITS.—Section 
1832(a)(2)(C) of the Social Security Act (42 
U.S.C. 1395k(a)(2)(C)) is amended by striking 
‘‘such sentence applies through the operation of 
section 1861(g))’’ and inserting ‘‘the second 
sentence of section 1861(g) applies)’’. 
(B) PAYMENT
OF
BENEFITS.—Section 
1833(g)(3) of the Social Security Act (42 
U.S.C. 1395l(g)(3)) is amended by striking 
‘‘section 1861(p)’’ and all that follows through 
‘‘section 
1861(g)’’ 
and 
inserting 
‘‘section 
1861(g) (but not described in subsection 
(a)(8)(B))’’. 
(C) PROVIDER CLAIMS PROCEDURES.—The 
second sentence of section 1835(a) of the Social 
Security Act (42 U.S.C. 1395n(a)) is amend-
ed— 
(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))’’ 
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))’’
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—
(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 ‘‘paragraph (4)’’ each place it ap-
pears and inserting ‘‘paragraph (5)’’; and 
(ii) by redesignating paragraph (4) as 
paragraph (5) and inserting after para-
graph (3) the following new paragraph: 
‘‘(4) Subject to paragraph (5), in the case of 
speech-language pathology services (of the type de-
scribed in section 1861(ll)(4) (but not described in 
subsection (a)(8)(B)) and speech-language pathology 
services of such type that are furnished by a physi-
cian or as incident to physicians’ services), with re-
spect to expenses incurred in any calendar year, no 
more than the amount specified in paragraph (2) for 
the year shall be considered as incurred expenses for 
purposes of subsections (a) and (b).’’.
(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)(5)(A)’’; 
(B) by striking ‘‘or section 1861(g)(4)(B)’’ 
and inserting ‘‘, section 1861(g)(4)(B), or sec-
tion 1861(ll)(4)(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)(4)(A))’’. 
(4) AGREEMENTS
WITH
PROVIDERS.—Section 
1866(e)(1) of the Social Security Act (42 U.S.C. 
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)(5)(A)’’;
(B) by striking ‘‘or section 1861(g)(4)(B)’’ 
and inserting ‘‘, section 1861(g)(4)(B), or sec-
tion 1861(ll)(4)(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)(4)(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: 
‘‘(4)(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 
such clinic or agency, unless such clinic or reha-
bilitation agency meets the requirements of 
paragraph (5); 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. 
‘‘(5) A clinic or rehabilitation agency meets the re-
quirements of this paragraph if it— 
‘‘(A) provides an adequate program of speech- 
language pathology services for outpatients and has 
the facilities and personnel required for such pro-
gram or required for the supervision of such a pro-
gram, in accordance with such requirements as the 
Secretary may specify;
‘‘(B) has policies, established by a group of pro-
fessional personnel, including one or more speech- 
language pathologists, to govern the services (re-
ferred to in subparagraph (A)) it provides; 
‘‘(C) maintains clinical records on all patients; 
‘‘(D) in the case of a clinic or agency that is 
situated in a State in which State or applicable local 
law provides for the licensing of institutions of this 
nature— 
‘‘(i) is licensed pursuant to such law, or 
‘‘(ii) is approved by the agency of such 
State or locality responsible for licensing insti-
tutions of this nature, as meeting the standards 
established for such licensing; and 
‘‘(E) meets such other conditions relating to the 
health and safety of individuals who are furnished 
services by such clinic or agency on an outpatient 
basis, as the Secretary may find necessary, and pro-
vides the Secretary on a continuing basis with a sur-
ety bond that is not less than $50,000.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2006. 
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