I 
108TH CONGRESS 
1ST SESSION H. R. 1902
To amend title XVIII of the Social Security Act to improve outpatient 
vision services under part B of the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 1, 2003
Mr. FOLEY (for himself, Mr. CAPUANO, Mr. ENGLISH, Mr. CAMP, Mr. ISRAEL, 
Mr. FOSSELLA, Mr. PAYNE, Mr. GOODLATTE, Mr. WAXMAN, Mr. UPTON, 
Mr. HINCHEY, Mr. ABERCROMBIE, Mr. MCNULTY, Mr. WATT, Mr. 
ENGEL, Mr. WELDON of Florida, Mr. MICHAUD, Mr. SERRANO, Mrs. 
CHRISTENSEN, Mr. KENNEDY of Rhode Island, Mr. HOEFFEL, Mr. 
TOWNS, Mr. FROST, Mr. ALLEN, Mr. LYNCH, Mr. DOYLE, Ms. CORRINE 
BROWN of Florida, and Mr. SIMMONS) 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 subse-
quently 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 improve 
outpatient vision services under part B of the Medicare 
Program.
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 Vision Reha-
bilitation Services Act of 2003’’.
SEC. 2. IMPROVEMENT OF OUTPATIENT VISION SERVICES 
UNDER PART B. 
(a) COVERAGE UNDER PART B.—Section 1861(s)(2) 
of the Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended—
(1) in subparagraph (U), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (V), by inserting ‘‘and’’ at 
the end; and; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(W) vision rehabilitation services (as defined 
in subsection (ww)(1));’’. 
(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x) is amended by adding 
at the end the following new subsection: 
‘‘Vision Rehabilitation Services: Vision Rehabilitation 
Professional 
‘‘(ww)(1)(A) The term ‘vision rehabilitation services’ 
means rehabilitative services (as determined by the Sec-
retary in regulations) furnished—
‘‘(i) to an individual diagnosed with a vision im-
pairment (as defined in paragraph (6)), 
‘‘(ii) pursuant to a plan of care established by 
a qualified physician (as defined in subparagraph
(C)), or by a qualified occupational therapist, and is 
periodically reviewed by the qualified physician, 
‘‘(iii) in an appropriate setting (including the 
home of the individual receiving such services if 
specified in the plan of care), and 
‘‘(iv) by any of the following individuals: 
‘‘(I) A qualified physician. 
‘‘(II) A qualified occupational therapist. 
‘‘(III) A vision rehabilitation professional 
(as defined in paragraph (2)) while under the 
general supervision (as defined in subparagraph 
(D)) of a qualified physician. 
‘‘(B) In the case of vision rehabilitation services fur-
nished by a vision rehabilitation professional, the plan of 
care may only be established and reviewed by a qualified 
physician. 
‘‘(C) The term ‘qualified physician’ means—
‘‘(i) a physician (as defined in subsection 
(r)(1)) who is an ophthalmologist; or 
‘‘(ii) a physician (as defined in subsection (r)(4) 
(relating to a doctor of optometry)). 
‘‘(D) The term ‘general supervision’ means, with re-
spect to a vision rehabilitation professional, overall direc-
tion and control of that professional by the qualified physi-
cian who established the plan of care for the individual,
but the presence of the qualified physician is not required 
during the furnishing of vision rehabilitation services by 
that professional to the individual. 
‘‘(2) The term ‘vision rehabilitation professional’ 
means any of the following individuals: 
‘‘(A) An orientation and mobility specialist (as 
defined in paragraph (3)). 
‘‘(B) A rehabilitation teacher (as defined in 
paragraph (4)). 
‘‘(C) A low vision therapist (as defined in para-
graph (5)). 
‘‘(3) The term ‘orientation and mobility specialist’ 
means an individual who—
‘‘(A) if a State requires licensure or certifi-
cation of orientation and mobility specialists, is li-
censed or certified by that State as an orientation 
and mobility specialist; 
‘‘(B)(i) holds a baccalaureate or higher degree 
from an accredited college or university in the 
United States (or an equivalent foreign degree) with 
a concentration in orientation and mobility; and 
‘‘(ii) has successfully completed 350 hours of 
clinical practicum under the supervision of an ori-
entation and mobility specialist and has furnished
not less than 9 months of supervised full-time ori-
entation and mobility services; 
‘‘(C) has successfully completed the national ex-
amination in orientation and mobility administered 
by the Academy for Certification of Vision Rehabili-
tation and Education Professionals; and 
‘‘(D) meets such other criteria as the Secretary 
establishes. 
‘‘(4) The term ‘rehabilitation teacher’ means an indi-
vidual who—
‘‘(A) if a State requires licensure or certifi-
cation of rehabilitation teachers, is licensed or cer-
tified by the State as a rehabilitation teacher; 
‘‘(B)(i) holds a baccalaureate or higher degree 
from an accredited college or university in the 
United States (or an equivalent foreign degree) with
a concentration in rehabilitation teaching, or holds 
such a degree in a health field; and 
‘‘(ii) has successfully completed 350 hours of 
clinical practicum under the supervision of a reha-
bilitation teacher and has furnished not less than 9 
months of supervised full-time rehabilitation teach-
ing services; 
‘‘(C) has successfully completed the national ex-
amination in rehabilitation teaching administered by
the Academy for Certification of Vision Rehabilita-
tion and Education Professionals; and 
‘‘(D) meets such other criteria as the Secretary 
establishes. 
‘‘(5) The term ‘low vision therapist’ means an indi-
vidual who—
‘‘(A) if a State requires licensure or certifi-
cation of low vision therapists, is licensed or certified 
by the State as a low vision therapist; 
‘‘(B)(i) holds a baccalaureate or higher degree 
from an accredited college or university in the 
United States (or an equivalent foreign degree) with 
a concentration in low vision therapy, or holds such 
a degree in a health field; and 
‘‘(ii) has successfully completed 350 hours of 
clinical practicum under the supervision of a physi-
cian, and has furnished not less than 9 months of 
supervised full-time low vision therapy services; 
‘‘(C) has successfully completed the national ex-
amination in low vision therapy administered by the 
Academy for Certification of Vision Rehabilitation 
and Education Professionals; and 
‘‘(D) meets such other criteria as the Secretary 
establishes.
‘‘(6) The term ‘vision impairment’ means vision loss 
that constitutes a significant limitation of visual capability 
resulting from disease, trauma, or a congenital or degen-
erative condition that cannot be corrected by conventional 
means, including refractive correction, medication, or sur-
gery, and that is manifested by one or more of the fol-
lowing: 
‘‘(A) Best corrected visual acuity of less than 
20/60, or significant central field defect. 
‘‘(B) Significant peripheral field defect includ-
ing homonymous or heteronymous bilateral visual 
field defect or generalized contraction or constriction 
of field. 
‘‘(C) Reduced peak contrast sensitivity in con-
junction with a condition described in subparagraph 
(A) or (B). 
‘‘(D) Such other diagnoses, indications, or other 
manifestations as the Secretary may determine to be 
appropriate.’’. 
(c) PAYMENT UNDER PART B.—
(1) 
PHYSICIAN
FEE
SCHEDULE.—Section 
1848(j)(3) of the Social Security Act (42 U.S.C. 
1395w–4(j)(3)) is amended by inserting ‘‘(2)(W),’’ 
after ‘‘(2)(S),’’.
(2) CARVE OUT FROM HOSPITAL OUTPATIENT 
DEPARTMENT
PROSPECTIVE
PAYMENT
SYSTEM.—
Section 1833(t)(1)(B)(iv) of such Act (42 U.S.C. 
1395l(t)(1)(B)(iv)), as redesignated by section 
201(e)(1)(B) of the Medicare, Medicaid, and SCHIP 
Balanced Budget Refinement Act of 1999 (as en-
acted into law by section 1000(a)(6) of Public Law 
106–113), is amended by inserting ‘‘vision rehabili-
tation services (as defined in section 1861(ww)(1)), 
or’’ after ‘‘does not include’’. 
(3) CLARIFICATION
OF
BILLING
REQUIRE-
MENTS.—The first sentence of section 1842(b)(6) of 
such Act (42 U.S.C. 1395u(b)(6)) is amended—
(A) by striking ‘‘and’’ before ‘‘(G)’’; and 
(B) by inserting before the period the fol-
lowing: ‘‘, and (H) in the case of vision rehabili-
tation 
services 
(as 
defined 
in 
section
1861(ww)(1)) furnished by a vision rehabilita-
tion 
professional 
(as 
defined 
in 
section 
1861(ww)(2)) while under the general super-
vision (as defined in section 1861(ww)(1)(D)) 
of a qualified physician (as defined in section 
1861(ww)(1)(C)), payment shall be made to (i) 
the qualified physician or (ii) the facility (such 
as a rehabilitation agency, a clinic, or other fa-
cility) through which such services are fur-
nished under the plan of care if there is a con-
tractual arrangement between the vision reha-
bilitation professional and the facility under 
which the facility submits the bill for such serv-
ices’’. 
(d) PLAN OF CARE.—Section 1835(a)(2) of the So-
cial Security Act (42 U.S.C. 1395n(a)(2)) is amended—
(1) in subparagraph (E), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (F), by striking the period 
and inserting ‘‘; and’’; and 
(3) by inserting after subparagraph (F) the fol-
lowing new subparagraph: 
‘‘(G) in the case of vision rehabilitation 
services, that (i) such services are or were re-
quired because the individual needed vision re-
habilitation services, (ii) an individualized, writ-
ten plan for furnishing such services has been 
established (I) by a qualified physician (as de-
fined in section 1861(ww)(1)(C)), (II) by a 
qualified occupational therapist, or (III) in the 
case of such services furnished by a vision reha-
bilitation professional, by a qualified physician, 
(iii) the plan is periodically reviewed by the
qualified physician, and (iv) such services are or 
were furnished while the individual is or was 
under the care of the qualified physician.’’. 
(e) RELATIONSHIP
TO REHABILITATION ACT
OF 
1973.—The provision of vision rehabilitation services 
under the medicare program under title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) shall not be 
taken into account for any purpose under the Rehabilita-
tion Act of 1973 (29 U.S.C. 701 et seq.). 
(f) EFFECTIVE DATE.—
(1) INTERIM, FINAL REGULATIONS.—The Sec-
retary shall publish a rule under this section in the 
Federal Register by not later than 180 days after 
the date of the enactment of this section to carry 
out the provisions of this section. Such rule shall be 
effective and final immediately on an interim basis, 
but is subject to change and revision after public no-
tice and opportunity for a period (of not less than 
60 days) for public comment. 
(2) CONSULTATION.—The Secretary shall con-
sult with the National Vision Rehabilitation Cooper-
ative, the Association for Education and Rehabilita-
tion of the Blind and Visually Impaired, the Acad-
emy for Certification of Vision Rehabilitation and 
Education Professionals, the American Academy of
Ophthalmology, the American Occupational Therapy 
Association, the American Optometric Association, 
and such other qualified professional and consumer 
organizations as the Secretary determines appro-
priate in promulgating regulations to carry out this 
Act.
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