(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 
‘‘(ww) 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 physicial therapy education accredi-
tation agency recognized by the Secretary of 
Education; 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 
physicial therapy services under this title, as deter-
mined 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-