I 
110TH CONGRESS 
1ST SESSION H. R. 1846 
To amend title XVIII of the Social Security Act to provide improved access 
to physical medicine and rehabilitation services under part B of the 
Medicare Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 29, 2007 
Mr. TOWNS 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 provide 
improved access to physical medicine and rehabilitation 
services under part B of the Medicare Program, 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 Access to 
Physical Medicine and Rehabilitation Services Improve-
ment Act of 2007’’. 
VerDate Aug 31 2005 
05:55 Apr 05, 2007
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H1846.IH
H1846
hmoore on PROD1PC68 with HMBILLS
SEC. 2. ACCESS TO PHYSICAL MEDICINE AND REHABILITA-
TION SERVICES PROVIDED INCIDENT TO A 
PHYSICIAN . 
Section 1862(a)(20) of the Social Security Act (42 
U.S.C. 1395y(a)(20)) is amended by striking ‘‘(other than 
any licensing requirement specified by the Secretary)’’ and 
inserting ‘‘(other than any licensing, education, or 
credentialing requirements specified by the Secretary)’’. 
SEC. 3. COVERAGE OF CERTIFIED ATHLETIC TRAINER 
SERVICES 
AND 
CERTIFIED 
LYMPHEDEMA 
THERAPIST SERVICES UNDER PART B OF THE 
MEDICARE PROGRAM. 
(a) COVERAGE OF SERVICES.—Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) in subparagraph (Z), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (AA), by adding 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(BB) certified athletic trainer services (as 
defined in subsection (ccc)(1)) and lymphedema 
therapist services (as defined in subsection 
(ccc)(3));’’; and 
VerDate Aug 31 2005 
05:55 Apr 05, 2007
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1846.IH
H1846
hmoore on PROD1PC68 with HMBILLS
(2) by adding at the end the following new sub-
section: 
‘‘Certified Athletic Trainer Services and Lymphedema 
Therapist Services 
‘‘(ccc)(1) The term ‘certified athletic trainer services’ 
means services performed by a certified athletic trainer (as 
defined in paragraph (2)) under the supervision of a physi-
cian (as defined in subsection (r)), which the athletic 
trainer is legally authorized to perform under State law 
(or the State regulatory mechanism provided by State law) 
of the State in which such services are performed, as 
would otherwise be covered if furnished by a physician (as 
so defined) or as an incident to a physician’s professional 
service, to an individual— 
‘‘(A) who is under the care of a physician (as 
so defined); and 
‘‘(B) with respect to whom a plan prescribing 
the type, amount, and duration of services that are 
to be furnished to such individual has been estab-
lished by a physician (as so defined). 
Such term does not include any services for which a facil-
ity or other provider charges or is paid any amounts with 
respect to the furnishing of such services. 
‘‘(2) The term ‘certified athletic trainer’ means an 
individual who— 
VerDate Aug 31 2005 
05:55 Apr 05, 2007
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H1846.IH
H1846
hmoore on PROD1PC68 with HMBILLS
‘‘(A) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of athletic trainers, is licensed or certified 
as an athletic trainer in such State; or 
‘‘(B) in the case of an individual performing 
services in a State that does not provide for licen-
sure or certification of athletic trainers, possesses a 
bachelors, master’s or doctoral degree which quali-
fies for certification as an athletic trainer, and, has 
successfully passed a national certification examina-
tion for Athletic Trainers recognized by the Sec-
retary. 
‘‘(3) The term ‘certified lymphedema therapist serv-
ices’ means services performed by a certified lymphedema 
therapist (as defined in paragraph (4)) under the super-
vision of a physician (as defined by paragraph (1) or (3) 
of subsection (r)) which the lymphedema therapist is le-
gally authorized to perform under State law (or the State 
regulatory mechanism provided by the State law) of the 
State in which such services are performed, as would oth-
erwise be covered if furnished by a physician (as so de-
fined) or as incident to a physicians professional service, 
to an individual— 
‘‘(A) who is under the care of a physician (as 
so defined); and 
VerDate Aug 31 2005 
05:55 Apr 05, 2007
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H1846.IH
H1846
hmoore on PROD1PC68 with HMBILLS
‘‘(B) with respect to whom a plan prescribing 
the type, amount, and duration of services that are 
to be furnished to such individual has been estab-
lished by a physician (as so defined). 
Such term does not include any services for which a facil-
ity or other provider charges or is paid any amounts with 
respect to the furnishing of such services. 
‘‘(4) The term ‘certified lymphedema therapist’ 
means an individual who— 
‘‘(A) possesses a current unrestricted license as 
a health professional in the State in which the indi-
vidual practices; 
‘‘(B) after obtaining such a license, has success-
fully completed 135 hours of Complete Decongestive 
Therapy coursework which consists of theoretical in-
struction and practical laboratory work utilizing 
teaching methods directly aimed at the treatment of 
lymphatic and vascular disease from a lymphedema 
training program recognized by the Secretary for 
purposes of certifying lymphedema therapists; and 
‘‘(C) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of lymphedema therapists, is licensed or 
certified as a lymphedema therapist in such State.’’. 
(b) PAYMENT.— 
VerDate Aug 31 2005 
05:55 Apr 05, 2007
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H1846.IH
H1846
hmoore on PROD1PC68 with HMBILLS
(1) IN
GENERAL.—Section 1832(a)(2)(B) of 
such Act (42 U.S.C. 1395k(a)(2)(B)) is amended by 
adding at the end the following new clause: 
‘‘(v) certified athletic trainer services 
and lymphedema therapist services;’’. 
(2) AMOUNT.—Section 1833(a)(1) of such Act 
(42 U.S.C. 1395l(a)(1)) is amended— 
(A) by striking ‘‘and (V)’’ and inserting 
‘‘(V)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (W) with respect 
to certified athletic trainer services and certified 
lymphedema therapist services under section 
1861(s)(2)(BB), the amounts paid shall be 80 
percent of the lesser of the actual charge for 
the service or the fee schedule amount under 
section 1848 for the same service performed by 
a physician’’. 
(3) PAYMENT TO EMPLOYER.—The first sen-
tence of section 1842(b)(6) of such Act (42 U.S.C. 
1395u(b)(6)) is amended— 
(A) by striking ‘‘and’’ before ‘‘(H)’’; and 
(B) by inserting before ‘‘; but nothing’’ the 
following: ‘‘, and (H) in the case of certified 
athletic trainer services and lymphedema thera-
VerDate Aug 31 2005 
05:55 Apr 05, 2007
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H1846.IH
H1846
hmoore on PROD1PC68 with HMBILLS
pist services, payment shall be made to the phy-
sician, clinic, or hospital that employs the ath-
letic trainer or lymphedema therapist involved’’. 
(c) INCLUSION
OF SERVICES
IN
THE THERAPY 
CAP.—Section 1833(g)(1) of such Act (42 U.S.C. 
1395l(g)(1)) is amended— 
(1) by striking ‘‘and’’ before ‘‘physical ther-
apy’’; and 
(2) by inserting after ‘‘or as incident to physi-
cians’ services,’’ the following: ‘‘and certified athletic 
trainer services and certified lymphedema therapist 
services’’. 
(d) INCLUSION
OF
ATHLETIC
TRAINERS
AND 
LYMPHEDEMA THERAPISTS AS PRACTITIONERS FOR AS-
SIGNMENT OF CLAIMS.—Section 1842(b)(18)(C) of such 
Act (42 U.S.C.1395u(b)(18)(C)) is amended by adding at 
the end the following new clauses: 
‘‘(vii) A certified athletic trainer (as defined in 
section 1861(ccc)(1)). 
‘‘(viii) A certified lymphedema therapist (as de-
fined in section 1861(ccc)(2)).’’. 
(e) COVERAGE
OF CERTAIN PHYSICAL MEDICINE 
AND REHABILITATION SERVICES PROVIDED IN RURAL 
HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH 
VerDate Aug 31 2005 
05:55 Apr 05, 2007
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H1846.IH
H1846
hmoore on PROD1PC68 with HMBILLS
CENTERS.—Section 1861(aa)(1)(B) of such Act (42 
U.S.C. 1395x(aa)(1)(B)) is amended— 
(1) by striking ‘‘or’’ before ‘‘by a clinical social 
worker’’; and 
(2) by inserting after ‘‘subsection (hh)(1)),’’ the 
following: ‘‘by a certified athletic trainer (as defined 
in subsection (ccc)(2)), or by a certified lymphedema 
therapist (as defined in subsection (ccc)(4))’’. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to services furnished 
on or after January 1, 2008. 
Æ 
VerDate Aug 31 2005 
05:55 Apr 05, 2007
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6301
E:\BILLS\H1846.IH
H1846
hmoore on PROD1PC68 with HMBILLS