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, 2003.
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