I 
115TH CONGRESS 
1ST SESSION H. R. 4136 
To amend title XVIII of the Social Security Act to strengthen intensive 
cardiac rehabilitation programs under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 25, 2017 
Mr. SMITH of Missouri (for himself, Ms. ESHOO, Mr. MULLIN, and Mr. BERA) 
introduced the following bill; which was referred to the Committee on En-
ergy 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 jurisdic-
tion of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to strength-
en intensive cardiac rehabilitation programs under 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 ‘‘Strengthening Medi-
care Intensive Cardiac Rehabilitation Programs Act’’. 
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SEC. 2. REVISED REQUIREMENTS FOR MEDICARE INTEN-
SIVE CARDIAC REHABILITATION PROGRAMS. 
Section 1861(eee)(4) of the Social Security Act (42 
U.S.C. 1395x(eee)(4)) is amended— 
(1) in subparagraph (A)— 
(A) in the matter preceding clause (i)— 
(i) by striking ‘‘physician-supervised 
program (as described in paragraph (2))’’ 
and inserting ‘‘program (supervised as de-
scribed in paragraph (2) for cardiac reha-
bilitation)’’; and 
(ii) by striking ‘‘, in peer-reviewed 
published research, that it accomplished’’ 
and inserting ‘‘in peer-reviewed published 
research specific to the exact program, 
that, notwithstanding other concurrent 
therapies, including prescription drugs, by 
lifestyle changes alone it accomplished’’; 
(B) in clause (i)— 
(i) in subclause (I), by striking ‘‘posi-
tively affected’’ and inserting ‘‘reversed’’; 
(ii) in subclause (II), by striking ‘‘or’’ 
and inserting ‘‘and’’; and 
(iii) by striking subclause (III); 
(C) in clause (ii), in the matter preceding 
subclause (I), by inserting ‘‘both a statistically 
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significant increase in the measure of blood flow 
to the heart when compared to a control group 
and’’ before ‘‘a statistically significant’’; and 
(D) by adding at the end the following new 
sentence: 
‘‘Any program that the Secretary approved under this 
paragraph before the date of the enactment of the 
Strengthening Medicare Intensive Cardiac Rehabilitation 
Programs Act as an intensive cardiac rehabilitation pro-
gram according to the requirements under this subpara-
graph as in effect before such date shall be deemed to 
meet the requirements under this subparagraph applied 
pursuant to the amendments made by such Act.’’; and 
(2) in subparagraph (B)— 
(A) in clause (v), by striking at the end 
‘‘or’’; 
(B) in clause (vi), by striking at the end 
the period; and 
(C) by adding at the end the following new 
clauses: 
‘‘(vii) stable, chronic heart failure (defined 
as patients with left ventricular ejection fraction 
of 35 percent or less and New York Heart As-
sociation (NYHA) class II to IV symptoms de-
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