I
106TH CONGRESS
1ST SESSION
H. R. 1736
To amend title XVIII of the Social Security Act to provide certain Medicare
beneficiaries with an exemption to the financial limitations imposed on
physical, speech-language pathology, and occupational therapy services
under part B of the Medicare Program, and to provide for a system
to vary those limitations using a classification of individuals based on
diagnostic category and prior use of services.
IN THE HOUSE OF REPRESENTATIVES
MAY 6, 1999
Mr. STARK introduced the following bill; which was referred to the Committee
on 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 jurisdiction of the
committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
certain Medicare beneficiaries with an exemption to the
financial limitations imposed on physical, speech-lan-
guage pathology, and occupational therapy services under
part B of the Medicare Program, and to provide for
a system to vary those limitations using a classification
of individuals based on diagnostic category and prior
use of services.
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 Rehabilita-
tion Benefit Equity Act of 1999’’.
SEC. 2. ESTABLISHMENT OF EXEMPTION TO CAP ON PHYS-
ICAL, SPEECH-LANGUAGE PATHOLOGY, AND
OCCUPATIONAL THERAPY SERVICES.
(a) IN GENERAL.—Section 1833(g) of the Social Se-
curity Act (42 U.S.C. 1395l(g)) is amended by adding at
the end the following:
‘‘(4)(A) For services furnished on or after the date
of the enactment of this paragraph and before January
1, 2002, the limitations in this subsection shall not apply
to an individual described in subparagraph (B).
‘‘(B) An individual described in this subparagraph is
an individual that meets any of the following criteria:
‘‘(i) The individual has received services de-
scribed in paragraph (1) or (3) in a calendar year
and is subsequently diagnosed with an illness, in-
jury, or disability that requires the provision in such
year of additional such services that are medically
necessary.
‘‘(ii) The individual has a diagnosis that re-
quires the provision of services described in para-
graph (1) or (3) and an additional diagnosis or inci-
dent that exacerbates the individual’s condition,
thereby requiring the provision of additional such
services.
‘‘(iii) The individual will require hospitalization
if the individual does not receive the services de-
scribed in paragraph (1) or (3).
‘‘(iv) The individual meets other criteria that
the Secretary determines are appropriate.
‘‘(C) Nothing in this paragraph shall be construed as
affecting any requirement for, or limitation on, payment
under this title (other than the financial limitation under
this subsection).
‘‘(D) Any service that is covered under this title by
reason of this paragraph shall be subject to the same rea-
sonable 
and 
necessary 
requirement 
under 
section
1862(a)(1) that is applicable to the services described in
paragraph (1) or (3) that are covered under this title with-
out regard to this paragraph.’’.
(b) CONFORMING AMENDMENTS.—Paragraphs (1)
and (3) of section 1833(g) of such Act (42 U.S.C.
1395l(g)) are each amended by striking ‘‘In the case’’ and
inserting ‘‘Subject to paragraph (4), in the case’’.
SEC. 3. ESTABLISHMENT OF VARIABLE DURATIONAL LIMI-
TATION BASED ON DIAGNOSTIC CATEGORIES
AND PRIOR USE OF SERVICES.
(a) IN GENERAL.—Subparagraph (B) of section
1833(g)(2) of the Social Security Act (42 U.S.C.
1395l(g)(2)) is amended to read as follows:
‘‘(B) for a subsequent year is an amount speci-
fied by the Secretary pursuant to a system which es-
tablishes different limitations (but not different pay-
ment rates or fee schedules) based on a classification
of individuals by diagnostic category and severity of
diagnosis, in both inpatient and outpatient set-
tings.’’.
(b) 
BUDGET-NEUTRAL
IMPLEMENTATION.—The
Secretary of Health and Human Services shall establish
the different limitations under section 1833(g)(2)(B) of
the Social Security Act, as amended by subsection (a), in
a manner so that the aggregate expenditures under such
limitations under part B of title XVIII of such Act is the
same as the aggregate expenditures that would have been
made under such part if this section has not been enacted.
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