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(A) The creation of multiple payment caps 
for such services to better reflect costs associ-
ated with specific health conditions. 
(B) The development of a prospective pay-
ment system, including an episode-based system 
of payments, for such services. 
(C) The data needed for the development 
of a system of multiple payment caps (or an al-
ternative payment methodology) for such serv-
ices and the availability of such data. 
(2) REPORT.—Not later than January 1, 2009, 
the Secretary shall submit to Congress a report on 
the study conducted under paragraph (1). 
SEC. 602. MEDICARE SEPARATE DEFINITION OF OUT-
PATIENT 
SPEECH-LANGUAGE 
PATHOLOGY 
SERVICES. 
(a) IN GENERAL.—Section 1861(ll) of the Social Se-
curity Act (42 U.S.C. 1395x(ll)) is amended— 
(1) by redesignating paragraphs (2) and (3) as 
paragraphs (3) and (4), respectively; and 
(2) by inserting after paragraph (1) the fol-
lowing new paragraph: 
‘‘(2) The term ‘outpatient speech-language pathology 
services’ has the meaning given the term ‘outpatient phys-
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ical therapy services’ in subsection (p), except that in ap-
plying such subsection— 
‘‘(A) ‘speech-language pathology’ shall be sub-
stituted for ‘physical therapy’ each place it appears; 
and 
‘‘(B) ‘speech-language pathologist’ shall be sub-
stituted for ‘physical therapist’ each place it ap-
pears.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1832(a)(2)(C) of the Social Security 
Act (42 U.S.C. 1395k(a)(2)(C)) is amended— 
(A) by striking ‘‘and outpatient’’ and in-
serting ‘‘, outpatient’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and outpatient speech- 
language pathology services (other than services 
to which the second sentence of section 1861(p) 
applies through the application of section 
1861(ll)(2))’’. 
(2) Subparagraphs (A) and (B) of section 
1833(a)(8) of such Act (42 U.S.C. 1395l(a)(8)) are 
each amended by striking ‘‘(which includes out-
patient speech-language pathology services)’’ and in-
serting ‘‘, outpatient speech-language pathology 
services,’’. 
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(3) Section 1833(g)(1) of such Act (42 U.S.C. 
1395l(g)(1)) is amended— 
(A) by inserting ‘‘and speech-language pa-
thology services of the type described in such 
section through the application of section 
1861(ll)(2)’’ after ‘‘1861(p)’’; and 
(B) by inserting ‘‘and speech-language pa-
thology services’’ after ‘‘and physical therapy 
services’’. 
(4) The second sentence of section 1835(a) of 
such Act (42 U.S.C. 1395n(a)) is amended— 
(A) by striking ‘‘section 1861(g)’’ and in-
serting ‘‘subsection (g) or (ll)(2) of section 
1861’’ each place it appears; and 
(B) by inserting ‘‘or outpatient speech-lan-
guage pathology services, respectively’’ after 
‘‘occupational therapy services’’. 
(5) Section 1861(p) of such Act (42 U.S.C. 
1395x(p)) is amended by striking the fourth sen-
tence. 
(6) Section 1861(s)(2)(D) of such Act (42 
U.S.C. 1395x(s)(2)(D)) is amended by inserting ‘‘, 
outpatient speech-language pathology services,’’ after 
‘‘physical therapy services’’. 
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(7) Section 1862(a)(20) of such Act (42 U.S.C. 
1395y(a)(20)) is amended— 
(A) by striking ‘‘outpatient occupational 
therapy services or outpatient physical therapy 
services’’ and inserting ‘‘outpatient physical 
therapy services, outpatient speech-language pa-
thology services, or outpatient occupational 
therapy services’’; and 
(B) by striking ‘‘section 1861(g)’’ and in-
serting ‘‘subsection (g) or (ll)(2) of section 
1861’’. 
(8) Section 1866(e)(1) of such Act (42 U.S.C. 
1395cc(e)(1)) is amended— 
(A) by striking ‘‘section 1861(g)’’ and in-
serting ‘‘subsection (g) or (ll)(2) of section 
1861’’ the first two places it appears; 
(B) by striking ‘‘defined) or’’ and inserting 
‘‘defined),’’; and 
(C) by inserting before the semicolon at 
the end the following: ‘‘, or (through the oper-
ation of section 1861(ll)(2)) with respect to the 
furnishing of outpatient speech-language pa-
thology’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2008. 
(d) CONSTRUCTION.—Nothing in this section shall be 
construed to affect existing regulations and policies of the 
Centers for Medicare & Medicaid Services that require 
physician oversight of care as a condition of payment for 
speech-language pathology services under part B of the 
medicare program. 
SEC. 603. INCREASED REIMBURSEMENT RATE FOR CER-
TIFIED NURSE-MIDWIVES. 
(a) IN GENERAL.—Section 1833(a)(1)(K) of the So-
cial Security Act (42 U.S.C.1395l(a)(1)(K)) is amended 
by striking ‘‘(but in no event’’ and all that follows through 
‘‘performed by a physician)’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to services furnished on or after 
April 1, 2008. 
SEC. 604. ADJUSTMENT IN OUTPATIENT HOSPITAL FEE 
SCHEDULE INCREASE FACTOR. 
The first sentence of section 1833(t)(3)(C)(iv) of the 
Social Security Act (42 U.S.C. 1395l(t)(3)(C)(iv)) is 
amended by inserting before the period at the end the fol-
lowing: ‘‘and reduced by 0.25 percentage point for such 
factor for such services furnished in 2008’’. 
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