I 
109TH CONGRESS 
2D SESSION 
H. R. 4824 
To amend title XVIII of the Social Security Act to provide coverage for 
cardiac rehabilitation and pulmonary rehabilitation services. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 1, 2006 
Mr. PICKERING (for himself and Mr. LEWIS of Georgia) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
coverage for cardiac rehabilitation and pulmonary reha-
bilitation 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 ‘‘Pulmonary and Car-
diac Rehabilitation Act of 2006’’. 
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SEC. 2. COVERAGE OF ITEMS AND SERVICES UNDER A CAR-
DIAC REHABILITATION PROGRAM AND A PUL-
MONARY REHABILITATION PROGRAM. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x), as amended by section 
5112(a) of the Deficit Reduction Act of 2005, is amend-
ed— 
(1) in subsection (s)(2)— 
(A) in subparagraph (Z), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (AA), by adding at 
the end ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(BB) items and services furnished under 
a cardiac rehabilitation program (as defined in 
subsection (ccc)) or under a pulmonary rehabili-
tation program (as defined in subsection 
(ddd)).’’; and 
(2) by adding at the end the following new sub-
sections: 
‘‘Cardiac Rehabilitation Program 
‘‘(ccc)(1) The term ‘cardiac rehabilitation program’ 
means a physician-supervised program (as described in 
paragraph (2)) that furnishes the items and services de-
scribed in paragraph (3). 
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‘‘(2) A program described in this paragraph is a pro-
gram under which— 
‘‘(A) items and services under the program are 
delivered— 
‘‘(i) in a physician’s office; 
‘‘(ii) in a physician-directed clinic; or 
‘‘(iii) in a hospital on an outpatient basis; 
‘‘(B) a physician is immediately available and 
accessible for medical consultation and medical 
emergencies at all times items and services are being 
furnished under the program, except that, in the 
case of items and services furnished under such a 
program in a hospital, such availability shall be pre-
sumed; and 
‘‘(C) individualized treatment is furnished 
under a written plan established, reviewed, and 
signed by a physician every 30 days that describes— 
‘‘(i) the patient’s diagnosis; 
‘‘(ii) the type, amount, frequency, and du-
ration of the items and services furnished under 
the plan; and 
‘‘(iii) the goals set for the patient under 
the plan. 
‘‘(3) The items and services described in this 
paragraph are— 
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‘‘(A) physician-prescribed exercise; 
‘‘(B) cardiac risk factor modification, in-
cluding education, counseling, and behavioral 
intervention (to the extent such education, 
counseling, and behavioral intervention is close-
ly related to the individual’s care and treatment 
and is tailored to the individual’s needs); 
‘‘(C) psychosocial assessment; 
‘‘(D) outcomes assessment; and 
‘‘(E) such other items and services as the 
Secretary may determine, but only if such items 
and services are— 
‘‘(i) reasonable and necessary for the 
diagnosis or active treatment of the indi-
vidual’s condition; 
‘‘(ii) reasonably expected to improve 
or maintain the individual’s condition and 
functional level; and 
‘‘(iii) furnished under such guidelines 
relating to the frequency and duration of 
such items and services as the Secretary 
shall establish, taking into account accept-
ed norms of medical practice and the rea-
sonable expectation of patient improve-
ment. 
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‘‘(4) The Secretary shall establish standards to 
ensure that a physician with expertise in the man-
agement of patients with cardiac pathophysiology 
who is licensed to practice medicine in the State in 
which a cardiac rehabilitation program is offered— 
‘‘(A) is responsible for such program; and 
‘‘(B) in consultation with appropriate staff, 
is involved substantially in directing the 
progress of individual patients in the program. 
‘‘Pulmonary Rehabilitation Program 
‘‘(ddd)(1) The term ‘pulmonary rehabilitation pro-
gram’ means a physician-supervised program (as de-
scribed in subsection (ccc)(2) with respect to a program 
under this subsection) that furnishes the items and serv-
ices described in paragraph (2). 
‘‘(2) The items and services described in this para-
graph are— 
‘‘(A) physician-prescribed exercise; 
‘‘(B) education or training (to the extent the 
education or training is closely and clearly related to 
the individual’s care and treatment and is tailored to 
such individual’s needs); 
‘‘(C) psychosocial assessment; 
‘‘(D) outcomes assessment; and 
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‘‘(E) such other items and services as the Sec-
retary may determine, but only if such items and 
services are— 
‘‘(i) reasonable and necessary for the diag-
nosis or active treatment of the individual’s 
condition; 
‘‘(ii) reasonably expected to improve or 
maintain the individual’s condition and func-
tional level; and 
‘‘(iii) furnished under such guidelines re-
lating to the frequency and duration of such 
items and services as the Secretary shall estab-
lish, taking into account accepted norms of 
medical practice and the reasonable expectation 
of patient improvement. 
‘‘(3) The Secretary shall establish standards to en-
sure that a physician with expertise in the management 
of patients with respiratory pathophysiology who is li-
censed to practice medicine in the State in which a pul-
monary rehabilitation program is offered— 
‘‘(A) is responsible for such program; and 
‘‘(B) in consultation with appropriate staff, is 
involved substantially in directing the progress of in-
dividual patients in the program.’’. 
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(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after the date of the enactment of this Act. 
Æ 
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