I
107TH CONGRESS
1ST SESSION
H. R. 3363
To amend title XVIII of the Social Security Act to authorize physical thera-
pists to diagnose, evaluate, and treat Medicare beneficiaries without
a requirement for a physician referral, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 28, 2001
Mr. CRANE (for himself and Mr. POMEROY) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be subse-
quently 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 authorize
physical therapists to diagnose, evaluate, and treat Medi-
care beneficiaries without a requirement for a physician
referral, and for other purposes.
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 Patient Ac-
cess to Physical Therapists Act of 2001’’.
SEC. 2. ACCESS TO OUTPATIENT PHYSICAL THERAPY SERV-
ICES FOR MEDICARE BENEFICIARIES.
(a) IN GENERAL.—
(1) ELIMINATION OF REQUIRED PHYSICIAN RE-
FERRAL.—
(A) DEFINITION
OF
OUTPATIENT
PHYS-
ICAL THERAPY SERVICES.—Section 1861(p) of
the Social Security Act (42 U.S.C. 1395x(p)) is
amended—
(i) in the matter preceding paragraph
(1), by striking ‘‘as an outpatient’’;
(ii) by amending paragraph (1) to
read as follows:
‘‘(1) who is an outpatient, and’’;
(iii) in paragraph (2)—
(I) by inserting ‘‘(as defined in
section 1861(ww))’’ after ‘‘qualified
physical therapist’’; and
(II) by inserting ‘‘or a qualified
physical therapist’’ after ‘‘physician’’
the second place it appears;
(iv) in paragraph (4)(A)(ii), by strik-
ing ‘‘including one or more’’ and all that
follows through ‘‘agency) and’’ and insert-
ing ‘‘including’’; and
(v) in the fifth sentence, by striking
‘‘with respect to outpatients who are not
entitled to benefits under this title’’ and
inserting ‘‘or as authorizing the Secretary
to require’’.
(B) CONFORMING AMENDMENTS.—Section
1835(a)(2) 
of 
such 
Act 
(42 
U.S.C.
1395n(a)(2)) is amended—
(i) in the matter preceding subpara-
graph (A), by inserting ‘‘, or in the case of
outpatient physical therapy services (as de-
scribed in subparagraph (C)) and physical
therapy services furnished as comprehen-
sive outpatient rehabilitation facility serv-
ices (described in subparagraph (E)), a
qualified physical therapist,’’ after ‘‘a phy-
sician’’;
(ii) in subparagraph (C)—
(I) in the matter preceding clause
(i), by striking ‘‘or outpatient occupa-
tional therapy services’’;
(II) in clause (i), by striking ‘‘or
occupational therapy services, respec-
tively,’’ and inserting ‘‘, and’’;
(III) in clause (ii), by striking
‘‘or qualified occupational therapist,
respectively,’’; and
(IV) beginning in clause (ii), by
striking ‘‘by a physician, and (iii)’’
and all that follows and inserting ‘‘by
a physician or a qualified physical
therapist;’’;
(iii) in subparagraph (D)—
(I) in the matter preceding clause
(i), by striking ‘‘outpatient speech pa-
thology services’’ and inserting ‘‘out-
patient occupational therapy services
or outpatient speech-language pathol-
ogy services’’;
(II) in clause (i), by striking
‘‘needed speech pathology services’’
and inserting ‘‘needed occupational
therapy services or speech-language
pathology services, respectively’’; and
(III) in clause (ii), by striking
‘‘speech pathologist’’ and inserting
‘‘occupational therapist or speech-lan-
guage pathologist, respectively,’’; and
(iv) in subparagraph (E)—
(I) in clause (ii), by inserting
‘‘(or, in the case of outpatient com-
prehensive rehabilitation facility serv-
ices consisting of physical therapy
services, by a qualified physical thera-
pist)’’ after ‘‘physician’’; and
(II) in clause (iii), by inserting
‘‘in the case of outpatient comprehen-
sive rehabilitation facility services not
consisting of physical therapy serv-
ices,’’ before ‘‘such services’’.
(2) DEFINITION
OF
QUALIFIED
PHYSICAL
THERAPIST.—Section 1861 of such Act (42 U.S.C.
1395x) is amended by adding at the end the fol-
lowing new subsection:
‘‘(ww) The term ‘qualified physical therapist’ means
an individual who is licensed as a physical therapist by
the State in which such individual is practicing and who
meets the applicable education and training requirements
under paragraph (1) or (2):
‘‘(1) With respect to years beginning with 2003,
except as provided in paragraph (2), the individual
has received a master’s or doctoral degree from a
professional physical therapy education program
that has been accredited by a national accreditation
agency recognized by the Secretary of Education.
‘‘(2) The requirement of paragraph (1) shall
not apply to an individual who, before 2003, meets
one of the following requirements:
‘‘(A) The individual has graduated from a
physical therapy curriculum approved by the
American Physical Therapy Association or the
Council on Medical Education and Hospitals of
the American Medical Association, or both.
‘‘(B) Before 1966, the individual—
‘‘(i) was admitted to membership by
the American Physical Therapy Associa-
tion;
‘‘(ii) was admitted to registration by
the American Registry of Physical Thera-
pist; or
‘‘(iii) graduated from a physical ther-
apy curriculum in a 4-year college or uni-
versity approved by a State department of
education.
‘‘(C) The individual has 2 years of appro-
priate experience as determined by the Sec-
retary as a physical therapist and, in the case
of such an individual who was initially licensed
by a State as a physical therapist before De-
cember 31, 1977, or seeking qualification as a
physical 
therapist 
before 
such 
date, 
has
achieved a satisfactory grade on a proficiency
examination approved by the Secretary.
‘‘(D) The individual—
‘‘(i) was licensed or registered as a
physical therapist before January 1, 1966;
and
‘‘(ii) had 15 years of full-time experi-
ence in the treatment of illness or injury
through the practice of physical therapy in
which services were rendered under the
order and direction of an attending or re-
ferring physician (as defined in subsection
(r)(1)) before January 1, 1970.
‘‘(E) In the case of an individual trained
outside of the United States, the individual—
‘‘(i) has graduated before January 1,
2003, from a physical therapy curriculum
approved by the country in which the cur-
riculum was located and in which there is
a member organization of the World Con-
ference for Physical Therapy;
‘‘(2) with respect to whom a plan prescribing
the type, amount, and duration of occupational ther-
apy services that are furnished to such individual
has been established by a physician (as so defined)
or by an occupational therapist and is periodically
reviewed by a physician (as so defined);
excluding, however—
‘‘(3) any item or service if it would not be in-
cluded under subsection (b) if furnished to an inpa-
tient of a hospital; and
‘‘(4) any such service—
‘‘(A) if furnished by a clinic, rehabilitation
agency, or by others under arrangements with
such clinic or agency, unless such clinic or reha-
bilitation agency—
‘‘(i) provides an adequate program of
occupational therapy services for out-
patients and has the facilities and per-
sonnel required for such program or re-
quired for the supervision of such a pro-
gram, in accordance with such require-
ments as the Secretary may specify;
‘‘(ii) has policies, established by a
group of professional personnel, including
one or more occupational therapists, to
govern the services (referred to in clause
(i)) it provides;
‘‘(iii) maintains clinical records on all
patients;
‘‘(iv) if such clinic or agency is situ-
ated in a State in which State or applica-
ble 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 institutions of this na-
ture, as meeting the standards estab-
lished for such licensing; and
‘‘(v) meets such other conditions relat-
ing to the health and safety of individuals
who are furnished services by such clinic or
agency on an outpatient basis, as the Sec-
retary may find necessary, and provides
the Secretary on a continuing basis with a
surety bond that is not less than $50,000;
or
‘‘(B) 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.
The term ‘outpatient occupational therapy services’ also
includes occupational therapy services furnished an indi-
vidual by an occupational therapist (in the office of the
occupational therapist or in such individual’s home) who
meets licensing and other standards prescribed by the Sec-
retary in regulations, otherwise than under an arrange-
ment with and under the supervision of a provider of serv-
ices, clinic, rehabilitation agency, or public health agency,
if the furnishing of such services meets such conditions
relating to health and safety as the Secretary may find
necessary. In addition, such term includes occupational
therapy services that meet the requirements of the first
sentence of this subsection except that they are furnished
to an inpatient of a hospital or extended care facility.
Nothing in this subsection shall be construed as requiring,
with respect to outpatients who are not entitled to benefits
under this title, an occupational therapist to provide out-
patient occupational therapy 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
(4)(A)(v) in the case of a clinic or agency that provides
a comparable surety bond under State law.’’.
(2) CONFORMING AMENDMENTS.—
(A) 
SCOPE
OF
BENEFITS.—Section
1832(a)(2)(C) 
of 
such 
Act 
(42 
U.S.C.
1395k(a)(2)(C)) is amended by striking ‘‘such
sentence applies through the operation of sec-
tion 1861(g))’’ and inserting ‘‘the second sen-
tence of section 1861(g) applies)’’.
(B) PAYMENT
OF
BENEFITS.—Section
1833(g)(3) of such Act (42 U.S.C. 1395l(g)(3))
is amended by striking ‘‘section 1861(p)’’ and
all that follows through ‘‘section 1861(g)’’ and
inserting ‘‘section 1861(g) (but not described in
subsection (a)(8)(B))’’.
(C) PROVIDER CLAIMS PROCEDURES.—The
second sentence of section 1835(a) of such Act
(42 U.S.C. 1395n(a)) is amended—
(i) by striking ‘‘section 1861(p)(4)(A)
(or meets the requirements of such section
through the operation of section 1861(g))’’
and inserting ‘‘section 1861(p)(4)(A) or
section 1861(g)(4)(A)’’;
(ii) by striking ‘‘section 1861(p)(4)(B)
(or meets the requirements of such section
through the operation of section 1861(g))’’
and inserting ‘‘section 1861(p)(4)(B) or
section 1861(g)(4)(B)’’; and
(iii) by striking ‘‘(as defined therein)
or (through the operation of section
1861(g)) with respect to the furnishing of
outpatient occupational therapy services’’
and inserting ‘‘(as defined in section
1861(p)) or outpatient occupational ther-
apy 
services 
(as 
defined 
in 
section
1861(g)), respectively’’.
(D) AGREEMENTS WITH PROVIDERS.—Sec-
tion 1866(e)(1) of such Act (42 U.S.C.
1395cc(e)(1)) is amended—
(i) by striking ‘‘section 1861(p)(4)(A)
(or meets the requirements of such section
through the operation of section 1861(g))’’
and inserting ‘‘section 1861(p)(4)(A) or
section 1861(g)(4)(A)’’;
(ii) by striking ‘‘section 1861(p)(4)(B)
(or meets the requirements of such section
through the operation of section 1861(g))’’
and inserting ‘‘section 1861(p)(4)(B) or
section 1861(g)(4)(B)’’; and
(iii) by striking ‘‘(as defined therein)
or (through the operation of section
1861(g)) with respect to the furnishing of
outpatient occupational therapy services’’
and inserting ‘‘(as defined in section
1861(p)) or outpatient occupational ther-
apy 
services 
(as 
defined 
in 
section
1861(g)), respectively’’.
(c) SEPARATE STATUTORY TREATMENT FOR OUT-
PATIENT
PHYSICAL
THERAPY
SERVICES
AND
OUT-
PATIENT SPEECH-LANGUAGE PATHOLOGY SERVICES.—
(1) 
SCOPE
OF
BENEFITS.—Section
1832(a)(2)(C) of the Social Security Act (42 U.S.C.
1395k(a)(2)(C)), 
as 
amended 
by 
subsection
(b)(2)(A), is further amended—
(A) by striking ‘‘and outpatient’’ and in-
serting ‘‘, outpatient’’; and
(B) by inserting before the semicolon the
following: ‘‘, and outpatient speech-language pa-
thology services’’.
(2) PAYMENT OF BENEFITS.—Section 1833 of
such Act (42 U.S.C. 1395l) is amended—
(A) in subparagraphs (A) and (B) of sub-
section (a)(8), by striking ‘‘services, (which in-
cludes outpatient speech-language pathology
U.S.C. 1395n(a)), as amended by subsection
(b)(2)(C), is further 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 such Act (42 U.S.C. 1395cc(e)(1)), as
amended 
by 
subsection 
(b)(2)(D), 
is 
further
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 such 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:
‘‘(4)(A) Subject to subparagraph (B), the term
‘outpatient 
speech-language 
pathology 
services’
means speech-language pathology services that are
furnished by a provider of services, a clinic, a reha-
bilitation agency, or a public health agency, or by
others under an arrangement with, and under the
supervision of, such provider, clinic, rehabilitation
agency, or public health agency to an individual as
an outpatient—
‘‘(i) who is under the care of a physician
(as defined in paragraph (1), (3), or (4) of sub-
section (r)); and
‘‘(ii) with respect to whom a plan pre-
scribing the type, amount, and duration of
speech-language pathology services that are fur-
nished to such individual has been established
by a physician (as so defined) or by a qualified
speech-language pathologist and is periodically
reviewed by a physician (as so defined).
‘‘(B) Such term does not include—
‘‘(i) any item or service if it would not be
included under subsection (b) if furnished to an
inpatient of a hospital; or
‘‘(ii) any item or service—
‘‘(I) if furnished by a clinic, rehabili-
tation agency, or by others under arrange-
ments with such clinic or agency, unless
such clinic or rehabilitation agency meets
the requirements of paragraph (5); and
‘‘(II) if furnished by a public health
agency, unless such agency meets such
other conditions relating to the safety of
individuals who are furnished services by
such agency on an outpatient basis, as the
Secretary may find necessary.
‘‘(C) Such term also includes speech-language
pathology 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 subsection shall be construed as re-
quiring, with respect to outpatients who are not enti-
tled 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
requirements of this paragraph if it—
‘‘(A) provides an adequate program of
speech-language pathology services for out-
patients and has the facilities and personnel re-
quired for such program or required for the su-
pervision of such a program, in accordance with
such requirements as the Secretary may specify;
‘‘(B) has policies, established by a group of
professional personnel, including one or more
speech-language pathologists, to govern the
services (referred to in subparagraph (A)) it
provides;
‘‘(C) maintains clinical records on all pa-
tients;
‘‘(D) in the case of a clinic or agency that
is situated in a State in which State or applica-
ble local law provides for the licensing of insti-
tutions of this nature—
‘‘(i) is licensed pursuant to such law,
or
‘‘(ii) is approved by the agency of
such State or locality responsible for li-
censing institutions 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 provides the Secretary on a con-
tinuing basis with a surety 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, 2002.
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