Title: Outpatient Therapy Modernization and Stabilization Act
Policy area: Health

Summary:
Outpatient Therapy Modernization and Stabilization Act
This bill modifies payment and funding for certain outpatient therapy services under Medicare.
Among other things, the bill specifically includes physicians, physical therapists, occupational therapists, and other specified practitioners who are enrolled as Medicare suppliers as eligible suppliers who may receive COVID-19 (i.e., coronavirus disease 2019) relief funds under the Public Health and Social Services Emergency Fund.
The bill also permanently allows physical therapists, occupational therapists, and speech-language pathologists to provide telehealth services under Medicare, and includes specified therapy services as eligible Medicare telehealth services. (Currently, the Centers for Medicare & Medicaid Services is authorized to waive requirements for Medicare telehealth services during the public health emergency relating to COVID-19, and it has done so to allow all providers that are otherwise eligible to furnish in-person services under Medicare to also furnish telehealth services.)

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7154 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 7154

 To amend title XVIII of the Social Security Act to improve and ensure 
ongoing Medicare beneficiary access to outpatient therapy services, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 11, 2020

 Mr. Brendan F. Boyle of Pennsylvania (for himself, Mr. Buchanan, Mr. 
Michael F. Doyle of Pennsylvania, Mr. Pascrell, Mr. Soto, Mrs. Beatty, 
    Ms. Sherrill, Ms. Blunt Rochester, and Mr. Rush) 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 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 improve and ensure 
ongoing Medicare beneficiary access to outpatient therapy services, and 
                          for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Outpatient Therapy Modernization and 
Stabilization Act''.

SEC. 2. MODERATING ANNUAL MEDICARE REIMBURSEMENT CHANGES.

    (a) Waiving Certain Rules With Respect to Implementation of 
Adjustments of Relative Value Units for Evaluation and Management 
Codes.--Section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)) is amended--
            (1) in subparagraph (B)(ii)(II), by inserting after 
        ``Subject to clauses (iv) and (v)'' the following: ``and 
        subparagraph (P)'';
            (2) in subparagraph (F), in the matter preceding clause 
        (i), by striking ``The'' and inserting ``Subject to 
        subparagraph (P), the''; and
            (3) by adding at the end the following new subparagraph:
                    ``(P) Evaluation and management codes.--The 
                Secretary shall not apply subparagraph (B)(ii)(II) 
                (relating to limitation on annual adjustments in 
                relative values) or subparagraph (F) (relating to 
                budget neutrality adjustments) with respect to the 
                implementation of adjustments of relative value units 
                for the evaluation and management codes described in 
                the final rule published by the Secretary in the 
                Federal Register on November 15, 2019 (84 Fed. Reg. 
                62568, 62847-62860), for 2021 and each subsequent 
                year.''.
    (b) Increase in Update Factor.--Paragraph (19) of section 1848(d) 
of the Social Security Act (42 U.S.C. 1395w-4(d)) is amended to read as 
follows:
            ``(19) Update for 2020 through 2025.--The update to the 
        single conversion factor established in paragraph (1)(C) for 
        2020 and each subsequent year through 2025 shall be as follows:
                    ``(A) For 2020, 0.0 percent.
                    ``(B) For 2021, 1.0 percent.
                    ``(C) For 2022 and 2023, 0.5 percent.
                    ``(D) For 2024 and 2025, 0.0 percent.''.

SEC. 3. HELPING OUTPATIENT PROVIDERS THROUGH THE COVID-19 PANDEMIC.

    (a) Clarification.--The third proviso of the third paragraph under 
the heading ``Office of the Secretary--Public Health and Social 
Services Emergency Fund'' in division B of the Coronavirus Aid, Relief, 
and Economic Security Act (Public Law 116-136) is amended by inserting 
``(including physicians, physical therapists, occupational therapists, 
speech language pathology therapists, audiologists, psychologists, 
social workers, and any other supplier enrolled through part B of the 
Medicare program under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.))'' after ``Medicare or Medicaid enrolled 
suppliers''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the enactment of the Coronavirus Aid, 
Relief, and Economic Security Act (Public Law 116-136).

SEC. 4. MAKING APPROPRIATE THERAPY SERVICES ACCESSIBLE THROUGH THE 
              MEDICARE TELEHEALTH PROGRAM.

    (a) Medicare Beneficiary Access to Therapy Services During National 
Health Emergencies.--
            (1) Permitting qualified therapists to provide medicare 
        telehealth therapy services.--Notwithstanding any other 
        provision of law, with respect to Medicare telehealth therapy 
        services furnished on or after March 1, 2020, with respect to 
        an emergency period during 2020, a physical therapist, an 
        occupational therapist, or a speech language pathologist who is 
        enrolled under the Medicare program under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.), or a facility 
        that is participating in such program, may furnish Medicare 
        telehealth therapy services to Medicare beneficiaries during 
        such emergency period under the same terms and conditions as 
        Medicare telehealth services may be furnished by physicians or 
        practitioners pursuant to the COVID-19 interim final rule.
            (2) Definitions.--In this subsection:
                    (A) COVID-19 interim final rule.--The term ``COVID-
                19 interim final rule'' means the interim final rule 
                entitled ``Medicare and Medicaid Programs; Policy and 
                Regulatory Revisions in Response to the COVID-19 Public 
                Health Emergency'' and published in the Federal 
                Register by the Centers for Medicare & Medicaid 
                Services on April 6, 2020 (85 Fed. Reg. 19230 et seq.).
                    (B) Emergency period.--The term ``emergency 
                period'' means the COVID-19 emergency period (as 
                described in subsection (g)(1)(B) of section 1135 of 
                the Social Security Act (42 U.S.C. 1320b-5)) or any 
                other subsequent emergency period during 2020 with 
                respect to which an emergency declaration described in 
                subsection (g)(1)(A) of such section is made.
                    (C) Facility.--The term ``facility'' means an 
                agency, clinic, facility, hospital, and entity 
                described in section 1833(a)(8) of the Social Security 
                Act (42 U.S.C. 1395l(a)(8)) that furnishes Medicare 
                telehealth therapy services.
                    (D) Medicare telehealth therapy services defined.--
                The term ``Medicare telehealth therapy services'' means 
                services identified by HCPCS codes 92507-92508, 92521-
                92524, 92526, 92601-92604, 92607-92610, 92626-92627, 
                92630, 92633, 96105, 96125, 97110, 97112, 97116, 97129-
                97130, 97150-97158, 97161-97168, 97530, 97535, 97542, 
                97750, 97755, 97760, and 97761-97763 (and as 
                subsequently modified by the Secretary of Health and 
                Human Services), and which may be furnished to Medicare 
                beneficiaries through telehealth under section 1834(m) 
                of the Social Security Act (42 U.S.C. 1395m(m)) 
                pursuant to the COVID-19 interim final rule.
                    (E) Occupational therapist.--The term 
                ``occupational therapist'' means a qualified 
                occupational therapist as that term is used in section 
                1861(g) of the Social Security Act (42 U.S.C. 
                1395x(g)).
                    (F) Physical therapist.--The term ``physical 
                therapist'' means a qualified physical therapist as 
                that term is used in section 1861(p) of the Social 
                Security Act (42 U.S.C. 1395x(p)).
                    (G) Speech language pathologist.--The term ``speech 
                language pathologist'' has the meaning given the term 
                ``qualified speech-language pathologist'' in section 
                1861(ll)(4)(A) of the Social Security Act (42 U.S.C. 
                1395x(ll)(4)(A)).
            (3) Implementation.--Notwithstanding any other provision of 
        law, the Secretary of Health and Human Services may implement 
        this subsection by program instruction or otherwise.
    (b) Services Furnished Beginning in 2021.--
            (1) In general.--Section 1834(m) of the Social Security Act 
        (42 U.S.C. 1395m(m)) is amended--
                    (A) in paragraph (1)--
                            (i) by striking ``or a practitioner 
                        (described in section 1842(b)(18)(C))'' and 
                        inserting ``, a practitioner (as defined in 
                        paragraph (4)(E)), or a facility (as defined in 
                        paragraph (4)(G))''; and
                            (ii) by striking ``individual physician or 
                        practitioner'' and inserting ``individual 
                        physician, practitioner, or facility'';
                    (B) in paragraph (2)--
                            (i) in subparagraph (A)--
                                    (I) by inserting after ``located at 
                                a distant site'' the following: ``, or 
                                a facility that is a distant site,''; 
                                and
                                    (II) by striking ``such physician 
                                or practitioner'' and inserting ``such 
                                physician, practitioner, or facility''; 
                                and
                            (ii) in subparagraph (C), by striking ``as 
                        determined by the'' and inserting ``as 
                        determined by a'';
                    (C) in paragraph (3)(A)--
                            (i) in the subparagraph heading, by 
                        striking ``Physician and practitioner'' and 
                        inserting ``Physician, practitioner, and 
                        facility''; and
                            (ii) by striking ``a physician or 
                        practitioner receiving payment'' and all that 
                        follows through the period and inserting ``a 
                        physician, practitioner, or facility receiving 
                        payment under this subsection to the same 
                        extent as they apply to physicians, 
                        practitioners, or facilities under such 
                        sections.'';
                    (D) in paragraph (4)--
                            (i) in subparagraph (A), by inserting 
                        before the period the following: ``, or a 
                        facility that furnishes a telehealth service to 
                        an eligible telehealth individual via a 
                        telecommuniciations system'';
                            (ii) in subparagraph (E), by inserting 
                        before the period at the end the following: ``, 
                        and also includes, for purposes of this 
                        subsection, a physical therapist, an 
                        occupational therapist, and a speech-language 
                        pathologist'';
                            (iii) in subparagraph (F)(i)--
                                    (I) by striking ``and office 
                                psychiatry'' and inserting ``office 
                                psychiatry''; and
                                    (II) by inserting before ``, and 
                                any additional'' the following: ``, 
                                therapy services (identified as of 
                                April 1, 2020, by HCPCS codes 92507-
                                92508, 92521-92524, 92526, 92601-92604, 
                                92607-92610, 92626-92627, 92630, 92633, 
                                96105, 96125, 97110, 97112, 97116, 
                                97129-97130, 97150-97158, 97161-97168, 
                                97530, 97535, 97542, 97750, 97755, 
                                97760, and 97761-97763 (and as 
                                subsequently modified by the 
                                Secretary))''; and
                            (iv) by adding at the end the following new 
                        subpragraph:
                    ``(G) Facility.--The term `facility' means an 
                agency, clinic, facility, hospital, and entity 
                described in section 1833(a)(8) of the Social Security 
                Act (42 U.S.C. 1395l(a)(8)) that furnishes therapy 
                services described in paragraph (4)(F)(i).''; and
                    (E) by adding at the end the following new 
                paragraph:
            ``(9) Treatment of telehealth therapy services.--The 
        geographic requirements described in paragraph (4)(C)(i) shall 
        not apply with respect to telehealth services that are therapy 
        services described in paragraph (4)(F)(i).''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall take effect on the date of the enactment of this Act and 
        apply to telehealth services furnished under the Medicare 
        program on or after January 1, 2021.

SEC. 5. REDUCING UNNECESSARY PAPERWORK IN THE DELIVERY OF THERAPY 
              SERVICES.

    (a) In General.--Section 1835(a) of the Social Security Act (42 
U.S.C. 1395n(a)) is amended by adding at the end the following new 
sentence: ``The requirement for review of a plan of care described in 
paragraphs (2)(C)(ii) and (2)(D)(ii) for outpatient physical therapy or 
outpatient occupational therapy services or speech-language pathology 
services, respectively, for an individual under the care of a physician 
shall be deemed to be met if either of the following is included in the 
individual's medical record: an order for such outpatient physical 
therapy or outpatient occupational therapy services or speech-language 
pathology services, as the case may be, signed by a physician under 
whom the individual is receiving care; or a certification of the 
individual's plan of care signed by a physician under whom the 
individual is receiving care.''.
    (b) Conforming Amendment.--Section 1861(p) of the Social Security 
Act (42 U.S.C. 1395x(p)) is amended by adding at the end the following 
new sentence: ``The requirement for review of a plan of care described 
in paragraph (2) for physical therapy services furnished to an 
individual under the care of a physician (as so defined) shall be 
deemed to be met if either of the following is included in the 
individual's medical record: an order for such physical therapy 
services signed by a physician under whom the individual is receiving 
care; or a certification of the individual's plan of care signed by a 
physician under whom the individual is receiving care.''.
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