[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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