To establish a demonstration project for direct access to physical therapy services under the Medicare program.

1. Adds SEC. ____. MEDICARE DEMONSTRATION PROJECT FOR DIRECT ACCESS TO PHYSICAL THERAPY SERVICES at the end of subtitle B of title IV

   Adds a section

   In S. 1 · Reported to Senate

   (b) Report.--Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the study conducted under subsection (a). The report shall include recommendations regarding the use of more current data in computing geographic cost of practice indices as well as the use of data directly representative of physicians' costs (rather than proxy measures of such costs).

   Inserted: SEC. ____. MEDICARE DEMONSTRATION PROJECT FOR DIRECT ACCESS TO PHYSICAL THERAPY SERVICES.

   Inserted: (a) In General.--The Secretary shall conduct a demonstration project under this section (in this section referred to as the "project") to demonstrate the impact of allowing medicare fee-for-service beneficiaries direct access to outpatient physical therapy services and physical therapy services furnished as comprehensive rehabilitation facility services on--

   Inserted: (1) costs under the medicare program under title XVIII of the Social Security Act; and

   Inserted: (2) the satisfaction of beneficiaries receiving such services.

   Inserted: (b) Deadline for Establishment; Duration; Sites.--

   Inserted: (1) Deadline.--The Secretary shall establish the project not later than 1 year after the date of enactment of this Act.

   Inserted: (2) Duration; sites.-- The project shall--

   Inserted: (A) be conducted for a period of 3 years;

   Inserted: (B) include sites in at least 5 States; and

   Inserted: (C) to the extent feasible, be conducted on a statewide basis in each State included under subparagraph (B).

   Inserted: (3) Early termination.--Notwithstanding paragraph (2)(A), the Secretary may terminate the operation of the project at a site before the end of the 3-year period specified in such paragraph if the Secretary determines, based on actual data, that the total amount expended for all services under this title for individuals at such site for a 12-month period are greater than the total amount that would have been expended for such services for such individuals for such period but for the operation of the project at such site.

   Inserted: (c) Waiver of Medicare Requirements.--The Secretary shall waive compliance with such requirements of the medicare program under title XVIII of the Social Security Act to the extent and for the period the Secretary finds necessary to conduct the demonstration project.

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   Inserted: (d) Evaluations and Reports.--

   Inserted: (1) Evaluations.--

   Inserted: (A) In general.--The Secretary shall conduct interim and final evaluations of the project.

   Inserted: (B) Focus.--The evaluations conducted under paragraph (1) shall--

   Inserted: (i) focus on the impact of the project on program costs under title XVIII of the Social Security Act and patient satisfaction with health care items and services for which payment is made under such title; and

   Inserted: (ii) include comparisons, with respect to episodes of care involving direct access to physical therapy services and episodes of care involving a physician referral for such services, of--

   Inserted: (I) the average number of claims paid per episode for outpatient physical therapy services and physical therapy services furnished as comprehensive outpatient rehabilitation facility services;

   Inserted: (II) the average number of physician office visits per episode; and

   Inserted: (III) the average expenditures under such title per episode.

   Inserted: (2) Interim and final reports.--The Secretary shall submit to the Committee on Finance of the Senate and the Committees on Ways and Means and Energy and Commerce of the House of Representatives reports on the evaluations conducted under paragraph (1) by--

   Inserted: (A) in the case of the report on the interim evaluation, not later than the end of the second year the project has been in operation; and

   Inserted: (B) in the case of the report on the final evaluation, not later than 180 days after the closing date of the project.

   Inserted: (3) Funding for evaluation.--There are authorized to be appropriated such sums as may be necessary to provide for the evaluations and reports required by this subsection.

   Inserted: (e) Definitions.--In this section:

   Inserted: (1) Comprehensive outpatient rehabilitation services.--Subject to paragraph (2), the term "comprehensive outpatient rehabilitation services" has the meaning given to such term in section 1861(cc) of the Social Security Act (42 U.S.C. 1395x(cc)).

   Inserted: (2) Direct access.--The term "direct access" means, with respect to outpatient physical therapy services and physical therapy services furnished as comprehensive outpatient rehabilitation facility services, coverage of and payment for such services in accordance with the provisions of title XVIII of the Social Security Act, except that sections 1835(a)(2), 1861(p), and 1861(cc) of such Act (42 U.S.C. 1395n(a)(2), 1395x(p), and 1395x(cc), respectively) shall be applied--

   Inserted: (A) without regard to any requirement that--

   Inserted: (i) an individual be under the care of (or referred by) a physician; or

   Inserted: (ii) services be provided under the supervision of a physician; and

   Inserted: (B) by allowing a physician or a qualified physical therapist to satisfy any requirement for--

   Inserted: (i) certification and recertification; and

   Inserted: (ii) establishment and periodic review of a plan of care.

   Inserted: (3) Fee-for-service medicare beneficiary.--The term "fee-for-service medicare beneficiary" means an individual who--

   Inserted: (A) is enrolled under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.); and

   Inserted: (B) is not enrolled in--

   Inserted: (i) a Medicare+Choice plan under part C of such title (42 U.S.C. 1395w-21 et seq.);

   Inserted: (ii) a plan offered by an eligible organization under section 1876 of such Act (42 U.S.C. 1395mm);

   Inserted: (iii) a program of all-inclusive care for the elderly (PACE) under section 1894 of such Act (42 U.S.C. 1395eee); or

   Inserted: (iv) a social health maintenance organization (SHMO) demonstration project established under section 4018(b) of the Omnibus Budget Reconciliation Act of 1987 (Public Law 100-203).

   Inserted: (4) Outpatient physical therapy services.--Subject to paragraph (2), the term "outpatient physical therapy services" has the meaning given to such term in section 1861(p) of the Social Security Act (42 U.S.C. 1395x(p)), except that such term shall not include the speech-language pathology services described in the fourth sentence of such section.

   Inserted: (5) Physician.--The term "physician" has the meaning given to such term in section 1861(r)(1) of such Act (42 U.S.C. 1395x(r)(1)).

   Inserted: (6) Qualified physical therapist.--The term "qualified physical therapist" has the meaning given to such term for purposes of section 1861(p) of such Act (42 U.S.C. 1395x(p)), as in effect on the date of enactment of this Act.

   Original wording

   At the end of subtitle B of title IV, add the following:

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As printed