payment for physical therapy services furnished to outpatients

payment for physical therapy services furnished to outpatients Sec. 133. (a) Section 1861 (s)(2) of the Social Security Act (as amended by section 129(a)(2) of this Act) is amended by— (1) striking out “and” at the end of subparagraph (B); (2) inserting “and” at the end of subparagraph (C); and (3) adding at the end thereof the following: “(D) outpatient physical therapy services;” (b) Section 1861 of such Act is amended by inserting after subsection (o) the following new subsection (in lieu of subsection (p) repealed by section 129(c)(10) of this Act): “Outpatient Physical Therapy Services “(p) The term ‘outpatient physical therapy services’ means physical therapy services furnished by a provider or services, a clinic, rehabilitation 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— “(1) who is under the care of a physician (as defined in section 1861(r)(1)),and “(2) with respect to whom a plan prescribing the type, amount, and duration of physical therapy services that are to be fur-81 Stat. 851nished such individual has been established, and is periodically reviewed, by a physician (as so defined); excluding, however— “(3) any item or service if it would not be included under subsection (b) if furnished to an inpatient of a hospital; and “(4) any such service— “(A) if furnished by a clinic or rehabilitation agency, or by others under arrangements with such clinic or agency, unless such clinic or rehabilitation agency— “(i) provides an adequate program of physical therapy services for outpatients and has the facilities and personnel required for such program or required for the supervision of such a program, in accordance with such requirements as the Secretary may specify, “(ii) has policies, established by a group of professional personnel, including one or more physicians (associated with the clinic or rehabilitation agency) and one or more, qualified physical 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 situated in a State in which State or applicable 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 nature, as meeting the standards established for such licensing; and “(v) 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, or “(B) if furnished by a public health agency, unless such agency meets such other conditions relating to health and safety of individuals who are furnished services by such agency on an outpatient basis, as the Secretary may find necessary.” (c) Section 1866 of such Act is amended by adding at the end thereof the following new subsection: “(e) For purposes of this section, the term ‘provider of services’ shall include a clinic, rehabilitation agency, or public health agency if, in the case of a clinic or rehabilitation agency, such clinic or agency meets the requirements of section 1861 (p)(4)(A), or if, in the case of a public health agency, such agency meets the requirements of section 1861(p)(4)(B), but only with respect to the furnishing of outpatient physical therapy services (as therein defined).” (d) Section 1832(a) of such Act is amended by— (1) deleting “and” at the end of paragraph (2)(A) thereof; (2) striking out the period at the end and inserting in lieu thereof the following: “; and”; and (3) adding at the end thereof the following new subparagraph: “(C) outpatient physical therapy services.” (e) Section 1835(a)(2) of such Act (as amended by section 126(b) of this Act) is amended by— (1) striking out “and” at the end of subparagraph (A); (2) striking out the period at the end and inserting in lieu thereof the following: “; and”; (3) adding at the end thereof the following new subparagraph: “(C) in the case of outpatient physical therapy services, (i) such services are or were required because the individual 81 Stat. 852needed physical therapy services on an outpatient basis, (ii) a plan for furnishing such services has been established, and is periodically reviewed, by a physician, and (iii) such services are or were furnished while the individual is or was under the care of a physician.”; (4) striking out “(B) and (C) of section 1861(s)(2)” and inserting in lieu thereof “(B), (C), and (D) of section 1861(s)(2)”; and (5) adding at the end thereof the following new sentence: “For purposes of this section, the term ‘provider of services’ shall include a clinic, rehabilitation agency, or public health agency if, in the case of a clinic or rehabilitation agency, such clinic or agency meets the requirements of section 1861 (p)(4)(A), or if, in the case of a public health agency, such agency meets the requirements of section 1861(p)(4)(B), but only with respect to the furnishing of outpatient physical therapy services (as therein defined).” (f) The first sentence of section 1864(a) of such Act is amended by inserting before the period the following: “, or whether a clinic, rehabilitation agency or public health agency meets the requirements of subparagraph (A) or (B), as the case may be, of section 1861(p)(4)”. (g) The amendments made by the preceding subsections of this section shall apply to services furnished after June 30, 1968.