HR 3630

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For those of you who want to read the current language in the Social Security

Act and see how the proposed bills language fits in, here is the link for you.

http://www.ssa.gov/OP_Home/ssact/title18/1833.htm#act-1833-a-8-b

Here is the language you are looking for:

(g)(1) Subject to paragraphs (4) and (5), in the case of physical therapy

services of the type described in section 1861(p) and speech-language pathology

services of the type described in such section through the application of

section 1861(ll)(2)[144], but not described in section 1833(a)(8)(, and

physical therapy services and speech-language pathology services[145]of such

type which are furnished by a physician or as incident to physicians’

services, with respect to expenses incurred in any calendar year, no more than

the amount specified in paragraph (2) for the year shall be considered as

incurred expenses for purposes of subsections (a) and (.

(2) The amount specified in this paragraph—

(A) for 1999, 2000, and 2001, is $1,500, and

( for a subsequent year is the amount specified in this paragraph for the

preceding year increased by the percentage increase in the MEI (as defined in

section 1842(i)(3)) for such subsequent year;

except that if an increase under subparagraph ( for a year is not a multiple

of $10, it shall be rounded to the nearest multiple of $10.

(3) Subject to paragraph 4, in the case of occupational therapy services (of the

type that are described in section 1861(p) (but not described in section

1833(a)(8)() through the operation of section 1861(g) and of such type which

are furnished by a physician or as incident to physicians’ services), with

respect to expenses incurred in any calendar year, no more than the amount

specified in paragraph (2) for the year shall be considered as incurred expenses

for purposes of subsections (a) and (.

(4) This subsection shall not apply to expenses incurred with respect to

services furnished during 2000, 2001, 2002, 2004, and 2005.

(5) With respect to expenses incurred during the period beginning on January 1,

2006, and ending on December 31, 2011[146], for services, the Secretary shall

implement a process under which an individual enrolled under this part may, upon

request of the individual or a person on behalf of the individual, obtain an

exception from the uniform dollar limitation specified in paragraph (2), for

services described in paragraphs (1) and (3) if the provision of such services

is determined to be medically necessary. Under such process, if the Secretary

does not make a decision on such a request for an exception within 10 business

days of the date of the Secretary’s receipt of the request, the Secretary

shall be deemed to have found the services to be medically necessary.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Sign up for January 24, 2012 audio conference on " 2012 Medicare & Private Payor

Updates " at:

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