,,ii  #aagth ,,congress  #b;d ,session  
,s4 #e  ,,in ,,the ,,senate ,,of ,,the  
,,united ,,states  ,november #ag1       
#bjbb,mr4 ,carper 7for himself and ,mr4 
,barrasso7 introduced the following     
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,to amend title ,,xviii of the ,social
 ,security ,act to ensure appropriate   
supervision requirements for outpatient 
physical therapy and outpatient         
occupational therapy4  #a4 ,ensuring    
appropriate supervision requirements for
 outpatient physical therapy and        
outpatient occupational therapy  7a7 ,in
 general  7#a7 ,payment ,section        
#ahcd7v77#a7 of the ,social ,security   
,act 7#db ,u4,s4,c4 #aciem7v77#a77 is   
amended1 in the second sentence 7as     
amended by subsection 7a771 by inserting
 1 but in no case shall the ,secretary  
impose a supervision requirement on such
 services that is different than any    
such requirement under applicable ,state
 law before the period at the end4  7#b7

 ,definition ,section #ahfa7p7 of the   
,social ,security ,act1 is amended1 in  
the first sentence of the flush matter  
following subparagraph 7#d77;,b71 by    
inserting 1 but in no case may those    
conditions impose a supervision         
requirement that is different than any  
such requirement under applicable ,state
 law after as the ,secretary may find   
necessary4  7#c7 ,effective date ,the   
amendments made this subsection shall   
take effect on ,july #a1 #bjbc4  7b7    
,implementation ,notwithstanding any    
other provision of law1 the ,secretary  
may implement the provisions of1 and the
 amendments made by1 this section by    
program instruction or otherwise4