HEW Report: Cover Letter

Dear Mr. Speaker:

I have the honor to transmit to you a report on the “Independent Practitioners Study.” This study was requested by the 90th Congress in Public Law 90-248, Social Security Amendments of 1967. Section 141 of the law states:

The Secretary shall make a study relating to the inclusion under the supplementary medical insurance program (part B of title XVIII of the Social Security Act) of services of additional types of licensed practitioners performing health services in independent practice. The Secretary shall make a report to the Congress prior to January 1, 1969, of his finding with respect to the need for covering, under the supplementary medical insurance program, any of the various types of services such practitioners perform and the costs to such program of covering such additional services, and shall make recommendations; as to the priority and method for covering these services and the measures that should he adopted to protect the health and safety of the individuals to whom such services would be furnished.

A primary concern throughout the study was the quality of health care provided under the coverage of the Medicare program. As planning for the study developed, however, it came to be recognized that the scope of the study necessarily included numerous complex issues with respect to the organization and delivery of health care. We have also been aware that the influence of the Medicare program is such that the conditions under which the services of any additional types of licensed practitioners are covered under Medicare may greatly influence the availability of care for the population as a whole, and the treatment accorded these services under private insurance and other public and private programs which provide or pay for health care services. It was also recognized that some of the practitioner groups most interested in coverage under Medicare have not gained full acceptance in the Nation’s present physician-oriented health care system, and that every effort should be made to assure them that their requests for coverage received unbiased, impartial consideration.

In view of these factors, the Department invited representatives of all groups of practitioners included in this study to present their position to the Department. Advice and expert knowledge was sought from medical and other scientific experts, providers of services, insurers, and consumers of health care, who would have special knowledge about the use of the services of the practitioners studied, the needs of the aged. and the organization and delivery of health care in general. The report describes in detail how these objectives were achieved.

In summary, the recommendations resulting from the study are:

  1. The present coverage for services of physical therapists remain as established in the 1967 Social Security Amendments, which extended coverage to outpatient services provided by approved providers, including rehabilitation agencies, clinics, and public health agencies meeting conditions of participation.
  2. Coverage be expanded for services of occupational therapists. clinical psychologists, social workers, and speech pathologists provided in organized agencies, centers, or other programs that are not presently eligible for participation and that meet requirements established by the Secretary and designed to promote maximum coordination, continuity, and quality of care, and to which patients are referred by a physician, who establishes a plan for the patient’s total care and retains over-all responsibility for patient management. Reimbursement for services would be to the provider agency, center, or program on the basis of reasonable cost.
  3. Present coverage for optometric services not be expanded at this time.
  4. No changes be made in present coverage for services of audiologists and corrective therapists.
  5. No changes be made in coverage in relation to the services of chiropractors.
  6. No changes be made in coverage in relation to the services of naturopaths.

I concur in the recommendations.


Wilbur J. Cohen Secretary


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