Directs the Secretary to conduct demonstration projects for the purpose of promoting disease self-management for conditions identified by the Working Group for target individuals.
Amends SSA title XVIII to outline Medicare coverage of various specified preventive services, or changes with respect to such services, including: (1) coverage of therapy and counseling for cessation of tobacco use and counseling for post-menopausal women; (2) coverage of screening for diminished visual acuity and for hypertension; (3) expansion of Medicare eligibility for bone mass measurement; (4) coverage of medical nutrition therapy services for Medicare beneficiaries with cardiovascular diseases; and (5) waiver of deductibles and coinsurance for existing preventive health benefits that include diabetes outpatient self-management training services.
Requires: (1) the Director of the Centers for Disease Control and Prevention to conduct a national falls prevention and awareness campaign; and (2) the Secretary to conduct demonstration projects to evaluate screenings for clinical depression as a Medicare part B benefit.
Amends SSA title XVIII to establish a health education and risk appraisal program that identifies target individuals with specified behavioral risk factors through self-assessment.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2058 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 2058
To promote primary and secondary health promotion and disease
prevention services and activities among the elderly, to amend title
XVIII of the Social Security Act to add preventive health benefits, and
for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 5, 2001
Mr. Levin (for himself, Mr. Foley, Mr. Stark, Mr. Leach, Mr.
Abercrombie, Mr. Baldacci, Mr. Cardin, Mr. Coyne, Mr. Crowley, Ms.
DeGette, Mr. Hinchey, Mr. Hoeffel, Mr. Horn, Mr. Kildee, Ms. Lee, Mr.
McNulty, Mr. Pastor, Ms. Roybal-Allard, Mr. Sanders, Mr. Serrano, Mr.
Simmons, Mrs. Thurman, and Mr. Waxman) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committees on Ways and Means and Rules, for a period to
be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To promote primary and secondary health promotion and disease
prevention services and activities among the elderly, to amend title
XVIII of the Social Security Act to add preventive health benefits, and
for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare Wellness
Act of 2001''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--HEALTHY SENIORS PROMOTION PROGRAM
Sec. 101. Definitions.
Sec. 102. Working Group on Disease Self-Management and Health
Promotion.
Sec. 103. Healthy seniors promotion grants.
Sec. 104. Disease self-management demonstration projects.
TITLE II--MEDICARE COVERAGE OF PREVENTIVE HEALTH BENEFITS
Sec. 201. Therapy and counseling for cessation of tobacco use.
Sec. 202. Counseling for post-menopausal women.
Sec. 203. Screening for diminished visual acuity.
Sec. 204. Screening for hearing impairment.
Sec. 205. Screening for cholesterol.
Sec. 206. Screening for hypertension.
Sec. 207. Expansion of eligibility for bone mass measurement.
Sec. 208. Coverage of medical nutrition therapy services for
beneficiaries with cardiovascular diseases.
Sec. 209. Elimination of deductibles and coinsurance for existing
preventive health benefits.
Sec. 210. Program integrity.
Sec. 211. Promotion of preventive health benefits.
TITLE III--NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN
Sec. 301. National falls prevention education and awareness campaign.
TITLE IV--CLINICAL DEPRESSION SCREENING DEMONSTRATION PROJECTS
Sec. 401. Clinical depression screening demonstration projects.
TITLE V--MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM
Sec. 501. Medicare health education and risk appraisal program.
TITLE VI--STUDIES, EVALUATIONS, AND REPORTS IN THE FIELD OF DISEASE
PREVENTION AND THE ELDERLY
Sec. 601. MedPAC evaluation and report on medicare benefit package in
relation to private sector benefit
packages.
Sec. 602. National Institute on Aging study and report on ways to
improve the quality of life of elderly.
Sec. 603. Institute of Medicine medicare prevention benefit study and
report.
Sec. 604. Fast-track consideration of prevention benefit legislation.
SEC. 2. DEFINITIONS.
In this Act:
(1) Medicare beneficiary.--The term ``medicare
beneficiary'' means any individual who is entitled to benefits
under part A or enrolled under part B of the medicare program,
including any individual enrolled in a Medicare+Choice plan
offered by a Medicare+Choice organization under part C of such
program.
(2) Medicare program.--The term ``medicare program'' means
the health benefits program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
TITLE I--HEALTHY SENIORS PROMOTION PROGRAM
SEC. 101. DEFINITIONS.
In this title:
(1) Cost-effective benefit.--The term ``cost-effective
benefit'' means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) demonstrated value as measured by unit costs
relative to health outcomes achieved.
(2) Cost-saving benefit.--The term ``cost-saving benefit''
means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) caused a net reduction in health care costs for
medicare beneficiaries.
(3) Eligible entity.--The term ``eligible entity'' means an
entity that the Working Group (as defined in paragraph (6))
determines has demonstrated expertise regarding health
promotion and disease prevention among medicare beneficiaries.
(4) Medically effective.--The term ``medically effective''
means, with respect to a benefit or technique, that the benefit
or technique has been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under
normal programmatic conditions.
(5) Medically efficacious.--The term ``medically
efficacious'' means, with respect to a benefit or technique,
that the benefit or technique has been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under
controlled conditions.
(6) Working group.--The term ``Working Group'' means the
Working Group on Disease Self-Management and Health Promotion
established under section 102.
SEC. 102. WORKING GROUP ON DISEASE SELF-MANAGEMENT AND HEALTH
PROMOTION.
(a) Establishment.--There is established within the Department of
Health and Human Services a Working Group on Disease Self-Management
and Health Promotion.
(b) Composition.--
(1) In general.--Subject to paragraph (2), the Working
Group shall be composed of 5 members as follows:
(A) The Administrator of the Health Care Financing
Administration.
(B) The Director of the Centers for Disease Control
and Prevention.
(C) The Director of the Agency for Healthcare
Research and Quality.
(D) The Assistant Secretary for Aging.
(E) The Director of the National Institutes of
Health.
(2) Alternative membership.--Any member of the Working
Group described in a subparagraph of paragraph (1) may appoint
an individual who is an officer or employee of the Federal
Government to serve as a member of the Working Group instead of
the member described in such subparagraph.
(c) Duties.--The duties of the Working Group are as follows:
(1) Healthy seniors promotion grants.--The Working Group
shall establish general policies and criteria with respect to
the functions of the Secretary under section 103, including--
(A) priorities for the approval of applications
submitted under subsection (c) of such section;
(B) procedures for monitoring and evaluating
research efforts conducted under such section; and
(C) such other matters relating to the grant
program established under such section as are
recommended by the Working Group and approved by the
Secretary.
(2) Disease self-management demonstration projects.--The
Working Group shall establish general policies and criteria
with respect to the functions of the Secretary under section
104, including--
(A) the identification of medical conditions for
which a demonstration project under such section may be
implemented;
(B) the prioritization of the conditions identified
under subparagraph (A) based on the potential for the
self-management of such condition to be medically
effective and for such self-management to be a cost-
effective benefit or cost-saving benefit;
(C) the identification of target individuals (as
defined in section 104(a)(2));
(D) the development of procedures for selecting
areas in which such a demonstration project may be
implemented; and
(E) such other matters relating to such
demonstration projects as are recommended by the
Working Group and approved by the Secretary.
(d) Chairperson.--The Secretary shall designate 1 of the members of
the Working Group to be the chairperson of the Group.
(e) Quorum.--A majority of the members of the Working Group shall
constitute a quorum, but, subject to subsection (f), a lesser number of
members may hold meetings.
(f) Meetings.--The Working Group shall meet at the call of the
chairperson, except that--
(1) it shall meet not less than 4 times each year; and
(2) it shall meet upon the written request of a majority of
the members.
(g) Compensation of Members.--Each member of the Working Group
shall serve without compensation in addition to that received for their
service as an officer or employee of the Federal Government.
(h) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary for the purpose of carrying
out this section.
SEC. 103. HEALTHY SENIORS PROMOTION GRANTS.
(a) Program Authorized.--The Secretary, using the general policies
and criteria established by the Working Group under section 102(c)(1)
and in accordance with the provisions of this section, is authorized to
make grants to eligible entities (as defined in section 101(3)) to pay
for the costs of the activities described in subsection (b).
(b) Use of Funds.--An eligible entity may use payments received
under this section in any fiscal year to conduct a program to--
(1) study whether using different types of providers of
care and alternative settings (including community-based senior
centers) for the implementation of a successful health
promotion and disease prevention strategy, including the
implications regarding the payment of such providers, is
medically efficacious or medically effective;
(2) determine the most effective means of educating
medicare beneficiaries, either directly or through providers of
care, regarding the importance of health promotion and disease
prevention among such beneficiaries;
(3) identify incentives that would increase the use of new
and existing preventive health benefits and healthy behaviors
by medicare beneficiaries;
(4) promote--
(A) the use of preventive health benefits by
medicare beneficiaries, including such services that
are covered under the medicare program;
(B) the proper use by medicare beneficiaries of
prescription and over-the-counter drugs in order to
reduce the number of hospital stays and physician
visits that are a result of improper use of such drugs;
and
(C) the utilization by medicare beneficiaries of
the steps (including exercise, maintenance of a proper
diet, and the utilization of accident prevention
techniques) that research has shown to promote and
safeguard individual health; and
(5) address other topics designated by the Secretary.
(c) Application.--
(1) In general.--Each eligible entity that desires to
receive a grant under this section shall submit an application
to the Secretary, at such time, in such manner, and accompanied
by such additional information as the Secretary may reasonably
require.
(2) Contents.--Each application submitted under paragraph
(1) shall--
(A) describe the activities for which assistance
under this section is sought;
(B) describe how such activities will--
(i) reflect the medical, behavioral, and
social aspects of care for medicare
beneficiaries;
(ii) lead to the development of cost-
effective benefits and cost-saving benefits;
and
(iii) impact the quality of life of
medicare beneficiaries;
(C) provide assurances that such activities will
focus on broad medicare populations rather than unique
local medicare populations;
(D) provide evidence that the eligible entity meets
the general policies and criteria established by the
Working Group under section 102(c)(1);
(E) provide assurances that the eligible entity
will take such steps as may be available to the entity
in order to continue the activities for which the
entity is making application after the period for which
assistance is sought; and
(F) provide such additional assurances as the
Secretary determines to be essential to ensure
compliance with the requirements of this title.
(3) Joint application.--A consortium of eligible entities
may file a joint application under the provisions of paragraph
(1).
(d) Approval of Application.--The Secretary shall approve
applications in accordance with the general policies and criteria
established by the Working Group under section 102(c)(1).
(e) Payments.--Subject to amounts appropriated under subsection
(g), the Secretary shall pay to each eligible entity having an
application approved under subsection (d) the cost of the activities
described in the application.
(f) Evaluation and Report.--
(1) Evaluation.--The Secretary shall conduct an annual
evaluation of grants made under this section to determine--
(A) the results of the activities conducted under
the programs for which grants were made under this
section;
(B) the extent to which research assisted under
this section has improved or expanded the general
research for health promotion and disease prevention
among medicare beneficiaries and identified practical
interventions based upon such research;
(C) a list of specific recommendations based upon
the activities conducted under the programs for which
grants were made under this section which show promise
as practical interventions for health promotion and
disease prevention among medicare beneficiaries;
(D) whether or not, as a result of the activities
conducted under the programs for which grants were made
under this section, certain health promotion and
disease prevention benefits or education efforts should
be added to the medicare program, including discussions
of quality of life, translating the applied research
results into a benefit under the medicare program, and
whether each additional benefit would be a cost-
effective benefit or a cost-saving benefit for each
proposed addition; and
(E) how best to increase utilization of existing
and recommended health promotion and disease prevention
services, such as an education and public awareness
campaign, providing financial incentives for providers
of care and medicare beneficiaries, or utilizing other
administrative means.
(2) Annual report.--Not later than December 31, 2003, and
annually thereafter through 2005, the Secretary, in
consultation with the Working Group, shall submit a report to
Congress on the evaluation conducted under paragraph (1),
together with such recommendations for such legislation and
administrative actions as the Secretary considers appropriate.
(g) Authorization of Appropriations.--There are authorized to be
appropriated for the purpose of carrying out this section $50,000,000
for each of fiscal years 2002, 2003, 2004, and 2005.
SEC. 104. DISEASE SELF-MANAGEMENT DEMONSTRATION PROJECTS.
(a) Demonstration Projects.--
(1) In general.--The Secretary shall conduct demonstration
projects for the purpose of promoting disease self-management
for conditions identified by the Working Group under section
102(c)(2) for target individuals (as defined in paragraph (2)).
(2) Target individual defined.--In this section, the term
``target individual'' means an individual who--
(A) is at risk for, or has, 1 or more of the
conditions identified by the Working Group under
section 102(c)(2); and
(B) is enrolled under the original medicare fee-
for-service program under parts A and B of title XVIII
of the Social Security Act (42 U.S.C. 1395c et seq.;
1395j et seq.) or is enrolled under the Medicare+Choice
program under part C of title XVIII of such Act (42
U.S.C. 1395w-21 et seq.).
(b) Number; Project Areas; Duration.--
(1) Number.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall implement a series
of demonstration projects to carry out the purpose described in
subsection (a)(1).
(2) Project areas.--The Secretary shall implement the
demonstration projects described in paragraph (1) in urban,
suburban, and rural areas.
(3) Duration.--The demonstration projects under this
section shall be conducted during the 3-year period beginning
on the date on which the initial demonstration project is
implemented.
(c) Report to Congress.--
(1) In general.--Not later than 18 months after the
conclusion of the demonstration projects under this section,
the Secretary shall submit a report to Congress on such projects.
(2) Contents of report.--The report required under
paragraph (1) shall include the following:
(A) A description of the demonstration projects.
(B) An evaluation of--
(i) whether each benefit provided under the
demonstration projects is a cost-effective
benefit or a cost-saving benefit;
(ii) the level of the disease self-
management attained by target individuals under
the demonstration projects; and
(iii) the satisfaction of target
individuals under the demonstration projects.
(C) Recommendations of the Secretary regarding
whether to conduct the demonstration projects on a
permanent basis.
(D) Such recommendations for legislation and
administrative action as the Secretary determines to be
appropriate.
(E) Any other information regarding the
demonstration projects that the Secretary determines to
be appropriate.
(d) Funding.--The Secretary shall provide for the transfer from the
Federal Hospital Insurance Trust Fund under section 1817 of the Social
Security Act (42 U.S.C. 1395i) an amount not to exceed $30,000,000 for
the costs of carrying out this section.
TITLE II--MEDICARE COVERAGE OF PREVENTIVE HEALTH BENEFITS
SEC. 201. THERAPY AND COUNSELING FOR CESSATION OF TOBACCO USE.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 105(a) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
(114 Stat. 2763A-471), as enacted into law by section 1(a)(6) of Public
Law 106-554, is amended--
(1) in subparagraph (U), by striking ``and'' at the end;
(2) in subparagraph (V), by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(W) supplemental preventive health services (as defined
in subsection (ww));''.
(b) Services Described.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x), as amended by section 105(b) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
(114 Stat. 2763A-471), as enacted into law by section 1(a)(6) of Public
Law 106-554, is amended by adding at the end the following new
subsection:
``Supplemental Preventive Health Services
``(ww) The term `supplemental preventive health services' means the
following:
``(1)(A) Therapy and counseling for cessation of tobacco
use for individuals who use tobacco products or who are being
treated for tobacco use that is furnished--
``(i) by or under the supervision of a physician;
or
``(ii) by any other health care professional who--
``(I) is legally authorized to furnish such
services under State law (or the State
regulatory mechanism provided by State law) of
the State in which the services are furnished;
and
``(II) is authorized to receive payment for
other services under this title or is
designated by the Secretary for this purpose.
``(B) Subject to subparagraph (C), such term is limited
to--
``(i) therapy and counseling services recommended
in `Treating Tobacco Use and Dependence: A Clinical
Practice Guideline', published by the Public Health
Service in June 2000, or any subsequent modification of
such Guideline; and
``(ii) such other therapy and counseling services
that the Secretary recognizes to be effective.
``(C) Such term shall not include coverage for drugs or
biologicals that are not otherwise covered under this title.''.
(c) Payment and Elimination of Cost-Sharing for All Supplemental
Preventive Health Services.--
(1) Payment and elimination of coinsurance.--Section
1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)),
as amended by section 223(c) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000
(114 Stat. 2763A-489), as enacted into law by section 1(a)(6) of Public
Law 106-554, is amended--
(A) in subparagraph (N), by inserting ``other than
supplemental preventive health services (as defined in
section 1861(ww))'' after ``(as defined in section
1848(j)(3))''
(B) by striking ``and'' before ``(U)''; and
(C) by inserting before the semicolon at the end
the following: ``, and (V) with respect to supplemental
preventive health services (as defined in section
1861(ww)), the amount paid shall be 100 percent of the
lesser of the actual charge for the services or the
amount determined under the payment basis determined
under section 1848 by the Secretary for the particular
supplemental preventive health service involved''.
(2) Payment under physician fee schedule.--Section
1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
``(2)(W),'' after ``(2)(S),''.
(3) Elimination of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) of the
Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by
inserting after ``1861(s)(10)(A)'' the following: ``, with
respect to supplemental preventive health services (as defined
in section 1861(ww)),''.
(4) Elimination of deductible.--The first sentence of
section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b))
is amended--
(A) by striking ``and'' before ``(6)''; and
(B) by inserting before the period the following:
``, and (7) such deductible shall not apply with
respect to supplemental preventive health services (as
defined in section 1861(ww))''.
(d) Application of Limits on Billing.--Section 1842(b)(18)(C) of
the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), as amended by
section 105(d) of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (114 Stat. 2763A-472), as
enacted into law by section 1(a)(6) of Public Law 106-554, is amended
by adding at the end the following new clause:
``(vii) Any health care professional designated under
section 1861(ww)(1)(A)(ii)(II) to perform therapy and
counseling for cessation of tobacco use.''.
(e) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the day that is 1 year after
the date of enactment of this Act.
SEC. 202. COUNSELING FOR POST-MENOPAUSAL WOMEN.
(a) Coverage.--Section 1861(ww) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as added by section 201(b), is amended by adding
at the end the following new paragraph:
``(2)(A) Counseling for post-menopausal women.
``(B) For purposes of subparagraph (A), the term
`counseling for post-menopausal women' means counseling
provided to a post-menopausal woman regarding--
``(i) the symptoms, risk factors, and conditions
associated with menopause;
``(ii) appropriate treatment options for post-
menopausal women, including hormone replacement
therapy; and
``(iii) other interventions that can be implemented
to prevent or delay the onset of health risks
associated with menopause.
``(C) Such term does not include coverage for drugs or
biologicals that are not otherwise covered under this title.''.
(b) Effective Date.--The amendment made by this section shall apply
to services furnished on or after the day that is 1 year after the date
of enactment of this Act.
SEC. 203. SCREENING FOR DIMINISHED VISUAL ACUITY.
(a) Coverage.--Section 1861(ww) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 202(a), is amended by adding
at the end the following new paragraph:
``(3)(A) Screening for diminished visual acuity.
``(B) For purposes of subparagraph (A), the term `screening
for diminished visual acuity' means a screening for diminished
visual acuity that is furnished by or under the supervision of
an optometrist or ophthalmologist who is legally authorized to
furnish such services under State law (or the State regulatory
mechanism provided by State law) of the State in which the
services are furnished.''.
(b) Effective Date.--The amendment made by this section shall apply
to services furnished on or after the day that is 1 year after the date
of enactment of this Act.
SEC. 204. SCREENING FOR HEARING IMPAIRMENT.
(a) Coverage.--Section 1861(ww) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 203(a), is amended by adding
at the end the following new paragraph:
``(4)(A) Screening for hearing impairment.
``(B) For purposes of subparagraph (A), the term `screening
for hearing impairment' means the following services:
``(i) A screening for hearing impairment using
periodic questions that is furnished by--
``(I) a physician, including an
otolaryngologist;
``(II) a qualified audiologist (as defined
in subsection (ll)(3)(B)); or
``(III) any other health care professional
who is legally authorized to furnish such
screening under State law (or the State
regulatory mechanism provided by State law) of
the State in which the screening is furnished.
``(ii) If the answers to such questions indicate
potential hearing impairment, an otoscopic examination
and an audiometric screening test that are furnished by
an otolaryngologist or a qualified audiologist (as so
defined).
``(iii) If the results of such examination or test
indicate a need for assistive listening devices
(whether or not such examination or test was based on a
screening or was diagnostic), counseling about such
devices that is furnished by an otolaryngologist or a
qualified audiologist (as so defined).''.
(b) Effective Date.--The amendment made by this section shall apply
to services furnished on or after the day that is 1 year after the date
of enactment of this Act.
SEC. 205. SCREENING FOR CHOLESTEROL.
(a) Coverage.--Section 1861(ww) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 204(a), is amended by adding
at the end the following new paragraph:
``(5)(A) Screening for cholesterol if the individual
involved has not had such a screening during the preceding 5
years.
``(B) Notwithstanding subparagraph (A), payment may be made
under this part for a screening for cholesterol with respect to
an individual even if the individual has had such a screening
during the preceding 5 years if the individual exhibits major
risk factors for coronary heart disease or a stroke, including,
but not limited to, smoking, hypertension, and diabetes.''.
(b) Conforming Amendment.--Section 1862(a)(1) of the Social
Security Act (42 U.S.C. 1395y(a)(1)) is amended--
(1) in subparagraph (H), by striking ``and'' at the end;
(2) in subparagraph (I), by striking the semicolon at the
end and inserting ``, and''; and
(3) by adding at the end the following new subparagraph:
``(J) in the case of a screening for cholesterol,
which is performed more frequently than is covered
under section 1861(ww)(5);''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the day that is 1 year after
the date of enactment of this Act.
SEC. 206. SCREENING FOR HYPERTENSION.
(a) Coverage.--Section 1861(ww) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 205(a), is amended by adding
at the end the following new paragraph:
``(6)(A) Screening for hypertension if the individual
involved has not had such a screening during the preceding 2
years.
``(B) Notwithstanding subparagraph (A), payment may be made
under this part for a screening for hypertension with respect
to an individual even if the individual has had such a
screening during the preceding 2 years if the individual has a
history of, or is at risk for, hypertension.''.
(b) Conforming Amendment.--Section 1862(a)(1) of the Social
Security Act (42 U.S.C. 1395y(a)(1)), as amended by section 205(b), is
amended--
(1) in subparagraph (I), by striking ``and'' at the end;
(2) in subparagraph (J), by striking the semicolon at the
end and inserting ``, and''; and
(3) by adding at the end the following new subparagraph:
``(K) in the case of a screening for hypertension,
which is performed more frequently than is covered
under section 1861(ww)(6);''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the day that is 1 year after
the date of enactment of this Act.
SEC. 207. EXPANSION OF ELIGIBILITY FOR BONE MASS MEASUREMENT.
(a) Expansion.--Section 1861(rr)(2) of the Social Security Act (42
U.S.C. 1395x(rr)(2)) is amended to read as follows:
``(2) For purposes of this subsection, the term `qualified
individual' means an individual who is (in accordance with regulations
prescribed by the Secretary)--
``(A) an estrogen-deficient woman (including those
receiving hormone replacement therapy);
``(B) an individual with low trauma or fragility fractures
(including vertebral abnormalities and hip, rib, wrist, pelvic,
or proximal humeral fractures);
``(C) an individual receiving long-term medications that
have associations to bone loss or osteoporosis (including
glucocorticoid therapy and androgen deprivation therapy);
``(D) an individual with a long-term medical condition that
has association to osteoporosis (including primary
hyperparathyroidism);
``(E) a man with risk factors for osteoporosis such as
hypogonadism; and
``(F) an individual being monitored to assess the response
to, or efficacy of, an approved osteoporosis therapy.''.
(b) Reference to Elimination of Coinsurance and Waiver of
Application of Deductible.--For the elimination of the coinsurance for
bone mass measurement and for the waiver of the application of the part
B deductible for such measurement, see section 209.
(c) Effective Date.--The amendment made by subsection (a) shall
apply to services furnished on or after the day that is 1 year after
the date of enactment of this Act.
SEC. 208. COVERAGE OF MEDICAL NUTRITION THERAPY SERVICES FOR
BENEFICIARIES WITH CARDIOVASCULAR DISEASES.
(a) In General.--Section 1861(s)(2)(V) of the Social Security Act
(42 U.S.C. 1395x(s)(2)(V)), as added by subsection (a) of section 105
of the Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 (114 Stat. 2763A-471), as enacted into law by
section 1(a)(6) of Public Law 106-554, is amended to read as follows:
``(V) medical nutrition therapy services (as defined in
subsection (vv)(1)) in the case of a beneficiary--
``(i) with a cardiovascular disease (including
congestive heart failure, arteriosclerosis,
hyperlipidemia, hypertension,
and hypercholesterolemia), diabetes, or a renal disease (or a
combination of such conditions) who--
``(I) has not received diabetes outpatient
self-management training services within a time
period determined by the Secretary;
``(II) is not receiving maintenance
dialysis for which payment is made under
section 1881; and
``(III) meets such other criteria
determined by the Secretary after consideration
of protocols established by dietitian or
nutrition professional organizations; or
``(ii) with a combination of such conditions who--
``(I) is not described in clause (i)
because of the application of subclause (I) or
(II) of such clause;
``(II) receives such medical nutrition
therapy services in a coordinated manner (as
determined appropriate by the Secretary) with
any services described in such subclauses that
the beneficiary is receiving; and
``(III) meets such other criteria
determined by the Secretary after consideration
of protocols established by dietitian or
nutrition professional organizations;''.
(b) Elimination of Coinsurance.--Section 1833(a)(1)(T) of the
Social Security Act (42 U.S.C. 1395l(a)(1)(T)), as added by section
105(c)(2) of the Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 (114 Stat. 2763A-472), as enacted into law by
section 1(a)(6) of Public Law 106-554, is amended by striking ``80
percent'' and inserting ``100 percent''.
(c) Reference to Waiver of Application of Deductible.--For the
waiver of the application of the part B deductible for medical
nutrition therapy services, see section 209.
(d) Effective Date.--The amendments made by this section shall take
effect as if included in the enactment of section 105 of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
(114 Stat. 2763A-471), as enacted into law by section 1(a)(6) of Public
Law 106-554.
SEC. 209. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR EXISTING
PREVENTIVE HEALTH BENEFITS.
(a) In General.--Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended by inserting after subsection (o) the following new
subsection:
``(p) Deductibles and Coinsurance Waived for Preventive Health
Items and Services.--The Secretary may not require the payment of any
deductible or coinsurance under subsection (a) or (b), respectively, of
any individual enrolled for coverage under this part for any of the
following preventive health items and services:
``(1) Blood-testing strips, lancets, and blood glucose
monitors for individuals with diabetes described in section
1861(n).
``(2) Diabetes outpatient self-management training services
(as defined in section 1861(qq)(1)).
``(3) Pneumococcal, influenza, and hepatitis B vaccines and
administration described in section 1861(s)(10).
``(4) Screening mammography (as defined in section
1861(jj)).
``(5) Screening pap smear and screening pelvic exam (as
defined in paragraphs (1) and (2) of section 1861(nn),
respectively).
``(6) Bone mass measurement (as defined in section
1861(rr)(1)).
``(7) Prostate cancer screening test (as defined in section
1861(oo)(1)).
``(8) Colorectal cancer screening test (as defined in
section 1861(pp)(1)).
``(9) Screening for glaucoma (as defined in section
1861(uu)).
``(10) Medical nutrition therapy services (as defined in
section 1861(vv)(1)).''.
(b) Waiver of Coinsurance.--
(1) In general.--Section 1833(a)(1)(B) of the Social
Security Act (42 U.S.C. 1395l(a)(1)(B)) is amended to read as
follows: ``(B) with respect to preventive health items and
services described in subsection (p), the amounts paid shall be
100 percent of the fee schedule or other basis of payment under
this title for the particular item or service,''.
(2) Elimination of coinsurance in outpatient hospital
settings.--The third sentence of section 1866(a)(2)(A) of the
Social Security Act (42 U.S.C. 1395cc(a)(2)(A)), as amended by
section 201(c)(3), is amended by inserting after ``section
1861(ww)'' the following: ``and preventive health items and
services described in section 1833(p)''.
(c) Waiver of Application of Deductible.--Section 1833(b)(1) of the
Social Security Act (42 U.S.C. 1395l(b)(1)) is amended to read as
follows: ``(1) such deductible shall not apply with respect to
preventive health items and services described in subsection (p),''.
(d) Adding ``Lancet'' to Definition of DME.--Section 1861(n) of the
Social Security Act (42 U.S.C. 1395x(n)) is amended by striking
``blood-testing strips and blood glucose monitors'' and inserting
``blood-testing strips, lancets, and blood glucose monitors''.
(e) Conforming Amendments.--
(1) Elimination of coinsurance for clinical diagnostic
laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of
section 1833(a) of the Social Security Act (42 U.S.C.
1395l(a)), as amended by section 201(b)(1) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of
2000 (114 Stat. 2763A-481), as enacted into law by section
1(a)(6) of Public Law 106-554, are each amended by inserting
``or which are described in subsection (p)'' after
``assignment-related basis''.
(2) Elimination of coinsurance for certain dme.--Section
1834(a)(1)(A) of the Social Security Act (42 U.S.C.
1395m(a)(1)(A)) is amended by inserting ``(or 100 percent, in
the case of such an item described in section 1833(p))'' after
``80 percent''.
(3) Elimination of deductibles and coinsurance for
colorectal cancer screening tests.--Section 1834(d) of the
Social Security Act (42 U.S.C. 1395m(d)) is amended--
(A) in paragraph (2)(C)--
(i) by striking ``(C) Facility payment
limit.--'' and all that follows through
``Notwithstanding subsections'' and inserting
the following:
``(C) Facility payment limit.--Notwithstanding
subsections'';
(ii) by striking ``(I) in accordance'' and
inserting the following:
``(i) in accordance'';
(iii) by striking ``(II) are performed''
and all that follows through ``payment under''
and inserting the following:
``(ii) are performed in an ambulatory
surgical center or hospital outpatient
department,
payment under''; and
(iv) by striking clause (ii); and
(B) in paragraph (3)(C)--
(i) by striking ``(C) Facility payment
limit.--'' and all that follows through
``Notwithstanding subsections'' and inserting
the following:
``(C) Facility payment limit.--Notwithstanding
subsections''; and
(ii) by striking clause (ii).
(f) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the day that is 1 year after
the date of enactment of this Act.
SEC. 210. PROGRAM INTEGRITY.
The Secretary, in consultation with the Inspector General of the
Department of Health and Human Services, shall integrate supplemental
preventive health services (as defined in section 1861(ww) of the
Social Security Act (as added by the preceding provisions of this
title)) with existing program integrity measures.
SEC. 211. PROMOTION OF PREVENTIVE HEALTH BENEFITS.
In order to promote the use by medicare beneficiaries of preventive
health benefits, including preventive health services (as defined in
section 1861(ww) of the Social Security Act (as added by the preceding
provisions of this title)) and preventive health items and services
described in section 1833(p) of such Act (as added by section 209), the
Secretary shall do the following:
(1) Medicare handbook and other annual notices.--Include in
any medicare handbook and any other annual notice provided to
medicare beneficiaries a detailed description of--
(A) the preventive health benefits that are covered
under the medicare program; and
(B) the importance of using such benefits.
(2) Fiscal intermediaries and carriers.--Require that
fiscal intermediaries with a contract under section 1816 of the
Social Security Act (42 U.S.C. 1395h) and carriers with a
contract under section 1842 of such Act (42 U.S.C. 1395u)
include preventive health benefits messages on Medicare Summary
Notice Statements and Explanations of Medicare Benefits
distributed by such entities.
(3) Medicare part b statement.--Regularly include
preventive health benefits messages on the medicare part B
statement.
(4) Medicare+choice plans.--Require that Medicare+Choice
organizations offering a Medicare+Choice plan disclose under
section 1852(c)(1)(B) of the Social Security Act (42 U.S.C.
1395w-22(c)(1)(B)) information regarding the preventive health
benefits that are covered under the plan.
(5) Other activities.--Conduct activities in addition to
those described in paragraphs (1) through (4) that the
Secretary determines to be useful in disseminating information
to medicare beneficiaries regarding--
(A) the preventive health benefits that are covered
under the medicare program;
(B) the importance of using such benefits; and
(C) general health promotion.
TITLE III--NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN
SEC. 301. NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN.
(a) In General.--The Director of the Centers for Disease Control
and Prevention, in consultation with the Administrator of the Health
Care Financing Administration, shall conduct a national falls
prevention and awareness campaign to reduce fall-related injuries among
medicare beneficiaries.
(b) Report to Congress.--
(1) In general.--The Director of the Centers for Disease
Control and Prevention, in consultation with the Administrator
of the Health Care Financing Administration, shall submit to
Congress a report on the campaign conducted under this section.
(2) Deadline for report.--The report required under
paragraph (1) shall be submitted not later than the earlier
of--
(A) 6 months after the campaign is completed; or
(B) 3 years after the campaign is implemented.
(3) Contents of report.--The report required under
paragraph (1) shall include the following:
(A) A description of the campaign.
(B) An evaluation of--
(i) whether the campaign has effectively
reached its target population; and
(ii) the cost-effectiveness of the
campaign.
(C) An assessment of whether the campaign has been
effective, as measured by whether--
(i) the target population has adopted the
interventions suggested in the campaign, and if
not, the reasons why such interventions have
not been adopted; and
(ii) the fall rates among the target
population have decreased since the campaign
was implemented, and if not, the reasons why
such fall rates have not decreased.
(D) Any other information regarding the campaign
that the Director of the Centers for Disease Control
and Prevention determines to be appropriate.
(c) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary for the purpose of carrying
out this section.
TITLE IV--CLINICAL DEPRESSION SCREENING DEMONSTRATION PROJECTS
SEC. 401. CLINICAL DEPRESSION SCREENING DEMONSTRATION PROJECTS.
(a) Definitions.--In this section:
(1) Demonstration project.--The term ``demonstration
project'' means a demonstration project established under
subsection (b)(1).
(2) Eligible beneficiary.--The term ``eligible
beneficiary'' means an individual enrolled for benefits under
part B who is not enrolled in any of the following:
(A) A Medicare+Choice plan under part C of title
XVIII of the Social Security Act (42 U.S.C. 1395w-21 et
seq.).
(B) A plan offered by an eligible organization
under section 1876 of such Act (42 U.S.C. 1395mm).
(C) A program of all-inclusive care for the elderly
(PACE) under section 1894 of such Act (42 U.S.C.
1395eee).
(D) 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).
(E) A health care prepayment plan under section
1833(a)(1)(A) of the Social Security Act (42 U.S.C.
1395l(a)(1)(A)).
(3) Part b.--The term ``part B'' means part B of the
original medicare fee-for-service program under title XVIII of
the Social Security Act (42 U.S.C. 1395j et seq.).
(4) Qualified health professional.--The term ``qualified
health professional'' means an individual that--
(A) is--
(i) a physician (as defined in section
1861(r)(1) of the Social Security Act (42
U.S.C. 1395x(r)(1)));
(ii) a nurse practitioner (as defined in
section 1861(aa)(5) of such Act (42 U.S.C.
1395x(aa)(5))); or
(iii) a mental health care professional
(including a clinical social worker, as defined
in section 1861(hh) of such Act (42 U.S.C.
1395x(hh))) that is licensed to perform mental
health services by the State in which a
screening for clinical depression is furnished
under a demonstration project; and
(B) has an agreement in effect with the Secretary
under which the professional agrees to accept the
amount determined by the Secretary under subsection
(b)(4) as full payment for such screening and to accept
an assignment described in section 1842(b)(3)(B)(ii) of
the Social Security Act (42 U.S.C. 1395u(b)(3)(B)(ii))
with respect to payment for each screening furnished by
the professional to an eligible beneficiary
participating in a demonstration project.
(5) Screening for clinical depression.--
(A) In general.--The term ``screening for clinical
depression'' means a consultation during which--
(i) a self-administered written screening
test (or an alternative format for such test
pursuant to subsection (b)(3)(B)) is made
available to an eligible beneficiary; and
(ii) a qualified health professional--
(I) interprets the results of such
test;
(II) discusses the beneficiary's
responses to the questions on the test
with the beneficiary;
(III) assesses the beneficiary's
risk of clinical depression; and
(IV) if the qualified health
professional determines that the
beneficiary is at high risk for
clinical depression, refers the
eligible beneficiary for a full
diagnostic evaluation and such additional treatment as may be required.
(B) Construction.--Nothing in subparagraph
(A)(ii)(IV) shall be construed as prohibiting a
qualified health professional performing the screening
for clinical depression with respect to an individual
from directly providing the diagnostic evaluation and
additional treatment described in such subparagraph to
such individual if legally authorized under State law
to do so.
(6) Self-administered written screening test.--The term
``self-administered written screening test'' means an
instrument on which an eligible beneficiary writes answers to
questions designed to enable a qualified health professional to
establish the level of risk of such eligible beneficiary for
clinical depression.
(b) Demonstration Projects.--
(1) In general.--The Secretary shall establish and conduct
demonstration projects for the purpose of evaluating the
efficacy of providing screenings for clinical depression as a
benefit under part B to eligible beneficiaries through
qualified health professionals in accordance with the
requirements of this section.
(2) Number, project areas, duration.--
(A) Number.--The Secretary shall establish no fewer
than 6 and no more than 10 demonstration projects.
(B) Project areas.--
(i) In general.--The Secretary shall
conduct demonstration projects in geographic
areas that include urban, suburban, and rural
areas.
(ii) Selection.--The Secretary shall select
the geographic areas described in clause (i) in
a manner that--
(I) ensures geographic diversity
and a mix of screening sites (including
physicians' offices, hospital
outpatient departments, community
mental health centers, and skilled
nursing facilities); and
(II) gives preference to areas with
a high concentration of eligible
beneficiaries.
(C) Duration.--The demonstration projects under
this section shall be conducted during the 3-year
period beginning on the date on which the initial
demonstration project is implemented.
(3) Identification and distribution of self-administered
tests.--
(A) In general.--The Secretary, in consultation
with professionals experienced in conducting large-
scale depression screening projects, shall--
(i) establish or identify a self-
administered written screening test to be used
in conducting the demonstration projects; and
(ii) not later than the date that is 3
months before the date on which a demonstration
project is implemented in a geographic area,
distribute such test to each qualified health
professional that provides services in such
area in which the Secretary conducts a
demonstration project, together with guidelines
for making the test available to eligible
beneficiaries.
(B) Alternative formats for test.--The Secretary
shall also establish and distribute alternative formats
for the self-administered written screening test under
subparagraph (A) which shall be available for use when
circumstances do not permit an individual to complete
the self-administered written screening test.
(4) Payment for screenings for clinical depression.--
(A) In general.--Subject to subparagraph (C), the
Secretary shall provide for payment of the reasonable
charges for each screening for clinical depression
furnished to an eligible beneficiary by a qualified
health professional from the amounts transferred under
subsection (d).
(B) Waiver of coinsurance and deductibles.--The
Secretary may not require the payment of any deductible
or coinsurance by any eligible beneficiary for a
screening for clinical depression furnished under a
demonstration project.
(C) Frequency limitation.--No payment may be made
under this section for a screening for clinical
depression if such a screening is performed with
respect to an eligible beneficiary within the year
after a previous screening of such beneficiary.
(5) Waiver authority.--The Secretary may waive such
requirements under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) as the Secretary determines necessary to
carry out the demonstration projects under this section.
(c) Reports to Congress.--
(1) Interim report.--
(A) In general.--Not later than 2 years after the
Secretary implements the initial demonstration project,
the Secretary shall submit to Congress a report
regarding the demonstration projects conducted under
this section.
(B) Contents of report.--The report submitted under
subparagraph (A) shall contain--
(i) a description of the demonstration
projects conducted under this section;
(ii) an evaluation of--
(I) whether screening for clinical
depression is a cost-effective benefit
or a cost-saving benefit; and
(II) the level of satisfaction of
eligible beneficiaries to whom such a
screening is furnished under the
demonstration project; and
(iii) any other information regarding the
demonstration projects that the Secretary
determines to be appropriate.
(2) Final report.--Not later than 1 year after the
conclusion of the demonstration projects, the Secretary shall
submit a final report to Congress on the demonstration projects
containing the recommendations of the Secretary regarding
whether to conduct the demonstration projects on a permanent
basis, together with such recommendations for legislation and
administrative action as the Secretary considers appropriate.
(d) Funding.--The Secretary shall provide for the transfer from the
Federal Hospital Insurance Trust Fund under section 1817 of the Social
Security Act (42 U.S.C. 1395i) an amount not to exceed $30,000,000 for
the costs of carrying out the demonstration projects under this
section.
TITLE V--MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM
SEC. 501. MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by adding at the end the following new section:
``medicare health education and risk appraisal program
``Sec. 1897. (a) Establishment.--Not later than 18 months after the
date of the conclusion of the demonstration projects conducted under
subsection (b)(1), the Secretary shall implement the demonstration
project that the Secretary identifies as being the most effective
project under subsection (c)(2)(C) on a nationwide and permanent basis.
``(b) Demonstration Projects.--
``(1) Establishment.--Not later than 1 year after the date
of enactment of this Act, the Secretary, in consultation with
the Health Care Financing Administration, the Centers for
Disease Control and Prevention, and the Agency for Healthcare
Research and Quality, shall conduct a demonstration project for
the purpose of developing a comprehensive and systematic model
for delivering health promotion and disease prevention services
that--
``(A) through self-assessment identifies--
``(i) behavioral risk factors, such as
tobacco use, physical inactivity, alcohol use,
and depression, among target individuals;
``(ii) needed medicare clinical preventive
and screening health benefits among target
individuals; and
``(iii) functional and self-management
information the Secretary determines to be
appropriate;
``(B) provides ongoing followup to reduce risk
factors and promote the appropriate use of preventive
and screening health benefits;
``(C) improves clinical outcomes, satisfaction,
quality of life, and appropriate use by target
individuals of items and services covered under the
medicare program; and
``(D) provides target individuals with information
regarding the adoption of healthy behaviors.
``(2) Self-assessment and provision of information.--The
Secretary shall conduct the demonstration projects established
under paragraph (1) in the following manner:
``(A) Self-assessment.--
``(i) In general.--The Secretary shall test
different--
``(I) methods of making self-
assessments available to each target
individual;
``(II) methods of encouraging each
target individual to participate in the
self-assessment; and
``(III) methods for processing
responses to the self-assessment.
``(ii) Contents.--A self-assessment made
available under clause (i) shall include--
``(I) questions regarding
behavioral risk factors;
``(II) questions regarding needed
preventive screening health services;
``(III) questions regarding the
target individual's preferences for
receiving follow-up information; and
``(IV) other information that the
Secretary determines appropriate.
``(B) Provision of information.--After each target
individual completes the self-assessment, the Secretary
shall ensure that the target individual is provided
with such information as the Secretary determines
appropriate, which may include--
``(i) information regarding the results of
the self-assessment;
``(ii) recommendations regarding any
appropriate behavior modification based on the
self-assessment;
``(iii) information regarding how to access
behavior modification assistance that promotes
healthy behavior, including information on
nurse hotlines, counseling services, provider
services, and case-management services;
``(iv) information, feedback, support, and
recommendations regarding any need for clinical
preventive and screening health services or
treatment; and
``(v) referrals to available community
resources in order to assist the target
individual in reducing health risks.
``(3) Project areas and duration.--
``(A) Project areas.--The Secretary shall implement
the demonstration projects in geographic areas that
include urban, suburban, and rural areas.
``(B) Duration.--The Secretary shall conduct the
demonstration projects during the 3-year period
beginning on the date on which the first demonstration
project is implemented.
``(c) Report to Congress.--
``(1) In general.--Not later than 1 year after the date on
which the demonstration projects conclude, the Secretary shall
submit to Congress a report on such projects.
``(2) Contents of report.--The report submitted under
paragraph (1) shall--
``(A) describe the demonstration projects conducted
under this section;
``(B) identify the demonstration project that is
the most effective; and
``(C) contain such other information regarding the
demonstration projects as the Secretary determines
appropriate.
``(3) Measurement of effectiveness.--For purposes of
paragraph (2)(B), in identifying the demonstration project that
is the most effective, the Secretary shall consider--
``(A) how successful the project was at--
``(i) reaching target individuals and
engaging them in an assessment of the risk
factors of such individuals;
``(ii) educating target individuals on
healthy behaviors and getting such individuals
to modify their behaviors in order to diminish
the risk of chronic disease; and
``(iii) ensuring that target individuals
were provided with necessary information;
``(B) the cost-effectiveness of the demonstration
project; and
``(C) the degree of beneficiary satisfaction under
the demonstration projects.
``(d) Waiver Authority.--The Secretary may waive such requirements
under this title as the Secretary determines necessary to carry out the
demonstration projects under this section.
``(e) Funding.--There are authorized to be appropriated $25,000,000
for carrying out the demonstration project under this section.
``(f) Definitions.--In this section:
``(1) Target individual.--The term `target individual'
means each individual that is--
``(A) entitled to benefits under part A or enrolled
under part B, including an individual enrolled under
the Medicare+Choice program under part C; or
``(B) between the ages of 50 and 64 who is not a
beneficiary under this title.
``(2) Major behavioral risk factor.--The term `major
behavioral risk factor' includes--
``(A) the lack of proper nutrition;
``(B) the use of alcohol;
``(C) the lack of regular exercise;
``(D) the use of tobacco;
``(E) depression; and
``(F) any other risk factor identified by the
Secretary.''.
TITLE VI--STUDIES, EVALUATIONS, AND REPORTS IN THE FIELD OF DISEASE
PREVENTION AND THE ELDERLY
SEC. 601. MEDPAC EVALUATION AND REPORT ON MEDICARE BENEFIT PACKAGE IN
RELATION TO PRIVATE SECTOR BENEFIT PACKAGES.
(a) In General.--Section 1805(b) of the Social Security Act (42
U.S.C. 1395b-6(b)), as amended by section 544(b) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
(114 Stat. 2763A-551), as enacted into law by section 1(a)(6) of Public
Law 106-554, is amended--
(1) in paragraph (1)--
(A) in subparagraph (C), by striking ``and'' at the
end;
(B) in subparagraph (D), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(E) on the date that is 3 years after the date of
enactment of the Medicare Wellness Act of 2001, and
each successive 3-year anniversary thereafter, submit
the report described in paragraph (8)(C) to
Congress.''; and
(2) by adding at the end the following new paragraph:
``(8) Evaluation of medicare benefit package in relation to
private sector benefit packages.--
``(A) Evaluation.--The Commission shall evaluate--
``(i) the benefit package offered under the
medicare program under this title; and
``(ii) the degree to which such benefit
package compares to the benefit packages
offered by health benefit programs available in
the private sector to individuals over age 55.
``(B) Issues.--In conducting the evaluation under
subparagraph (A)(ii), the Commission shall address the
following issues:
``(i) Whether the benefit packages
available under the programs are--
``(I) similar;
``(II) appropriate for the
enrollees of the programs (based on
what experts recommend for such
enrollees);
``(III) actuarially equivalent; and
``(IV) comprehensive.
``(ii) The financial liabilities of
enrollees of the programs and whether such
liabilities are appropriate.
``(iii) The ability of enrollees of the
programs to take advantage of benefits under
the programs.
``(C) Report.--The Commission shall submit a report
to Congress that shall contain--
``(i) a detailed statement of the findings
and conclusions of the Commission regarding the
evaluation conducted under subparagraph (A);
``(ii) the recommendations of the
Commission regarding changes in the benefit
package offered under the medicare program
under this title that would keep the program
modern and competitive in relation to health
benefit packages offered by health benefit
programs available in the private sector to
individuals over age 55; and
``(iii) the recommendations of the
Commission for such legislation and
administrative actions as it considers
appropriate.''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
SEC. 602. NATIONAL INSTITUTE ON AGING STUDY AND REPORT ON WAYS TO
IMPROVE THE QUALITY OF LIFE OF ELDERLY.
(a) Studies.--The Director of the National Institute on Aging, in
consultation with the Working Group on Disease Self-Management and
Health Promotion (established in section 102) and the United States
Preventive Services Task Force, shall conduct 1 or more studies
focusing on ways to--
(1) improve quality of life for the elderly; and
(2) develop better ways to prevent or delay the onset of
age-related functional decline and disease and disability among
the elderly.
(b) Reports.--
(1) Report for each study.--The Director of the National
Institute on Aging, in consultation with the Working Group on
Disease Self-Management and Health Promotion and the United
States Preventive Services Task Force, shall submit a report to
the Secretary regarding each study conducted under subsection
(a), together with a detailed statement of research findings
and conclusions that are scientifically valid and are
demonstrated to prevent or delay the onset of chronic illness
or disability among the elderly.
(2) Timing for submitting reports.--Each report regarding a
study that is required to be submitted pursuant to paragraph
(1) shall be submitted by not later than the earlier of--
(A) the date that is 18 months after the completion
of the study involved; or
(B) January 1, 2008.
(c) Transmission to Institute of Medicine.--Upon receipt of each
report described in subsection (b), the Secretary shall transmit such
report to the Institute of Medicine of the National Academy of Sciences
for consideration in its effort to conduct the comprehensive study of
current literature and best practices in the field of health promotion
and disease prevention among the medicare beneficiaries described in
section 603.
(d) Authorization of Appropriations.--
(1) In general.--There are authorized to be appropriated
for the purpose of carrying out this section such sums as may
be necessary for the period of fiscal years 2002 through 2008.
(2) Availability.--Any sums appropriated under the
authorization contained in this subsection shall remain
available, without fiscal year limitation, until September 30,
2008.
SEC. 603. INSTITUTE OF MEDICINE MEDICARE PREVENTION BENEFIT STUDY AND
REPORT.
(a) Study.--
(1) In general.--The Secretary shall contract with the
Institute of Medicine of the National Academy of Sciences to--
(A) conduct a comprehensive study of current
literature and best practices in the field of health
promotion and disease prevention among medicare
beneficiaries, including the issues described in
paragraph (2); and
(B) submit the report described in subsection (b).
(2) Issues studied.--The study required under paragraph (1)
shall include an assessment of--
(A) whether each health promotion and disease
prevention benefit covered under the medicare program
is--
(i) medically effective (as defined in
section 101(4)); and
(ii) a cost-effective benefit (as defined
in section 101(2)) or a cost-saving benefit (as
defined in section 101(3));
(B) utilization by medicare beneficiaries of such
benefits (including any barriers to or incentives to
increase utilization);
(C) quality of life issues associated with such
benefits; and
(D) health promotion and disease prevention
benefits that are not covered under the medicare
program that would affect all medicare beneficiaries.
(b) Reports.--
(1) Three-year report.--On the date that is 3 years after
the date of enactment of this Act, and each successive 3-year
anniversary thereafter, the Institute of Medicine of the
National Academy of Sciences shall submit to the President a
report that contains--
(A) a detailed statement of the findings and
conclusions of the study conducted under subsection
(a); and
(B) the recommendations for legislation described
in paragraph (3).
(2) Interim report based on new guidelines.--If the United
States Preventive Services Task Force or the Task Force on
Community Preventive Services establishes new guidelines
regarding preventive health benefits for medicare beneficiaries
more than 1 year prior to the date that a report described in
paragraph (1) is due to be submitted to the President, then not
later than 6 months after the date such new guidelines are
established, the Institute of Medicine of the National Academy
of Sciences shall submit to the President a report that
contains a detailed description of such new guidelines. Such
report may also contain recommendations for legislation
described in paragraph (3).
(3) Recommendations for legislation.--The Institute of
Medicine of the National Academy of Sciences, in consultation
with the United States Preventive Services Task Force and the
Task Force on Community Preventive Services, shall develop
recommendations in legislative form that--
(A) prioritize the preventive health benefits under
the medicare program; and
(B) modify such benefits, including adding new
benefits under such program, based on the study
conducted under subsection (a).
(c) Transmission to Congress.--
(1) In general.--On the day on which the report described
in paragraph (1) of subsection (b) (or paragraph (2) of such
subsection if the report contains recommendations in
legislative form described in subsection (b)(3)) is submitted
to the President, the President shall transmit the report and
recommendations to Congress.
(2) Delivery.--Copies of the report and recommendations in
legislative form required to be transmitted to Congress under
paragraph (1) shall be delivered--
(A) to both Houses of Congress on the same day;
(B) to the Clerk of the House of Representatives if
the House is not in session; and
(C) to the Secretary of the Senate if the Senate is
not in session.
SEC. 604. FAST-TRACK CONSIDERATION OF PREVENTION BENEFIT LEGISLATION.
(a) Rules of House of Representatives and Senate.--This section is
enacted by Congress--
(1) as an exercise of the rulemaking power of the House of
Representatives and the Senate, respectively, and is deemed a
part of the rules of each House of Congress, but--
(A) is applicable only with respect to the
procedure to be followed in that House of Congress in
the case of an implementing bill (as defined in
subsection (d)); and
(B) supersedes other rules only to the extent that
such rules are inconsistent with this section; and
(2) with full recognition of the constitutional right of
either House of Congress to change the rules (so far as
relating to the procedure of that House of Congress) at any
time, in the same manner and to the same extent as in the case
of any other rule of that House of Congress.
(b) Introduction and Referral.--
(1) Introduction.--
(A) In general.--Subject to paragraph (2), on the
day on which the President transmits the report
pursuant to section 603(c) to the House of
Representatives and the Senate, the recommendations in
legislative form transmitted by the President with
respect to such report shall be introduced as a bill
(by request) in the following manner:
(i) House of representatives.--In the House
of Representatives, by the Majority Leader, for
himself and the Minority Leader, or by Members
of the House of Representatives designated by
the Majority Leader and Minority Leader.
(ii) Senate.--In the Senate, by the
Majority Leader, for himself and the Minority
Leader, or by Members of the Senate designated
by the Majority Leader and Minority Leader.
(B) Special rule.--If either House of Congress is
not in session on the day on which such recommendations
in legislative form are transmitted, the
recommendations in legislative form shall be introduced
as a bill in that House of Congress, as provided in
subparagraph (A), on the first day thereafter on which
that House of Congress is in session.
(2) Referral.--Such bills shall be referred by the
presiding officers of the respective Houses to the appropriate
committee, or, in the case of a bill containing provisions
within the jurisdiction of 2 or more committees, jointly to
such committees for consideration of those provisions within
their respective jurisdictions.
(c) Consideration.--After the recommendations in legislative form
have been introduced as a bill and referred under subsection (b), such
implementing bill shall be considered in the same manner as an
implementing bill is considered under subsections (d), (e), (f), and
(g) of section 151 of the Trade Act of 1974 (19 U.S.C. 2191).
(d) Implementing Bill Defined.--In this section, the term
``implementing bill'' means only the recommendations in legislative
form of the Institute of Medicine of the National Academy of Sciences
described in section 603(b)(3), transmitted by the President to the
House of Representatives and the Senate under subsection 603(c), and
introduced and referred as provided in subsection (b) as a bill of
either House of Congress.
(e) Counting of Days.--For purposes of this section, any period of
days referred to in section 151 of the Trade Act of 1974 shall be
computed by excluding--
(1) the days on which either House of Congress is not in
session because of an adjournment of more than 3 days to a day
certain or an adjournment of Congress sine die; and
(2) any Saturday and Sunday, not excluded under paragraph
(1), when either House is not in session.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E1008)
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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