Directs the Secretary to conduct demonstration projects to promote 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, including: (1) therapy and counseling for cessation of tobacco use, and counseling for post-menopausal women; (2) screening for diminished visual acuity, and screening for depression; and (3) medical nutrition therapy services for beneficiaries with cardiovascular diseases, diabetes, or a renal disease.
Provides for: (1) expansion of eligibility for bone mass measurement; and (2) inclusion of the office visit associated with the screening colonoscopy in the screening colonoscopy benefit.
Directs the Secretary to integrate supplemental preventive health services with existing program integrity measures.
Permits waiver of coinsurance and deductibles for certain preventive services, such as: (1) diabetes outpatient self-management training services; (2) colorectal and prostate cancer screening tests; and (3) bone mass measurement.
Provides for coverage of initial preventive physical examination.
Directs the Secretary to take specified informational actions to promote the use by Medicare beneficiaries of preventive health benefits.
Directs the Director of the Centers for Disease Control and Prevention to conduct a national falls prevention and awareness campaign among Medicare beneficiaries.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1860 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 1860
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
April 29, 2003
Mr. Levin (for himself and Mr. Foley) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, 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 2003''.
(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 type II diabetes mellitus for certain at-risk
individuals.
Sec. 205. Screening for cholesterol.
Sec. 206. Screening for depression.
Sec. 207. Expansion of eligibility for bone mass measurement.
Sec. 208. Coverage of medical nutrition therapy services for
beneficiaries with cardiovascular diseases.
Sec. 209. Payment for office visit in connection with screening
colonoscopy.
Sec. 210. Program integrity.
Sec. 211. Effective date.
TITLE III--INCREASING UTILIZATION OF MEDICARE PREVENTIVE SERVICES
Sec. 301. Elimination of deductibles and coinsurance for existing
preventive health benefits.
Sec. 302. Coverage of initial preventive physical examination.
Sec. 303. Promotion of preventive health benefits.
TITLE IV--NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN
Sec. 401. National Falls Prevention Education and Awareness Campaign.
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, 2005, and
annually thereafter through 2007, 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 2004, 2005, 2006, and 2007.
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)) 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) 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))
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)) is amended by
adding at the end the following new clause:
``(vii) Any health care professional with respect to the
furnishing of supplemental preventive health services.''.
SEC. 202. COUNSELING FOR POST-MENOPAUSAL WOMEN.
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.''.
SEC. 203. SCREENING FOR DIMINISHED VISUAL ACUITY.
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.''.
SEC. 204. SCREENING FOR TYPE II DIABETES MELLITUS FOR CERTAIN AT-RISK
INDIVIDUALS.
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) Screening for diabetes II mellitus for individuals
with hypertension or hyperlipidenia if the individual involved
has not had such a screening during the preceding 3 years.''.
SEC. 205. SCREENING FOR CHOLESTEROL.
(a) In General.--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 Applying Frequency Limitations.--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 supplemental preventive health
services, which is performed more frequently than is
covered under section 1861(ww);''.
SEC. 206. SCREENING FOR DEPRESSION.
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) Screenings for clinical depression to an
individual through qualified health professionals in accordance
with the requirements of this paragraph, if the individual has
not had such a screening performed during the preceding 12
months.
``(B) In this paragraph, the term `qualified health
professional' means an individual that--
``(i) is--
``(I) a physician (as defined in subsection
(r)(1));
``(II) a nurse practitioner (as defined in
subsection (aa)(5)); or
``(III) a mental health care professional
(including a clinical social worker, as defined
in subsection 1861(hh)) that is licensed to
perform mental health services by the State in
which a screening for clinical depression is furnished; and
``(ii) is a participating physician or supplier and
has an agreement in effect with the Secretary under
which the individual agrees to accept the amount
determined under part B 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.
``(C)(i) The term `screening for clinical depression' means
a consultation during which a self-administered written
screening test (or an alternative format for such test pursuant
to subparagraph (D)) is made available to an individual and 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.
``(ii) Nothing in clause (i)(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 clause to such
individual if legally authorized under State law to do so.
``(D) For purposes of this paragraph, the term `self-
administered written screening test' means an instrument on
which an individual writes answers to questions designed to
enable a qualified health professional to establish the level
of risk of such eligible beneficiary for clinical depression.
``(E)(i) 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 under this paragraph;
and
``(II) not later than the date that is 3 months
before the date on which this paragraph is implemented,
distribute such test to qualified health professionals
that provide services, together with guidelines for
making the test available to individuals.
``(ii) The Secretary shall also establish and
distribute alternative formats for the self-
administered written screening test under clause (i)
which shall be available for use when circumstances do
not permit an individual to complete the self-
administered written screening test.''.
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 301.
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)) 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)) 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 301.
SEC. 209. PAYMENT FOR OFFICE VISIT IN CONNECTION WITH SCREENING
COLONOSCOPY.
(a) Inclusion of Office Visit in Benefit.--Section 1861(pp)(1) of
the Social Security Act (42 U.S.C. 1395x(pp)(1)) is amended by
inserting ``(and includes, in the case of screening colonoscopy, the
office visit associated with the colonoscopy)'' after ``for the purpose
of early detection of colorectal cancer''.
(b) Conforming Payment.--Section 1834(d)(3)(B) of such Act (42
U.S.C. 1395m(d)(3)(B)) is amended by adding at the end the following:
``Such payment shall take into account payment for the office visit
associated with the colonoscopy.''.
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. EFFECTIVE DATE.
Except as otherwise provided in this title, the amendments made by
this title shall apply to services furnished on or after January 1,
2004.
TITLE III--INCREASING UTILIZATION OF MEDICARE PREVENTIVE SERVICES
SEC. 301. 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))
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. 302. COVERAGE OF INITIAL PREVENTIVE PHYSICAL EXAMINATION.
(a) In General.--Section 1861(ww) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 206(a), is amended by adding
at the end the following new paragraph:
``(7)(A) An initial preventive physical examination.
``(B) For purposes of subparagraph (A), the term `initial
preventive physical examination' means physicians' services
consisting of a physical examination with the goal of health
promotion and disease detection and includes a history and
physical exam, a health risk appraisal, and health risk
counseling, and laboratory tests or other items and services as
determined by the Secretary in consultation with the United
States Preventive Services Task Force.
``(C) In the case of any item or service that is included
as part of an initial preventive physical examination and that
is otherwise separately covered under a preceding paragraph of
this subsection, the item or service shall be treated for
purposes of that preceding paragraph as having been received at
the time of such examination.''.
(b) Conforming Amendment Applying Frequency Limitations.--Section
1862(a) of such Act (42 U.S.C. 1395y(a)), as amended by section 205(b),
is amended--
(1) in paragraph (1)--
(A) by striking ``and'' at the end of subparagraph
(I);
(B) by striking the semicolon at the end of
subparagraph (J) and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(K) in the case of an initial preventive physical
examination (as defined in section 1861(ww)(7)(B)), which is
performed not later than 6 months after the date the
individual's first coverage period begins under part B;''; and
(2) in paragraph (7), by striking ``or (H)'' and inserting
``(H), or (K)''.
(c) Application of Payment Provisions.--For provisions providing
payment for supplemental preventive health services (including an
initial preventive physical examination) without application of any
deductible or coinsurance, see the amendments made by section 201(c).
(d) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2004, but only for
individuals whose coverage period begins on or after such date.
SEC. 303. 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 301), 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+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.
(4) Other activities.--Conduct activities in addition to
those described in paragraphs (1) through (3) 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 IV--NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN
SEC. 401. 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.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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 Committee on Ways and Means, 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 Committee on Ways and Means, 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.
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