Diabetic Eye Disease Prevention Act of 2016
This bill amends title XVIII of the Social Security Act (Medicare) to establish a demonstration project through which primary care practices may receive incentives for referring diabetic Medicare beneficiaries to local eye doctors for comprehensive dilated eye exams. The project must test the extent to which these incentives: (1) improve early detection and treatment of diabetes-related vision problems, (2) reduce the cost of Medicare services, and (3) achieve beneficiary satisfaction.
The project shall identify for participation at least 100 primary care practices in at least 10 states that have high per capita costs of diabetes care for Medicare beneficiaries.
Project costs shall be paid from the Federal Supplementary Medical Insurance Trust Fund.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4642 Introduced in House (IH)]
<DOC>
114th CONGRESS
2d Session
H. R. 4642
To amend title XVIII of the Social Security Act to establish a Medicare
diabetic eye disease prevention and early treatment demonstration
project.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 26, 2016
Mr. Collins of New York (for himself and Mr. McNerney) 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 amend title XVIII of the Social Security Act to establish a Medicare
diabetic eye disease prevention and early treatment demonstration
project.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Diabetic Eye Disease Prevention Act
of 2016''.
SEC. 2. MEDICARE DIABETIC EYE DISEASE PREVENTION AND EARLY TREATMENT
DEMONSTRATION PROJECT.
Title XVIII of the Social Security Act is amended by inserting
after section 1866E (42 U.S.C. 1395cc-5) the following new section:
``diabetic eye disease prevention and early treatment demonstration
project
``Sec. 1866F. (a) Establishment.--The Secretary shall conduct,
during a 5-year period beginning no later than January 1, 2017, a
diabetic eye disease prevention and early treatment demonstration
project (in this section referred to as the `demonstration project') to
provide incentives to primary care practices to refer to local eye
doctors for comprehensive dilated eye exams--
``(1) diabetic Medicare beneficiaries at the time of their
diagnosis of diabetes; and
``(2) diabetic Medicare beneficiaries who have been
diagnosed with diabetes mellitus and have not received a
comprehensive dilated eye examination in the previous 5 years.
``(b) Requirement.--The demonstration project shall test the extent
to which such incentives result in--
``(1) improving early detection and treatment of diabetes-
related vision problems and the reduction of significant eye
and vision loss and blindness associated with delayed diagnosis
and treatment of diabetes-related eye and vision conditions;
``(2) reducing the cost of health care services covered
under this title; and
``(3) achieving beneficiary satisfaction.
``(c) Conduct of Project.--The demonstration project shall be
conducted consistent with the following:
``(1) Identification of primary care practices.--The
demonstration project shall identify at least 100 primary care
practices, in each of at least 10 States which have high per
capita costs of diabetes care for diabetic Medicare
beneficiaries, for participation in the demonstration project.
``(2) Listing of participating eye doctors.--Each practice
so identified shall be provided with a list of eye doctors who
are located in the area of such practice and who have agreed to
participate in the demonstration project.
``(3) Requirements for participating eye doctors.--As part
of the participation agreement of an eye doctor under the
demonstration project, the eye doctor agrees--
``(A) to offer to furnish to each diabetic Medicare
beneficiary referred to the doctor by a primary care
practice so identified a comprehensive dilated eye
examination and needed diabetes-related eye care
covered under this title; and
``(B) to report back to such practice on the
results of such an examination or care within 72 hours
after the time of conducting such examination or
furnishing such care.
``(d) Incentive Payment Methodology.--
``(1) In general.--Under the demonstration project, subject
to paragraph (2), the Secretary shall pay an incentive on an
annual basis to each primary care practice participating in the
demonstration project for each beneficiary the practice refers
in the year for an eye examination under the demonstration
project. Such amount shall be set at a level so as to encourage
primary care practices to participate in the demonstration
project.
``(2) Budget neutrality.--The Secretary shall ensure that
the aggregate payments made under this title, including
incentive payments made under this section, with respect to
individuals participating in the demonstration project do not
exceed the aggregate amounts that the Secretary estimates would
have been paid under title with respect to such individuals if
the demonstration project had not been implemented. In order to
carry out the previous sentence, the Secretary is authorized to
reduce payment rates under part B for eye care services for
diabetic Medicare beneficiaries (other than those described in
subsection (a)) to take into account the costs of comprehensive
dilated eye examinations furnished to individuals otherwise
eligible to participate in the demonstration project.
``(3) Funding.--The costs, including incentive payments, of
carrying out the demonstration project shall be paid from the
Federal Supplementary Medical Insurance Trust Fund established
under section 1841.
``(e) Waiver.--The Secretary may waive such provisions of this
title and title XI as the Secretary determines necessary in order to
implement the demonstration project.
``(f) Evaluation and Reports.--
``(1) Evaluation.--The Secretary shall conduct an
independent evaluation of the demonstration project to assess
whether the project has the results described in subsection
(b).
``(2) Reports.--
``(A) Preliminary report.--Not later than 60 days
after the completion of the first year of the
demonstration project, the Secretary shall submit to
Congress a preliminary report on the results of the
project.
``(B) Final report.--No later than 6 months after
the date of the completion of the demonstration
project, the Secretary shall submit to Congress a final
report on the results of the project and shall include
in such report the findings of the evaluation conducted
under paragraph (1).
``(g) Definitions.--In this section:
``(1) Diabetic medicare beneficiary.--The term `diabetic
Medicare beneficiary' means, with respect to a primary care
practice, an individual who--
``(A) is entitled to benefits under part A and
enrolled for benefits under part B;
``(B) is not enrolled in a Medicare Advantage plan
under part C or a PACE program under section 1894;
``(C) has been determined to have diabetes
mellitus; and
``(D) is receiving primary care services through
one or more physicians or nurse practitioners in such
practice.
``(2) Eye doctor.--The term `eye doctor' means a
participating physician who is a State-licensed optometrist or
ophthalmologist.
``(3) Primary care practice.--The term `primary care
practice'--
``(A) means a physician (as described in section
1861(r)(1)) who has a primary specialty designation of
family medicine, internal medicine, or geriatric
medicine; and
``(B) includes a group practice the physicians
within which are primarily physicians with such a
specialty designation and may also include physician
assistants and nurse practitioners.''.
<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.
Referred to the Subcommittee on Health.
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