Improvements to the Medicare annual wellness visit

(a)

Additional elements

(1)

In general

Section 1861(hhh)(2) of the Social Security Act (42 U.S.C. 1395x(hhh)(2)) is amended— (A) in subparagraph (F), by striking and nutrition and inserting nutrition, mobility, food security, housing security, transportation access, social support, and other social determinants of health as determined by the Secretary; (B) by moving subparagraphs (G) and (H) 2 ems to the left; (C) by redesignating subparagraph (I) as subparagraph (J); and (D) by inserting after subparagraph (H) the following new subparagraph:

(I) Screening for balance to identify risk for falls and referral for treatment as appropriate.

(2)

Effective date

The amendments made by paragraph (1) shall apply to items and services furnished on or after January 1, 2026. (b)

Incentive payments

Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended by adding at the end the following new subsection:

(ee)

Incentive payments for annual wellness visits that include certain elements

(1)

In general

In the case of personalized prevention plan services (as defined in paragraph (1) of section 1861(hhh)) that are furnished on or after January 1, 2026, and that include the element described in subparagraph (F) of paragraph (2) of such section 1861(hhh) and at least 2 additional elements described in subparagraphs (A) through (E) and (G) through (J) of such paragraph (2), in addition to the amount of payment that would otherwise be made for such personalized prevention plan services under this part, there also shall be paid an amount equal to 10 percent of the payment amount for the service under this part. (2)

Coordination with other payments

The amount of the additional payment for a service under this subsection and subsection (m) shall be determined without regard to any additional payment for the service under subsection (m) and this subsection, respectively. The amount of the additional payment for a service under this subsection and subsection (z) shall be determined without regard to any additional payment for the service under subsection (z) and this subsection, respectively.

(c)

Education and outreach

(1)

In general

The Secretary of Health and Human Services (in this section referred to as the Secretary) shall conduct education and outreach activities regarding the coverage of annual wellness visits under the Medicare program, including changes to such visits under the amendments made by subsections (a) and (b). (2)

National outreach campaign

Not later than 1 year after the date of enactment of this Act, the Secretary shall conduct a national outreach campaign to educate beneficiaries on the annual wellness visit under the Medicare program. In conducting such outreach campaign, the Secretary may prioritize education and outreach to low-income beneficiaries, non-physician providers, and to providers working and beneficiaries living in rural areas or health professional shortage areas. (3)

Authorization of appropriations

There is authorized to be appropriated for fiscal years 2026 through 2030 such sums as may be necessary to carry out this subsection. (d)

Inclusion as telehealth service

Section 1834(m)(4)(F)(i) of the Social Security Act (42 U.S.C. 1395m(m)(4)(F)(i)) is amended by adding at the end the following new sentence: Such term includes, with respect to telehealth services furnished on or after January 1, 2026, an annual wellness visit (as defined in section 1861(hhh)). (e)

Provider eligibility

(1)

In general

Section 1861(hhh)(3) of the Social Security Act (42 U.S.C. 1395x(hhh)(3)) is amended: (A) by striking or at the end of subparagraph (B); (B) by redesignating subparagraph (C) as subparagraph (D); and (C) by inserting after subparagraph (B) the following new subparagraph:

(2)

Effective date

The amendments made by paragraph (1) shall apply to items and services furnished on or after January 1, 2026. (f)

Guidance revision

Not later than 1 year after the date of enactment of this Act, the Secretary shall issue guidance amending section 410.15 of title 42, Code of Federal Regulations (or any successor regulation), to include guidance on processes, oversight, and standards for the post-visit follow-up to ensure consistency and compliance with the Health Risk Assessment, personalized prevention plan, and referrals. (g)

Research and evaluation

(1)

Report

(A)

In general

Not later than 1 year after the date of enactment of this Act, the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services (in this subsection referred to as the Administrator), shall analyze and publish a report on the prevalence in use of the annual wellness visit (as defined in section 1861(hhh) of the Social Security Act (42 U.S.C. 1395x(hhh))) by Medicare beneficiaries, including current practices and recommendations for increasing the use and effectiveness of the annual wellness visit under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). Such report shall include— (i) information regarding the interviews conducted under subparagraph (B); (ii) data on the prevalence of annual wellness visits furnished to Medicare beneficiaries via telehealth during the COVID–19 public health emergency; and (iii) utilization and claims data for annual wellness visits over the preceding 10 years broken down by State, demographic groups (including age, race, ethnicity, income, and education), the type of provider furnishing the annual wellness visit, and whether the beneficiary is enrolled for benefits under the original Medicare-fee-for-service program under parts A and B of title XVIII of the Social Security Act or the Medicare Advantage program under part C of title XVIII of the Social Security Act. (B)

Interviews with stakeholders

The Administrator shall conduct interviews with stakeholders, including provider groups, on their concerns regarding billing for and using the annual wellness visit under the Medicare program, including whether and to what extent personalized prevention plan services and appropriate referrals and follow-up are taking place for beneficiaries who are at particular risk and which referral models are most effective. (2)

Focus group study

Not later than 6 months after the date of enactment of this Act, the Secretary, acting through the Administrator, shall conduct a focus group study among providers, community-based organizations, and beneficiaries towards increasing use of the annual wellness visit by Medicare beneficiaries. The Secretary shall work with beneficiary and stakeholder groups to develop the interview questions for such focus group study, and shall include questions on— (A) improving referrals to community services; (B) barriers to utilization and recommendations to increase uptake; and (C) the types of providers in practices that furnish the visits. (3)

Authorization of appropriations

There is authorized to be appropriated for fiscal years 2026 through 2030 such sums as may be necessary to carry out this subsection.