[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1968 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1968

    To amend title XVIII of the Social Security Act to provide for 
additional benefits under the Medicare Program to prevent or delay the 
              onset of illnesses, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 26, 1999

  Mr. Stark introduced the following bill; which was referred to the 
  Committee on 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 provide for 
additional benefits under the Medicare Program to prevent or delay the 
              onset of illnesses, 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.

    This Act may be cited as the ``Medicare Preventive Care Improvement 
Act of 1999''.

SEC. 2. AUTHORITY TO PROVIDE PREVENTIVE SERVICES UNDER PART B OF THE 
              MEDICARE PROGRAM.

    (a) Preventive Services Benefit.--
            (1) In general.--Section 1861(s) of the Social Security Act 
        (42 U.S.C. 1395x(s)) is amended--
                    (A) by redesignating paragraphs (16) and (17) as 
                paragraphs (17) and (18), respectively; and
                    (B) by inserting after paragraph (15) the following 
                new paragraph:
            ``(16) qualified preventive services, as defined in 
        subsection (uu);''.
            (2) Conforming amendments.--Sections 1864(a) 1902(a)(9)(C), 
        and 1915(a)(1)(B)(ii)(I) of such Act (42 U.S.C. 1395aa(a), 
        1396a(a)(9)(C), and 1396n(a)(1)(B)(ii)(I)) are each amended by 
        striking ``paragraphs (16) and (17)'' each place it appears and 
        inserting ``paragraphs (17) and (18)''.
    (b) Definition of Preventive Services.--Section 1861 of such Act 
(42 U.S.C. 1395x) is amended by adding at the end the following new 
subsection:

                    ``Qualified Preventive Services

    ``(uu)(1) Subject to paragraph (2), the term `qualified preventive 
services' means items and services determined by the Secretary to be 
reasonable and necessary for the prevention or early detection of an 
illness or disability.
    ``(2) An item or service described in paragraph (1) shall be 
qualified as a preventive service if the Secretary determines by 
authoritative evidence that the provision of such item or service is 
cost effective. In determining if such an item or service is cost 
effective, the Secretary shall consider the following:
            ``(A) Whether furnishing such an item or service for an 
        illness or disability results in reductions in estimated 
        expenditures under the Social Security Act for the illness or 
        disability, or avoids treatment in a more expensive setting.
            ``(B) Whether the item or service improves the health of 
        the individual for whom the item or service is furnished.
            ``(C) In the case of an individual entitled to benefits 
        under this title by reason of section 226(b), whether the item 
        or service facilitates the return to work of the individual.''.
    (c) Exclusion From Coverage Conforming Amendment.--Section 
1862(a)(1)(B) of such Act (42 U.S.C. 1395y(a)(1)(B)) is amended by 
striking ``section 1861(s)(10)'' and inserting ``section 1834(e)(6)''.

SEC. 3. PAYMENT FOR PREVENTIVE SERVICES.

    (a) In General.--Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by inserting after subsection (d) the following new 
subsection:
    ``(e) Alternative Payment for Preventive Services.--
            ``(1) General payment rule.--
                    ``(A) Qualified preventive services.--The Secretary 
                shall establish by regulation a payment amount for 
                qualified preventive services, as defined in section 
                1861(uu).
                    ``(B) Other preventive services.--The Secretary may 
                establish by regulation a payment amount for each type 
                of preventive service described in subparagraphs (A) 
                through (H) of paragraph (6).
            ``(2) Minimum payment amount.--In the case of a preventive 
        service described in paragraph (6) that may be performed as a 
        diagnostic or therapeutic service under this title, the payment 
        amount under this subsection for a service performed as a 
        preventive service may not be less than the payment amount 
        established under this title for such service performed as a 
        diagnostic or therapeutic service.
            ``(3) Manner of payment.--In the case of a preventive 
        service described in paragraph (6) that may be performed as a 
        diagnostic or therapeutic service under this title, the 
        Secretary shall apply the same method of payment under this 
        subsection for a service performed as a preventive service as 
the Secretary applies under this title for such service performed as a 
diagnostic or therapeutic service.
            ``(4) Authority to waive coinsurance.--Notwithstanding any 
        other provision of this title, in the case of a preventive 
        service described in paragraph (6), the Secretary may waive the 
        imposition of any applicable coinsurance amount with respect to 
        such service.
            ``(5) Prohibition on balance billing.--The provisions of 
        subparagraphs (A) and (B) of section 1842(b)(18) shall apply to 
        the furnishing of preventive services described in paragraph 
        (6) for which payment is made under this subsection in the same 
        manner as such subparagraphs apply to services furnished by a 
        practitioner described in subparagraph (C) of such section.
            ``(6) Preventive services described.--For purposes of this 
        subsection, the preventive services described in this paragraph 
        are any of the following services:
                    ``(A) Antigens (under section 1861(s)(2)(G)).
                    ``(B) Prostate cancer screening tests (as defined 
                in section 1861(oo)).
                    ``(C) Colorectal cancer screening tests (as defined 
                in section 1861(pp)).
                    ``(D) Diabetes outpatient self-management training 
                services (as defined in section 1861(qq)).
                    ``(E)(i) Pneumococcal vaccine and its 
                administration and influenza vaccine and its 
                administration (under section 1861(s)(10)(A)).
                    ``(ii) Hepatitis B vaccine and its administration 
                (under section 1861(s)(10)(B)).
                    ``(F) Screening mammography (as defined in section 
                1861(jj)).
                    ``(G) Screening pap smear and screening pelvic exam 
                (as defined in paragraphs (1) and (2), respectively, of 
                section 1861(nn)).
                    ``(H) Bone mass measurement (as defined in section 
                1861(rr)).
                    ``(I) Qualified preventive services (as defined in 
                section 1861(uu)).''.
    (b) Waiver of Deductible.--The first sentence of section 1833(b) of 
such Act (42 U.S.C. 1395l(b)) is amended by striking ``, (5) such 
deductible'' and all that follows through the period and inserting: ``, 
and (5) such deductible shall not apply with respect to preventive 
services (as described in section 1834(e)(6)).''.
    (c) Conforming Amendments.--(1) Section 1833(a)(1)(B) of such Act 
(42 U.S.C. 1395l(a)(1)(B)) is amended by inserting ``subject to section 
1834(e),'' before ``the amounts paid shall be 100 percent of the 
reasonable charges for such items and services,''.
    (2) Section 1833(a)(2)(G) of such Act (42 U.S.C. 1395l(a)(2)(G)) is 
amended by inserting ``subject to section 1834(e),'' before ``with 
respect to items and services''.
    (3) Section 1834(c)(1)(C) of such Act (42 U.S.C. 1395m(c)) is 
amended by striking ``the amount of the payment'' and inserting 
``except as provided by the Secretary under subsection (e), the amount 
of the payment''.
    (4) Section 1834(d) of such Act (42 U.S.C. 1395m(d)) is amended--
            (A) in paragraph (1)(A), by striking ``The payment amount'' 
        and inserting ``Except as provided by the Secretary under 
        subsection (e), the payment amount''; and
            (B) in paragraphs (2)(A) and (3)(A), by striking ``payment 
        under section 1848'' each place it appears and inserting 
        ``except as provided by the Secretary under subsection (e), 
        payment under section 1848''.
    (5) Section 1848(g)(2)(C) of such Act (42 U.S.C. 1395w-4(g)(2)(C)) 
is amended--
            (A) by striking ``For'' and inserting ``(i) Subject to 
        clause (ii), for''; and
            (B) by adding at the end the following new clause:
                    ``(ii) For physicians' services consisting of 
                preventive services (as described in section 
                1834(e)(6)) furnished on or after February 1, 2000, the 
                `limiting charge' shall be 100 percent of the 
                recognized payment amount under this part for 
                nonparticipating physicians or for nonparticipating 
                suppliers or other persons.''.
    (6) Section 1848(g)(2)(D) of such Act (42 U.S.C. 1395w-4(g)(2)(D)) 
is amended by striking ``the fee schedule amount determined under 
subsection (a)'' and all that follows and inserting ``the fee schedule 
amount determined under subsection (a), in the case of preventive 
services (as described in section 1834(e)(6)) the amount determined by 
the Secretary under section 1834(e), or, if payment under this part is 
made on a basis other than the fee schedule under this section or other 
than the amount established under section 1834(e) with respect to such 
preventive services, 95 percent of the other payment basis.''.

SEC. 4. EFFECTIVE DATE.

    The amendments made by this Act apply to items and services 
furnished on or after February 1, 2000.
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