[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4107 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4107

To amend title XVIII of the Social Security Act to provide for coverage 
of a program of coordinated lifestyle changes to reverse individuals at 
   significant clinical risk for a heart attack under part B of the 
                           medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 28, 2000

  Mr. Rangel 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 coverage 
of a program of coordinated lifestyle changes to reverse individuals at 
   significant clinical risk for a heart attack under part B of the 
                           Medicare Program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. COVERAGE OF LIFESTYLE CHANGES FOR INDIVIDUALS AT SIGNIFICANT 
              RISK OF HEART ATTACKS.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (S), by striking ``and'' at the end;
            (2) in subparagraph (T), by inserting ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
            ``(U) services furnished under a coordinated lifestyle 
        change program (as defined in subsection (uu)(1)) for certain 
        individuals (described in subsection (uu)(2)) who are at a 
        significant risk of a heart attack;''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended by adding at the end the following new subsection:

                 ``Coordinated Lifestyle Change Program

    ``(uu)(1) The term `coordinated lifestyle exchange program' means a 
program of 1 year's duration that--
            ``(A) is designed for individuals described in paragraph 
        (2);
            ``(B) consists of lifestyle changes, including a very low-
        fat, low-cholesterol diet, stress management techniques, 
        moderate exercise, smoking cessation, and psychosocial support, 
        without the use of cholesterol-lowering drugs;
            ``(C) has been validated to reverse disease in the majority 
        of patients, as measured by quantitative coronary arteriography 
        in a scientific study that is at least 5 years in duration and 
        that used randomly-assigned control and experimental groups; 
        and
            ``(D) is conducted by a medical facility that is 
        experienced in conducting such a scientifically validated 
        program, or whose staff has been trained by such a facility.
    ``(2) An individual described in this paragraph is an individual--
            ``(A) whose physician has recommended revascularization (in 
        the form of angioplasty or coronary artery bypass graft 
        surgery) in the near future; and
            ``(B) who has undergone at least one diagnostic study which 
        demonstrates clinically significant ventricular myocardium at 
        risk for infarction.''.
    (c) Payment.--Section 1833(a)(1) of such Act (42 U.S.C. 
1395l(a)(1)) is amended--
                    (A) by striking ``and'' before ``(S)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (T) with respect to services 
                furnished under a coordinated lifestyle change program 
                (as defined in subsection (uu)(1)), the amount paid 
                shall be 80 percent of the lesser of the actual charge 
                for the services or the amount determined to be 
                reasonable and related to the costs of furnishing such 
                services (taking into account the period of time during 
                which the services are furnished)''.
    (d) Participation Agreements.--Section 1866(e) of such Act (42 
U.S.C. 1395cc(e)) is amended--
            (1) by striking ``and'' at the end of paragraph (1);
            (2) by striking the period at the end of paragraph (2) and 
        inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(3) a medical facility described in section 
        1861(uu)(1)(D), but only with respect to the furnishing of 
        services under a coordinated lifestyle change program (as 
        defined in subsection (uu)(1)).''.
    (e) Effective Date.--The amendments made by this section apply to 
services furnished on or after January 1, 2001.
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