[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1618 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                S. 1618

     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 benefits, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 22, 1999

   Mr. Graham (for himself, Mr. Jeffords, Mr. Chafee, Mr. Bryan, Mr. 
 Rockefeller, and Mr. Kerry) introduced the following bill; which was 
          read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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 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 1999''.
    (b) Table of Contents.--The table of contents is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Finding.
Sec. 3. Definitions.
               TITLE I--HEALTHY SENIORS PROMOTION PROGRAM

Sec. 101. Healthy Seniors Promotion Program.
Sec. 102. Sense of Congress regarding the response of HCFA to 
                            preventive health issues.
Sec. 103. Sense of Congress regarding the efforts of HCFA to study 
                            health promotion and disease prevention for 
                            medicare beneficiaries.
Sec. 104. Sense of Congress regarding the establishment of a medicare 
                            health promotion and disease prevention 
                            clearinghouse.
           TITLE II--MEDICARE COVERAGE OF PREVENTIVE SERVICES

Sec. 201. Counseling for cessation of tobacco use.
Sec. 202. Screening for hypertension.
Sec. 203. Counseling for hormone replacement therapy.
Sec. 204. Screening for glaucoma.
Sec. 205. Screening for diminished visual acuity.
Sec. 206. Screening for hearing impairment.
Sec. 207. Screening and counseling for osteoporosis.
Sec. 208. Screening for cholesterol.
Sec. 209. Elimination of cost sharing for current preventive benefits.
Sec. 210. National falls prevention education and awareness campaign.
Sec. 211. Program integrity.
    TITLE III--MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM

Sec. 301. Medicare Health Education and Risk Appraisal Program.
        TITLE IV--DISEASE SELF-MANAGEMENT DEMONSTRATION PROJECTS

Sec. 401. Disease self-management demonstration projects.
 TITLE V--STUDIES AND REPORTS ADVANCING ORIGINAL RESEARCH IN THE FIELD 
                 OF DISEASE PREVENTION AND THE ELDERLY

Sec. 501. MedPAC biannual report.
Sec. 502. National Institute on Aging study and report.
Sec. 503. Institute of Medicine 5-year medicare prevention benefit 
                            study and report.
Sec. 504. Fast-track consideration of prevention benefit legislation.

SEC. 2. FINDING.

    Congress finds that despite significant advancements in general 
research for health promotion and disease prevention among the elderly, 
there has been a failure in translating that research into practical 
intervention.

SEC. 3. DEFINITIONS.

    As used in this Act:
            (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) 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.
            (4) Medical efficacy; medically efficacious.--The terms 
        ``medical efficacy'' and ``medically efficacious'' mean, 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.
            (5) 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.
            (6) Medicare program.--The term ``medicare program'' means 
        the health care program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

               TITLE I--HEALTHY SENIORS PROMOTION PROGRAM

SEC. 101. HEALTHY SENIORS PROMOTION PROGRAM.

    (a) Definitions.--As used in this section:
            (1) Eligible entity.--The term ``eligible entity'' means an 
        entity that the Working Group determines has demonstrated 
        expertise in research regarding health promotion and disease 
        prevention among the elderly.
            (2) Working group.--The term ``Working Group'' means the 
        Healthy Seniors Working Group established under subsection (d).
    (b) Program Authorized.--The Secretary, subject to the general 
policies and criteria established by the Working Group and in 
accordance with the provisions of this Act, is authorized to make 
grants to eligible entities to pay for the costs of the activities 
described in subsection (c).
    (c) Use of Funds.--An eligible entity may use payments received 
under this section in any fiscal year to study--
            (1) whether using different types of providers of care who 
        are not physicians 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) the most medically effective means of educating 
        medicare beneficiaries and providers of services regarding the 
        importance of health promotion and disease prevention among the 
        elderly and identification of incentives that would increase 
        the use of new and existing preventive services and healthy 
        behaviors by medicare beneficiaries; and
            (3) other topics designated by the Secretary.
    (d) Healthy Seniors Working Group.--
            (1) Establishment.--There is established within the 
        Department of Health and Human Services a Healthy Seniors 
        Working Group.
            (2) Composition.--Subject to paragraph (3), the Working 
        Group established pursuant to subsection (b) 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 Administrator of the Agency for Health Care 
                Policy and Research.
                    (D) The Assistant Secretary for Aging.
                    (E) The Director of the National Institute on 
                Aging.
            (3) Alternative membership.--
                    (A) Appointment.--Any member of the Working Group 
                described in a subparagraph of paragraph (2) 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.
                    (B) Deadline.--If a member described in 
                subparagraph (A) elects to appoint an individual under 
                such subparagraph, such individual shall be appointed 
                not later than December 31, 2000.
            (4) General policies and criteria.--The Working Group shall 
        establish general policies and criteria with respect to the 
        functions of the Secretary under this section including--
                    (A) priorities for the approval of applications;
                    (B) procedures for developing, monitoring, and 
                evaluating research efforts conducted under this 
                section; and
                    (C) such other matters as are recommended by the 
                Working Group and approved by the Secretary.
            (5) Chairperson.--The Chairperson of the Working Group 
        shall be the Administrator of the Agency for Health Care Policy 
        and Research.
            (6) Quorum.--A majority of the members of the Working Group 
        shall constitute a quorum, but a lesser number of members may 
        hold hearings.
            (7) Meetings.--The Working Group shall meet at the call of 
        the Chairperson, except that--
                    (A) it shall meet not less than 4 times each year; 
                and
                    (B) it shall meet whenever a majority of the 
                appointed members request a meeting in writing.
            (8) Compensation of members.--Each member of the Working 
        Group shall be an officer or employee of the Federal Government 
        and shall serve without compensation in addition to that 
        received for their service as an officer or employee of the 
        Federal Government.
    (e) Application.--
            (1) In general.--Each eligible entity which 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 pursuant to 
        paragraph (1) shall--
                    (A) describe the activities for which assistance 
                under this section is sought;
                    (B) describe how the research effort proposed to be 
                conducted will reflect the medical, behavioral, and 
                social aspects of care for the elderly, lead to the 
                development of cost-effective benefits and cost-saving 
                benefits, and impact the quality of life of medicare 
                beneficiaries;
                    (C) provide evidence that the eligible entity meets 
                the general policies established by the Working Group 
                pursuant to subsection (d)(4);
                    (D) provide assurances that the eligible entity 
                will take such steps as may be available to it to 
                continue the activities for which the eligible entity 
                is making application after the period for which 
                assistance is sought; and
                    (E) provide such additional assurances as the 
                Secretary determines to be essential to ensure 
                compliance with the requirements of this Act.
            (3) Joint application.--A consortium of eligible entities 
        may file a joint application under the provisions of paragraph 
        (1) of this subsection.
    (f) Approval of Application.--The Secretary shall approve 
applications in accordance with the general policies established by the 
Working Group under subsection (d).
    (g) Payments.--The Secretary shall pay to each eligible entity 
having an application approved under subsection (f) the cost of the 
activities described in the application.
    (h) 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 overall applied research 
                conducted under this Act;
                    (B) the extent to which research assisted under 
                this section has improved or expanded the general 
                research for health promotion and disease prevention 
                among the elderly and identified practical 
                interventions based upon such research;
                    (C) a list of specific recommendations based upon 
                research conducted under this section which show 
                promise as practical interventions for health promotion 
                and disease prevention among the elderly;
                    (D) whether or not as a result of the applied 
                research effort 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 cost-saving benefit for each 
                proposed addition;
                    (E) the utility of, potential for, and issues 
                surrounding health risk appraisals sponsored under the 
                medicare program and targeted followup; and
                    (F) how best to increase utilization of existing 
                and recommended health promotion and disease prevention 
                services, including an education and public awareness 
                component discussion of financial incentives for 
                providers of services and medicare beneficiaries to 
                improve utilization and other administrative means of 
                increasing utilization.
            (2) Annual report.--Not later than December 31, 2002, and 
        each year thereafter through 2005, the Secretary shall submit a 
        report to Congress based on the annual studies made under 
        paragraph (1), which shall contain a detailed statement of the 
        findings and conclusions of the Working Group together with its 
        recommendations for such legislation and administrative actions 
        as it considers appropriate.
    (i) Authorization of Appropriations.--There are authorized to be 
appropriated $40,000,000 for each of the fiscal years 2000, 2001, 2002, 
and 2003 to carry out the provisions of this section.

SEC. 102. SENSE OF CONGRESS REGARDING THE RESPONSE OF HCFA TO 
              PREVENTIVE HEALTH ISSUES.

    It is the sense of Congress that in administering the medicare 
program the Secretary should ensure that the Administrator of the 
Health Care Financing Administration encourages the inclusion of 
preventive measures as part of all treatments described in such 
program.

SEC. 103. SENSE OF CONGRESS REGARDING THE EFFORTS OF HCFA TO STUDY 
              HEALTH PROMOTION AND DISEASE PREVENTION FOR MEDICARE 
              BENEFICIARIES.

    It is the sense of Congress that the Secretary should ensure that 
the Administrator of the Health Care Financing Administration expands 
the study of the most promising behavioral modification of risk factors 
associated with health promotion and disease prevention for all 
medicare beneficiaries.

SEC. 104. SENSE OF CONGRESS REGARDING THE ESTABLISHMENT OF A MEDICARE 
              HEALTH PROMOTION AND DISEASE PREVENTION CLEARINGHOUSE.

    It is the sense of Congress that the National Library of Medicine 
should collect information regarding innovative and successful health 
promotion and disease prevention interventions from both published and 
unpublished sources, establish a clearinghouse targeting all medicare 
beneficiaries in a variety of settings for the consolidation and 
coordination of all such information, and make the clearinghouse 
available to the public and accessible through the Internet.

           TITLE II--MEDICARE COVERAGE OF PREVENTIVE SERVICES

SEC. 201. 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 (S), by striking ``and'' at the end;
            (2) in subparagraph (T), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(U) counseling for cessation of tobacco use (as defined 
        in subsection (uu)) for individuals who have a history of 
        tobacco use.''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended by adding at the end the following:

               ``Counseling for Cessation of Tobacco Use

    ``(uu)(1) Except as provided in paragraph (2), the term `counseling 
for cessation of tobacco use' means diagnostic, therapy, and counseling 
services for cessation of tobacco use which are furnished by or under 
the supervision of a physician or other health care professional 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, as would otherwise be covered if furnished 
by a physician or as an incident to a physician's professional service.
    ``(2) The term `counseling for cessation of tobacco use' does not 
include coverage for drugs or biologicals that are not otherwise 
covered under this title.''.
    (c) Elimination of Cost Sharing.--
            (1) Elimination of coinsurance.--Section 1833(a)(1) of such 
        Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (S)'' and inserting ``(S)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (T) with respect to 
                counseling for cessation of tobacco use (as defined in 
                section 1861(uu)), the amount paid shall be 100 percent 
                of the lesser of the actual charge for the services or 
                the amount determined by a fee schedule established by 
                the Secretary for the purposes of this subparagraph;''.
            (2) Elimination of deductible.--The first sentence of 
        section 1833(b) of such 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 counseling for cessation of tobacco use (as 
                defined in section 1861(uu))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 202. SCREENING FOR HYPERTENSION.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 201(a)) is amended--
            (1) in subparagraph (T), by striking ``and'' at the end;
            (2) in subparagraph (U), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(V) screening for hypertension (as defined in subsection 
        (vv)) not more frequently than once every 2 years for 
        individuals with normotensive blood pressure measurements and 
        annually for individuals with blood pressure measurements that 
        are not normotensive.''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 201(b)) is amended by adding at the end the 
following:

                      ``Screening for Hypertension

    ``(vv) The term `screening for hypertension' means diagnostic 
services for hypertension which are furnished by or under the 
supervision of a physician or other health care professional 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, as would otherwise be covered if furnished 
by a physician or as an incident to a physician's professional 
service.''.
    (c) Elimination of Cost Sharing.--
            (1) Elimination of coinsurance.--Section 1833(a)(1) of such 
        Act (42 U.S.C. 1395l(a)(1)) (as amended by section 201(c)(1)) 
        is amended--
                    (A) by striking ``and (T)'' and inserting ``(T)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (U) with respect to 
                screening for hypertension (as defined in section 
                1861(vv)), the amount paid shall be 100 percent of the 
                lesser of the actual charge for the services or the 
                amount determined by a fee schedule established by the 
                Secretary for the purposes of this subparagraph;''.
            (2) Elimination of deductible.--The first sentence of 
        section 1833(b) of such Act (42 U.S.C. 1395l(b)) (as amended by 
        section 201(c)(2)) is amended--
                    (A) by striking ``and'' before ``(7)''; and
                    (B) by inserting before the period the following: 
                ``, and (8) such deductible shall not apply with 
                respect to screening for hypertension (as defined in 
                section 1861(vv))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 203. COUNSELING FOR HORMONE REPLACEMENT THERAPY.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 202(a)) is amended--
            (1) in subparagraph (U), by striking ``and'' at the end;
            (2) in subparagraph (V), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(W) counseling for hormone replacement therapy (as 
        defined in subsection (ww)).''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 202(b)) is amended by adding at the end the 
following:

              ``Counseling for Hormone Replacement Therapy

    ``(ww)(1) Except as provided in paragraph (2), the term `counseling 
for hormone replacement therapy' means diagnostic, therapy, and 
counseling services for hormone replacement which are furnished by or 
under the supervision of a physician or other health care professional 
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, as would otherwise be covered if 
furnished by a physician or as an incident to a physician's 
professional service.
    ``(2) The term `counseling for hormone replacement therapy' does 
not include coverage for drugs or biologicals that are not otherwise 
covered under this title.''.
    (c) Elimination of Cost Sharing.--
            (1) Elimination of coinsurance.--Section 1833(a)(1) of such 
        Act (42 U.S.C. 1395l(a)(1)) (as amended by section 202(c)(1)) 
        is amended--
                    (A) by striking ``and (U)'' and inserting ``(U)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (V) with respect to 
                counseling for hormone replacement therapy (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 by a fee schedule 
                established by the Secretary for the purposes of this 
                subparagraph;''.
            (2) Elimination of deductible.--The first sentence of 
        section 1833(b) of such Act (42 U.S.C. 1395l(b)) (as amended by 
        section 202(c)(2)) is amended--
                    (A) by striking ``and'' before ``(8)''; and
                    (B) by inserting before the period the following: 
                ``, and (9) such deductible shall not apply with 
                respect to counseling for hormone replacement therapy 
                (as defined in section 1861(ww))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 204. SCREENING FOR GLAUCOMA.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 203(a)) is amended--
            (1) in subparagraph (V), by striking ``and'' at the end;
            (2) in subparagraph (W), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(X) screening for glaucoma (as defined in subsection 
        (xx)) for individuals determined to be at high risk for 
        glaucoma, individuals with a family history of glaucoma, and 
        individuals with diabetes or myopia.''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 203(b)) is amended by adding at the end the 
following:

                        ``Screening for Glaucoma

    ``(xx) The term `screening for glaucoma' means a dilated eye 
examination with an intraocular pressure measurement, and a direct 
ophthalmoscopy or a slit-lamp biomicroscopic examination for the early 
detection of glaucoma which 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, as would otherwise be covered if furnished by a physician or 
as an incident to a physician's professional service.''.
    (c) Elimination of Cost Sharing.--
            (1) Elimination of coinsurance.--Section 1833(a)(1) of such 
        Act (42 U.S.C. 1395l(a)(1)) (as amended by section 203(c)(1)) 
        is amended--
                    (A) by striking ``and (V)'' and inserting ``(V)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (W) with respect to 
                screening for glaucoma (as defined in section 
                1861(xx)), the amount paid shall be 100 percent of the 
                lesser of the actual charge for the services or amount 
                determined by a fee schedule established by the 
                Secretary for the purposes of this subparagraph;''.
            (2) Elimination of deductible.--The first sentence of 
        section 1833(b) of such Act (42 U.S.C. 1395l(b)) (as amended by 
        section 203(c)(2)) is amended--
                    (A) by striking ``and'' before ``(9)''; and
                    (B) by inserting before the period the following: 
                ``, and (10) such deductible shall not apply with 
                respect to screening for glaucoma (as defined in 
                section 1861(xx))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 205. SCREENING FOR DIMINISHED VISUAL ACUITY.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 204(a)) is amended--
            (1) in subparagraph (W), by striking ``and'' at the end;
            (2) in subparagraph (X), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(Y) screening for diminished visual acuity (as defined in 
        subsection (yy)).''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 204(b)) is amended by adding at the end the 
following:

                ``Screening for Diminished Visual Acuity

    ``(yy) The term `screening for diminished visual acuity' means 
diagnostic services for screening for diminished visual acuity which 
are 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, as 
would otherwise be covered if furnished by a physician or as an 
incident to a physician's professional service.''.
    (c) Elimination of Cost Sharing.--
            (1) Elimination of coinsurance.--Section 1833(a)(1) of such 
        Act (42 U.S.C. 1395l(a)(1)) (as amended by section 204(c)(1)) 
        is amended--
                    (A) by striking ``and (W)'' and inserting ``(W)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (X) with respect to 
                screening for diminished visual acuity (as defined in 
                section 1861(yy)), the amount paid shall be 100 percent 
                of the lesser of the actual charge for the services or 
                the amount determined by a fee schedule established by 
                the Secretary for the purposes of this subparagraph;''.
            (2) Elimination of deductible.--The first sentence of 
        section 1833(b) of such Act (42 U.S.C. 1395l(b)) (as amended by 
        section 204(c)(2)) is amended--
                    (A) by striking ``and'' before ``(10)''; and
                    (B) by inserting before the period the following: 
                ``, and (11) such deductible shall not apply with 
                respect to screening for diminished visual acuity (as 
                defined in section 1861(yy))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 206. SCREENING FOR HEARING IMPAIRMENT.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 205(a)) is amended--
            (1) in subparagraph (X), by striking ``and'' at the end;
            (2) in subparagraph (Y), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(Z) screening for hearing impairment (as defined in 
        subsection (zz)).''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 205(b)) is amended by adding at the end the 
following:

                   ``Screening for Hearing Impairment

    ``(zz) The term `screening for hearing impairment' means diagnostic 
services for hearing impairment by use of periodic questions, otoscopic 
examination and audio metric testing if such questions indicate 
potential hearing impairment, and counseling about hearing aid devices 
which are furnished by or under the supervision of a physician or other 
health care professional 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, as would 
otherwise be covered if furnished by a physician or as an incident to a 
physician's professional service.''.
    (c) Elimination of Cost Sharing.--
            (1) Elimination of coinsurance.--Section 1833(a)(1) of such 
        Act (42 U.S.C. 1395l(a)(1)) (as amended by section 205(c)(1)) 
        is amended--
                    (A) by striking ``and (X)'' and inserting ``(X)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (Y) with respect to 
                screening for hearing impairment (as defined in section 
                1861(zz)), the amount paid shall be 100 percent of the 
                lesser of the actual charge for the services or the 
                amount determined by a fee schedule established by the 
                Secretary for the purposes of this subparagraph;''.
            (2) Elimination of deductible.--The first sentence of 
        section 1833(b) of such Act (42 U.S.C. 1395l(b)) (as amended by 
        section 205(c)(2)) is amended--
                    (A) by striking ``and'' before ``(11)''; and
                    (B) by inserting before the period the following: 
                ``, and (12) such deductible shall not apply with 
                respect to screening for hearing impairment (as defined 
                in section 1861(zz))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 207. SCREENING AND COUNSELING FOR OSTEOPOROSIS.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 206(a)) is amended--
            (1) in subparagraph (Y), by striking ``and'' at the end;
            (2) in subparagraph (Z), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(AA) screening and counseling for osteoporosis (as 
        defined in subsection (aaa)) for--
                    ``(i) women; and
                    ``(ii) men with fractures.''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 206(b)) is amended by adding at the end the 
following:

              ``Screening and counseling for Osteoporosis

    ``(aaa) The term `screening and counseling for osteoporosis' means 
diagnostic and counseling services for osteoporosis in addition to a 
bone mass measurement (as defined in subsection (rr)) which are 
furnished in accordance with methods approved by the Food and Drug 
Administration by or under the supervision of a physician or other 
health care professional 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, as would 
otherwise be covered if furnished by a physician or as an incident to a 
physician's professional service.''.
    (c) Elimination of Cost Sharing.--
            (1) Elimination of coinsurance.--Section 1833(a)(1) of such 
        Act (42 U.S.C. 1395l(a)(1)) (as amended by section 206(c)(1)) 
        is amended--
                    (A) by striking ``and (Y)'' and inserting ``(Y)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (Z) with respect to 
                screening and counseling for osteoporosis (as defined 
                in section 1861(aaa)), the amount paid shall be 100 
                percent of the lesser of the actual charge for the 
                services or the amount determined by a fee schedule 
established by the Secretary for the purposes of this subparagraph;''.
            (2) Elimination of deductible.--The first sentence of 
        section 1833(b) of such Act (42 U.S.C. 1395l(b)) (as amended by 
        section 206(c)(2)) is amended--
                    (A) by striking ``and'' before ``(12)''; and
                    (B) by inserting before the period the following: 
                ``, and (13) such deductible shall not apply with 
                respect to screening and counseling for osteoporosis 
                (as defined in section 1861(aaa))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 208. SCREENING FOR CHOLESTEROL.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 207(a)) is amended--
            (1) in subparagraph (Z), by striking ``and'' at the end;
            (2) in subparagraph (AA), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(BB) screening for cholesterol (as defined in subsection 
        (bbb)) for individuals between the ages of 65 and 75 that 
        exhibit major risk factors for coronary heart disease, 
        including smoking, hypertension, and diabetes.''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 207(b)) is amended by adding at the end the 
following:

                      ``Screening for Cholesterol

    ``(bbb) The term `screening for cholesterol' means diagnostic 
services for cholesterol that are furnished by or under the supervision 
of a physician or other health care professional 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, as would otherwise be covered if furnished by a 
physician or as an incident to a physician's professional service.''.
    (c) Elimination of Cost Sharing.--
            (1) Elimination of coinsurance.--Section 1833(a)(1) of such 
        Act (42 U.S.C. 1395l(a)(1)) (as amended by section 207(c)(1)) 
        is amended--
                    (A) by striking ``and (Z)'' and inserting ``(Z)''; 
                and
                    (B) by striking the semicolon at the end and 
                inserting the following: ``, and (AA) with respect to 
                screening for cholesterol (as defined in section 
                1861(bbb)), the amount paid shall be 100 percent of the 
                lesser of the actual charge for the services or the 
                amount determined by a fee schedule established by the 
                Secretary for the purposes of this subparagraph;''.
            (2) Elimination of deductible.--The first sentence of 
        section 1833(b) of such Act (42 U.S.C. 1395l(b)) (as amended by 
        section 207(c)(2)) is amended--
                    (A) by striking ``and'' before ``(13)''; and
                    (B) by inserting before the period the following: 
                ``, and (14) such deductible shall not apply with 
                respect to screening and counseling for osteoporosis 
                (as defined in section 1861(bbb))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 209. ELIMINATION OF COST SHARING FOR CURRENT PREVENTIVE BENEFITS.

    (a) Waiver of Coinsurance and Deductibles.--
            (1) In general.--Section 1834 of the Social Security Act 
        (42 U.S.C. 1395m) is amended by adding at the end the 
        following:
    ``(m) Waiver of Coinsurance and Deductible for Preventive 
Services.--
            ``(1) Coinsurance.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this part--
                            ``(i) the Secretary shall waive any 
                        coinsurance applicable to services described in 
                        subparagraph (B); and
                            ``(ii) with respect to payment for such 
                        services, any reference to a percent that is 
                        less than 100 percent shall be deemed to be a 
                        reference to 100 percent.
                    ``(B) Services described.--The services described 
                in this subparagraph are the following services:
                            ``(i) Screening mammography (as defined in 
                        section 1861(jj)).
                            ``(ii) Screening pelvic exam (as defined in 
                        section 1861(nn)(2)).
                            ``(iii) Hepatitis B vaccine and its 
                        administration (under section 1861(s)(10)(B)).
                            ``(iv) Colorectal cancer screening test (as 
                        defined in section 1861(pp)).
                            ``(v) Bone mass measurement (as defined in 
                        section 1861(rr)).
                            ``(vi) Prostate cancer screening test (as 
                        defined in section 1861(oo)).
                            ``(vii) Diabetes outpatient self-management 
                        training services (as defined in section 
                        1861(qq)).
            ``(2) Deductible.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this part, the deductible described in 
                section 1833(b) shall not apply with respect to 
                services described in subparagraph (B).
                    ``(B) Services described.--The services described 
                in this subparagraph are the following services:
                            ``(i) Hepatitis B vaccine and its 
                        administration (under section 1861(s)(10)(B)).
                            ``(ii) Colorectal cancer screening test (as 
                        defined in section 1861(pp)).
                            ``(iii) Bone mass measurement (as defined 
                        in section 1861(rr)).
                            ``(iv) Prostate cancer screening test (as 
                        defined in section 1861(oo)).
                            ``(v) Diabetes outpatient self-management 
                        training services (as defined in section 
                        1861(qq)).''.
            (2) Conforming amendment.--Section 1833(a) of the Social 
        Security Act (42 U.S.C. 1395l(a)) is amended by striking 
        ``section 1876'' and inserting ``sections 1834 and 1876'' in 
        the matter preceding paragraph (1).
    (b) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 210. NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN.

    The Secretary, in consultation with the Director of the Centers for 
Disease Control and Prevention, shall conduct a national falls 
prevention and awareness campaign to reduce fall-related injuries among 
medicare beneficiaries.

SEC. 211. PROGRAM INTEGRITY.

    The Secretary, in consultation with the Inspector General of the 
Department of Health and Human Services, shall integrate the benefits 
described in sections 201 through 208 with existing program integrity 
measures.

    TITLE III--MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM

SEC. 301. MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM.

    (a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by adding at the end the following:

         ``medicare health education and risk appraisal program

    ``Sec. 1897. (a) Establishment.--The Secretary, in consultation 
with the Director of the Centers for Disease Control and Prevention, 
the Administrator of the Agency for Health Care Policy and Research, 
and the Administrator of the Health Care Financing Administration, 
shall establish a health education and risk appraisal program to inform 
the target individuals described in subsection (b) of the major 
behavioral risk factors described in subsection (c) through the self-
assessment described in subsection (d) and shall conduct the periodic 
followup described in subsection (e).
    ``(b) Target Individuals.--The target individuals described in this 
subsection are the following:
            ``(1) Medicare beneficiaries.--Individuals that are 
        beneficiaries under this title.
            ``(2) Individuals between the ages of 50 and 64.--
        Individuals between the ages of 50 and 64.
    ``(c) Major Behavioral Risk Factors.--The major behavioral risk 
factors described in this subsection include--
            ``(1) the lack of proper nutrition;
            ``(2) the use of alcohol;
            ``(3) the lack of regular exercise;
            ``(4) the use of tobacco;
            ``(5) depression; and
            ``(6) other risk factors identified by the Secretary.
    ``(d) Self-Assessment.--
            ``(1) In general.--The self-assessment described in this 
        subsection is a form delivered by the Secretary to each target 
        individual that--
                    ``(A) includes questions regarding major behavioral 
                risk factors;
                    ``(B) requests that such individual answer the 
                questions and return the form to the Secretary; and
                    ``(C) is then assessed using--
                            ``(i) knowledge coupling computer software 
                        that assesses overall health risks and then 
                        provides options for management of identified 
                        risk factors;
                            ``(ii) nurse hotlines; and
                            ``(iii) case managers as the Secretary 
                        determines appropriate.
            ``(2) Individuals between the ages of 50 and 64.--With 
        respect to the target individuals described in subsection 
        (b)(2), the Secretary shall coordinate the delivery of the 
        self-assessment form with the issuance of the statement 
        described in section 1143(c)(2).
    ``(e) Periodic Followup.--
            ``(1) Medicare beneficiaries.--Not less frequently than 
        once every 2 years, the Secretary shall conduct periodic 
        followup appraisals with respect to the target individuals 
        described in subsection (b)(1) to reduce major behavioral risk 
        factors described in subsection (c)--
                    ``(A) by providing such individuals with--
                            ``(i) information regarding the results of 
                        the self-administered risk appraisal;
                            ``(ii) recommendations regarding behavior 
                        modifications based on such appraisal; and
                            ``(iii) information regarding any need for 
                        further assessment or treatment; and
                    ``(B) by providing the information described in 
                subparagraph (A) to the provider designated by such 
                individual to receive such information.
            ``(2) Individuals between the ages of 50 and 64.--The 
        Secretary shall conduct such periodic followup appraisals with 
        respect to the target individuals described in subsection 
        (b)(2) as the Secretary determines appropriate.''.

        TITLE IV--DISEASE SELF-MANAGEMENT DEMONSTRATION PROJECTS

SEC. 401. DISEASE SELF-MANAGEMENT DEMONSTRATION PROJECTS.

    (a) Demonstration Projects.--
            (1) In general.--The Secretary, acting through the 
        Administrator of the Health Care Financing Administration, 
        shall conduct demonstration projects for the purpose of 
        promoting disease self-management for conditions identified by 
        the working group established under paragraph (2) for target 
        individuals (as defined in paragraph (3)).
            (2) Disease self-management working group.--
                    (A) Establishment.--There is established within the 
                Department of Health and Human Services a Disease Self-
                Management Working Group.
                    (B) Composition.--The Disease Self-Management 
                Working Group established under subparagraph (A) shall 
                be composed of 4 members as follows:
                            (i) The Administrator of the Health Care 
                        Financing Administration.
                            (ii) The Director of the Centers for 
                        Disease Control and Prevention.
                            (iii) The Administrator of the Agency for 
                        Health Care Policy and Research.
                            (iv) The Director of the Administration on 
                        Aging.
                    (C) General policies and criteria.--The Disease 
                Self-Management Working Group established under 
                paragraph (1) shall establish general policies and 
                criteria with respect to the functions of the Secretary 
                under this section including--
                            (i) the identification of conditions for 
                        which a demonstration project may be 
                        implemented;
                            (ii) the prioritization of the conditions 
                        identified under clause (i) based on potential 
                        of self-management of such condition to be 
                        medically effective and for such self-
                        management to be a cost-effective benefit or 
                        cost-saving benefit, as those terms are defined 
                        in section 3 of this Act;
                            (iii) the identification of target 
                        individuals;
                            (iv) the development of procedures for 
                        selecting areas in which a demonstration 
                        project may be implemented; and
                            (v) such other matters as are recommended 
                        by the Disease Self-Management Working Group 
                        and approved by the Secretary.
            (3) Target individual defined.--In this section, the term 
        ``target individual'' means an individual that is at risk for 
        or has a condition identified by the working group described 
        under paragraph (2) and is eligible for benefits under the 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, and 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.
            (2) Project areas.--The Secretary, acting through the 
        Administrator of the Health Care Financing Administration, 
        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 for a period of 3 years, beginning 
        on the date on which the Secretary implements the initial 
        demonstration project.
    (c) Reports to Congress.--
            (1) Annual reports.--
                    (A) In general.--Not later than 1 year after the 
                Secretary implements the initial demonstration project 
                under this section, and biannually thereafter, the 
                Secretary shall submit to Congress a report regarding 
                the demonstration projects conducted under this 
                section.
                    (B) Contents of report.--The report in subparagraph 
                (A) shall include the following:
                            (i) A description of the demonstration 
                        projects conducted under this section.
                            (ii) An evaluation of--
                                    (I) whether each benefit provided 
                                under the demonstration project 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 
                                project.
                            (iii) Any other information regarding the 
                        demonstration projects conducted under this 
                        section that the Secretary determines to be 
                        appropriate.
            (2) Final report.--Not later than 1 year after the 
        conclusion of the demonstration projects under this section, 
        the Secretary shall submit a final report to Congress on the 
        demonstration projects conducted under this section containing 
        the recommendations of the Secretary regarding whether to 
        conduct the demonstration projects on a permanent basis, 
        together with such recommendations for legislation and 
        administrative action as the Secretary considers 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 the demonstration projects under this 
section, establishing the Disease Self-Management Working Group under 
subsection (a)(2), and submitting the reports to Congress under 
subsection (c).

 TITLE V--STUDIES AND REPORTS ADVANCING ORIGINAL RESEARCH IN THE FIELD 
                 OF DISEASE PREVENTION AND THE ELDERLY

SEC. 501. MEDPAC BIANNUAL REPORT.

    (a) In General.--Section 1805(b) of the Social Security Act (42 
U.S.C. 1395b-6(b)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (C), by striking ``and'' at the 
                end;
                    (B) in subparagraph (D), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
                    ``(E) by not later than January 1, 2001, and 
                biannually thereafter, submit the report to Congress 
                described in paragraph (7).''; and
            (2) by adding at the end the following:
            ``(7) Evaluation of actuarial equivalence of medicare and 
        private sector benefit packages.--
                    ``(A) Evaluation.--The Commission shall--
                            ``(i) evaluate the benefit package offered 
                        under the medicare program under this title; 
                        and
                            ``(ii) determine the degree to which such 
                        benefit package is actuarially equivalent to 
                        that offered by health benefit programs 
                        available in the private sector to individuals 
                        over age 65.
                    ``(B) Report.--The Commission shall submit a report 
                to Congress that shall contain--
                            ``(i) a detailed statement of the findings 
                        and conclusions of the Commission regarding the 
                        evaluation conducted under subparagraph (A);
                            ``(ii) the recommendations of the 
                        Commission regarding changes in the benefit 
                        package offered under the medicare program 
                        under this title that would keep the program 
                        modern and competitive in relation to health 
                        benefit programs available in the private 
                        sector; and
                            ``(iii) the recommendations of the 
                        Commission for such legislation and 
                        administrative actions as it considers 
                        appropriate.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 502. NATIONAL INSTITUTE ON AGING STUDY AND REPORT.

    (a) Studies.--The Director of the National Institute on Aging shall 
conduct 1 or more studies focusing on ways to--
            (1) improve quality of life for the elderly;
            (2) develop better ways to prevent or delay the onset of 
        age-related functional decline and disease and disability among 
        the elderly; and
            (3) develop means of assessing the long-term development of 
        cost-effective benefits and cost-savings benefits for health 
        promotion and disease prevention among the elderly.
    (b) Report.--Not later than January 1, 2005, the Director of the 
National Institute on Aging shall submit a report to the Secretary 
regarding each study conducted under subsection (a) and containing a 
detailed statement of research findings and conclusions that are 
scientifically valid and are demonstrated to prevent or delay the onset 
of chronic illness or disability among the elderly.
    (c) Transmission to Institute of Medicine.--Upon receipt of each 
report described in subsection (b), the Secretary shall transmit such 
report to the Institute of Medicine of the National Academy of Sciences 
for consideration in its effort to conduct the comprehensive study of 
current literature and best practices in the field of health promotion 
and disease prevention among the medicare beneficiaries described in 
section 503.
    (d) Authorization of Appropriations.--
            (1) In general.--There are authorized to be appropriated 
        $100,000,000 for fiscal years 2000 through 2005 to carry out 
        the purposes of this section.
            (2) Availability.--Any sums appropriated under the 
        authorization contained in this subsection shall remain 
        available, without fiscal year limitation, until September 30, 
        2004.

SEC. 503. INSTITUTE OF MEDICINE 5-YEAR MEDICARE PREVENTION BENEFIT 
              STUDY AND REPORT.

    (a) Study.--
            (1) In general.--The Secretary shall contract with the 
        Institute of Medicine of the National Academy of Sciences to 
        conduct a comprehensive study of current literature and best 
        practices in the field of health promotion and disease 
        prevention among medicare beneficiaries including the issues 
        described in paragraph (2) and to submit the report described 
        in subsection (b).
            (2) Issues studied.--The study required under paragraph (1) 
        shall include an assessment of--
                    (A) whether each covered benefit is--
                            (i) medically effective; and
                            (ii) a cost-effective benefit or a cost-
                        saving benefit;
                    (B) utilization of covered benefits (including any 
                barriers to or incentives to increase utilization); and
                    (C) quality of life issues associated with both 
                health promotion and disease prevention benefits 
                covered under the medicare program and those that are 
                not covered under such program that would affect all 
                medicare beneficiaries.
    (b) Report.--
            (1) In general.--Not later than 5 years after the date of 
        enactment of this section, and every fifth year thereafter, the 
        Institute of Medicine of the National Academy of Sciences shall 
        submit to the President a report that contains a detailed 
        statement of the findings and conclusions of the study 
        conducted under subsection (a) and the recommendations for 
        legislation described in paragraph (2).
            (2) Recommendations for legislation.--The Institute of 
        Medicine of the National Academy of Sciences, in consultation 
        with the Partnership for Prevention, shall develop 
        recommendations in legislative form that--
                    (A) prioritize the preventive benefits under the 
                medicare program; and
                    (B) modify preventive benefits offered under the 
                medicare program based on the study conducted under 
                subsection (a).
    (c) Transmission to Congress.--
            (1) In general.--On the day on which the report described 
        in subsection (b) is submitted to the President, the President 
        shall transmit the report and recommendations in legislative 
        form described in subsection (b)(2) to Congress.
            (2) Delivery.--Copies of the report and recommendations in 
        legislative form required to be transmitted to Congress under 
        paragraph (1) shall be delivered--
                    (A) to both Houses of Congress on the same day;
                    (B) to the Clerk of the House of Representatives if 
                the House is not in session; and
                    (C) to the Secretary of the Senate if the Senate is 
                not in session.

SEC. 504. FAST-TRACK CONSIDERATION OF PREVENTION BENEFIT LEGISLATION.

    (a) Rules of House of Representatives and Senate.--This section is 
enacted by Congress--
            (1) as an exercise of the rulemaking power of the House of 
        Representatives and the Senate, respectively, and is deemed a 
        part of the rules of each House of Congress, but--
                    (A) is applicable only with respect to the 
                procedure to be followed in that House of Congress in 
                the case of an implementing bill (as defined in 
                subsection (d)); and
                    (B) supersedes other rules only to the extent that 
                such rules are inconsistent with this section; and
            (2) with full recognition of the constitutional right of 
        either House of Congress to change the rules (so far as 
        relating to the procedure of that House of Congress) at any 
        time, in the same manner and to the same extent as in the case 
        of any other rule of that House of Congress.
    (b) Introduction and Referral.--
            (1) Introduction.--
                    (A) In general.--Subject to paragraph (2), on the 
                day on which the President transmits the report 
                pursuant to section 503(c) to the House of 
                Representatives and the Senate, the recommendations in 
                legislative form transmitted by the President with 
                respect to such report shall be introduced as a bill 
                (by request) in the following manner:
                            (i) House of representatives.--In the House 
                        of Representatives, by the Majority Leader, for 
                        himself and the Minority Leader, or by Members 
                        of the House of Representatives designated by 
                        the Majority Leader and Minority Leader.
                            (ii) Senate.--In the Senate, by the 
                        Majority Leader, for himself and the Minority 
                        Leader, or by Members of the Senate designated 
                        by the Majority Leader and Minority Leader.
                    (B) Special rule.--If either House of Congress is 
                not in session on the day on which such recommendations 
                in legislative form are transmitted, the 
                recommendations in legislative form shall be introduced 
                as a bill in that House of Congress, as provided in 
                subparagraph (A), on the first day thereafter on which 
                that House of Congress is in session.
            (2) Referral.--Such bills shall be referred by the 
        presiding officers of the respective Houses to the appropriate 
        committee, or, in the case of a bill containing provisions 
        within the jurisdiction of 2 or more committees, jointly to 
        such committees for consideration of those provisions within 
        their respective jurisdictions.
    (c) Consideration.--After the recommendations in legislative form 
have been introduced as a bill and referred under subsection (b), such 
implementing bill shall be considered in the same manner as an 
implementing bill is considered under subsections (d), (e), (f), and 
(g) of section 151 of the Trade Act of 1974 (19 U.S.C. 2191).
    (d) Implementing Bill Defined.--In this section, the term 
``implementing bill'' means only the recommendations in legislative 
form of the Institute of Medicine of the National Academy of Sciences 
described in section 503(b)(2), transmitted by the President to the 
House of Representatives and the Senate under subsection 503(c), and 
introduced and referred as provided in subsection (b) as a bill of 
either House of Congress.
    (e) Counting of Days.--For purposes of this section, any period of 
days referred to in section 151 of the Trade Act of 1974 shall be 
computed by excluding--
            (1) the days on which either House of Congress is not in 
        session because of an adjournment of more than 3 days to a day 
        certain or an adjournment of Congress sine die; and
            (2) any Saturday and Sunday, not excluded under paragraph 
        (1), when either House is not in session.
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