[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4898 Introduced in House (IH)]






108th CONGRESS
  2d Session
                                H. R. 4898

   To amend title XVIII of the Social Security Act to modernize the 
 Medicare Program by ensuring that appropriate preventive services are 
                      covered under such program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 22, 2004

 Mr. Brown of Ohio (for himself, Mr. Dingell, Mr. Waxman, Mr. Rangel, 
 Mr. Stark, Mr. Strickland, Mr. Engel, and Mr. Pallone) 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 modernize the 
 Medicare Program by ensuring that appropriate preventive services are 
                      covered under such program.

    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 Services 
Coverage Act of 2004''.

SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE SERVICES DETERMINED 
              APPROPRIATE BY THE SECRETARY.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 642(a) of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108-173; 117 Stat. 2322), is amended--
            (1) in subparagraph (Y), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (Z), by adding ``and'' after the 
        semicolon at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(AA) additional preventive services (as defined in 
        subsection (bbb)(1));''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x), as amended by section 706(b) of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108-173; 117 Stat. 2339), is amended by adding at the end the 
following new subsection:
    ``(bbb) Additional Preventive Services.--(1) The term `additional 
preventive services' means items and services, including mental health 
services, not otherwise covered under this title that the Secretary 
determines to be reasonable and necessary for the prevention or early 
detection of an illness or disability.
    ``(2) In making determinations under paragraph (1), the Secretary 
shall--
            ``(A) take into account evidence-based recommendations by 
        the United States Preventive Services Task Force and other 
        appropriate organizations; and
            ``(B) use the process for making national coverage 
        determinations (as defined in section 1869(f)(1)(B)) under this 
        title.''.
    (c) Payment and Elimination of Cost-sharing.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)), as amended by section 302(b)(2) of 
        the Medicare Prescription Drug, Improvement, and Modernization 
        Act of 2003 (Public Law 108-173; 117 Stat. 2229), is amended--
                    (A) by striking ``and'' before ``(V)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (W) with respect to additional 
                preventive services (as defined in section 
                1861(bbb)(1)), the amount paid shall be 100 percent of 
                the lesser of the actual charge for the services or the 
                amount determined under a fee schedule established by 
                the Secretary for purposes of this subparagraph''.
            (2) Elimination of coinsurance in outpatient hospital 
        settings.--
                    (A) Exclusion from opd fee schedule.--Section 
                1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 
                1395l(t)(1)(B)(iv)), as amended by section 614 of the 
                Medicare Prescription Drug, Improvement, and 
                Modernization Act of 2003 (Public Law 108-173; 117 
                Stat. 2306), is amended by striking ``and diagnostic 
                mammography'' and inserting ``, diagnostic mammography, 
                or additional preventive services (as defined in 
                section 1861(bbb)(1))''.
                    (B) Conforming amendments.--Section 1833(a)(2) of 
                the Social Security Act (42 U.S.C. 1395l(a)(2)) is 
                amended--
                            (i) in subparagraph (F), by striking 
                        ``and'' after the semicolon at the end;
                            (ii) in subparagraph (G)(ii), by striking 
                        the comma at the end and inserting ``; and''; 
                        and
                            (iii) by inserting after subparagraph 
                        (G)(ii) the following new subparagraph:
                    ``(H) with respect to additional preventive 
                services (as defined in section 1861(bbb)(1)) furnished 
                by an outpatient department of a hospital, the amount 
                determined under paragraph (1)(W),''.
            (3) Waiver of application of deductible.--The first 
        sentence of section 1833(b) of the Social Security 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 additional preventive services (as defined 
                in section 1861(bbb)(1))''.
    (d) Inclusion as Part of Initial Preventive Physical Examination.--
Section 1861(ww)(2) of the Social Security Act (42 U.S.C. 
1395x(ww)(2)), as added by section 611(b) of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173; 
117 Stat. 2303), is amended by adding at the end the following new 
subparagraph:
            ``(L) Additional preventive services (as defined in 
        subsection (bbb)(1)).''.
    (e) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the date of enactment of this 
Act.
                                 <all>