[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1095 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1095

 To amend title XVIII of the Social Security Act to improve outpatient 
         vision services under part B of the medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 21, 2003

   Mr. Sununu (for himself, Mr. Kerry, Mr. Stevens, Mr. McCain, Mrs. 
    Lincoln, Ms. Collins, Mr. Bunning, Mr. Miller, Mr. Specter, Mr. 
 Rockefeller, Ms. Cantwell, Mr. Kennedy, Ms. Landrieu, Mr. Burns, and 
  Mr. Allen) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to improve outpatient 
         vision services 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. SHORT TITLE.

    This Act may be cited as the ``Medicare Vision Rehabilitation 
Services Act of 2003''.

SEC. 2. IMPROVEMENT OF OUTPATIENT VISION SERVICES UNDER PART B.

    (a) Coverage Under Part B.--Section 1861(s)(2) of the Social 
Security Act (42 U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (U), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (V)(iii), by adding ``and'' after the 
        semicolon at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(W) vision rehabilitation services (as defined in 
        subsection (ww)(1));''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended by adding at the end the following new 
subsection:

  ``Vision Rehabilitation Services: Vision Rehabilitation Professional

    ``(ww)(1)(A) The term `vision rehabilitation services' means 
rehabilitative services (as determined by the Secretary in regulations) 
furnished--
            ``(i) to an individual diagnosed with a vision impairment 
        (as defined in paragraph (6));
            ``(ii) pursuant to a plan of care established by a 
        qualified physician (as defined in subparagraph (C)) or by a 
        qualified occupational therapist that is periodically reviewed 
        by a qualified physician;
            ``(iii) in an appropriate setting (including the home of 
        the individual receiving such services if specified in the plan 
        of care); and
            ``(iv) by any of the following individuals:
                    ``(I) A qualified physician.
                    ``(II) A qualified occupational therapist.
                    ``(III) A vision rehabilitation professional (as 
                defined in paragraph (2)) while under the general 
                supervision (as defined in subparagraph (D)) of a 
                qualified physician.
    ``(B) In the case of vision rehabilitation services furnished by a 
vision rehabilitation professional, the plan of care may only be 
established and reviewed by a qualified physician.
    ``(C) The term `qualified physician' means--
            ``(i) a physician (as defined in subsection (r)(1)) who is 
        an ophthalmologist; or
            ``(ii) a physician (as defined in subsection (r)(4) 
        (relating to a doctor of optometry)).
    ``(D) The term `general supervision' means, with respect to a 
vision rehabilitation professional, overall direction and control of 
that professional by the qualified physician who established the plan 
of care for the individual, but the presence of the qualified physician 
is not required during the furnishing of vision rehabilitation services 
by that professional to the individual.
    ``(2) The term `vision rehabilitation professional' means any of 
the following individuals:
            ``(A) An orientation and mobility specialist (as defined in 
        paragraph (3)).
            ``(B) A rehabilitation teacher (as defined in paragraph 
        (4)).
            ``(C) A low vision therapist (as defined in paragraph (5)).
    ``(3) The term `orientation and mobility specialist' means an 
individual who--
            ``(A) if a State requires licensure or certification of 
        orientation and mobility specialists, is licensed or certified 
        by that State as an orientation and mobility specialist;
            ``(B)(i) holds a baccalaureate or higher degree from an 
        accredited college or university in the United States (or an 
        equivalent foreign degree) with a concentration in orientation 
        and mobility; and
            ``(ii) has successfully completed 350 hours of clinical 
        practicum under the supervision of an orientation and mobility 
        specialist and has furnished not less than 9 months of 
        supervised full-time orientation and mobility services;
            ``(C) has successfully completed the national examination 
        in orientation and mobility administered by the Academy for 
        Certification of Vision Rehabilitation and Education 
        Professionals; and
            ``(D) meets such other criteria as the Secretary 
        establishes.
    ``(4) The term `rehabilitation teacher' means an individual who--
            ``(A) if a State requires licensure or certification of 
        rehabilitation teachers, is licensed or certified by the State 
        as a rehabilitation teacher;
            ``(B)(i) holds a baccalaureate or higher degree from an 
        accredited college or university in the United States (or an 
        equivalent foreign degree) with a concentration in 
rehabilitation teaching, or holds such a degree in a health field; and
            ``(ii) has successfully completed 350 hours of clinical 
        practicum under the supervision of a rehabilitation teacher and 
        has furnished not less than 9 months of supervised full-time 
        rehabilitation teaching services;
            ``(C) has successfully completed the national examination 
        in rehabilitation teaching administered by the Academy for 
        Certification of Vision Rehabilitation and Education 
        Professionals; and
            ``(D) meets such other criteria as the Secretary 
        establishes.
    ``(5) The term `low vision therapist' means an individual who--
            ``(A) if a State requires licensure or certification of low 
        vision therapists, is licensed or certified by the State as a 
        low vision therapist;
            ``(B)(i) holds a baccalaureate or higher degree from an 
        accredited college or university in the United States (or an 
        equivalent foreign degree) with a concentration in low vision 
        therapy, or holds such a degree in a health field; and
            ``(ii) has successfully completed 350 hours of clinical 
        practicum under the supervision of a physician, and has 
        furnished not less than 9 months of supervised full-time low 
        vision therapy services;
            ``(C) has successfully completed the national examination 
        in low vision therapy administered by the Academy for 
        Certification of Vision Rehabilitation and Education 
        Professionals; and
            ``(D) meets such other criteria as the Secretary 
        establishes.
    ``(6) The term `vision impairment' means vision loss that 
constitutes a significant limitation of visual capability resulting 
from disease, trauma, or a congenital or degenerative condition that 
cannot be corrected by conventional means, including refractive 
correction, medication, or surgery, and that is manifested by 1 or more 
of the following:
            ``(A) Best corrected visual acuity of less than 20/60, or 
        significant central field defect.
            ``(B) Significant peripheral field defect including 
        homonymous or heteronymous bilateral visual field defect or 
        generalized contraction or constriction of field.
            ``(C) Reduced peak contrast sensitivity in conjunction with 
        a condition described in subparagraph (A) or (B).
            ``(D) Such other diagnoses, indications, or other 
        manifestations as the Secretary may determine to be 
        appropriate.''.
    (c) Payment Under Part B.--
            (1) Physician fee schedule.--Section 1848(j)(3) of the 
        Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by 
        inserting ``(2)(W),'' after ``(2)(S),''.
            (2) Carve out from hospital outpatient department 
        prospective payment system.--Section 1833(t)(1)(B)(iv) of the 
        Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended 
        by inserting ``vision rehabilitation services (as defined in 
        section 1861(ww)(1)) or'' after ``does not include''.
             (3) Clarification of billing requirements.--The first 
        sentence of section 1842(b)(6) of such Act (42 U.S.C. 
        1395u(b)(6)) is amended--
                    (A) by striking ``and'' before ``(G)''; and
                    (B) by inserting before the period the following: 
                ``, and (H) in the case of vision rehabilitation 
                services (as defined in section 1861(ww)(1)) furnished 
                by a vision rehabilitation professional (as defined in 
                section 1861(ww)(2)) while under the general 
                supervision (as defined in section 1861(ww)(1)(D)) of a 
                qualified physician (as defined in section 
                1861(ww)(1)(C)), payment shall be made to (i) the 
                qualified physician or (ii) the facility (such as a 
                rehabilitation agency, a clinic, or other facility) 
                through which such services are furnished under the 
                plan of care if there is a contractual arrangement 
                between the vision rehabilitation professional and the 
                facility under which the facility submits the bill for 
                such services''.
    (d) Plan of Care.--Section 1835(a)(2) of the Social Security Act 
(42 U.S.C. 1395n(a)(2)) is amended--
            (1) in subparagraph (E), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (F), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after subparagraph (F) the following new 
        subparagraph:
                    ``(G) in the case of vision rehabilitation 
                services, (i) such services are or were required 
                because the individual needed vision rehabilitation 
                services, (ii) an individualized, written plan for 
                furnishing such services has been established (I) by a 
                qualified physician (as defined in section 
                1861(ww)(1)(C)), (II) by a qualified occupational 
                therapist, or (III) in the case of such services 
                furnished by a vision rehabilitation professional, by a 
                qualified physician, (iii) the plan is periodically 
                reviewed by the qualified physician, and (iv) such 
                services are or were furnished while the individual is 
                or was under the care of the qualified physician.''.
    (e) Relationship to Rehabilitation Act of 1973.--The provision of 
vision rehabilitation services under the medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) shall not be 
taken into account for any purpose under the Rehabilitation Act of 1973 
(29 U.S.C. 701 et seq.).
    (f) Effective Date.--
            (1) Interim, final regulations.--The Secretary of Health 
        and Human Services shall publish a rule under this section in 
        the Federal Register by not later than 180 days after the date 
        of enactment of this Act to carry out the provisions of this 
        section. Such rule shall be effective and final immediately on 
        an interim basis, but is subject to change and revision after 
        public notice and opportunity for a period (of not less than 60 
        days) for public comment.
            (2) Consultation.--The Secretary of Health and Human 
        Services shall consult with the National Vision Rehabilitation 
        Cooperative, the Association for Education and Rehabilitation 
        of the Blind and Visually Impaired, the Academy for 
        Certification of Vision Rehabilitation and Education 
        Professionals, the American Academy of Ophthalmology, the 
        American Occupational Therapy Association, the American 
        Optometric Association, and such other qualified professional 
        and consumer organizations as the Secretary determines 
        appropriate in promulgating regulations to carry out this Act.
                                 <all>