[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2671 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 2671

To provide for the expansion of Federal programs to prevent and manage 
                  vision loss, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 26, 2005

 Mr. Gene Green of Texas (for himself, Ms. Ros-Lehtinen, Mr. Price of 
 North Carolina, and Mr. Tiberi) 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 provide for the expansion of Federal programs to prevent and manage 
                  vision loss, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Vision Preservation Act of 2005''.

SEC. 2. FINDINGS.

     The Congress finds as follows:
            (1) An estimated 80 million Americans have a potentially 
        blinding eye disease. Three million Americans have low vision, 
        1.1 million Americans are legally blind, and 200,000 Americans 
        are more severely visually impaired. Visual impairment is one 
        of the 10 more frequent causes of disability in the United 
        States.
            (2) While it is believed that half of all blindness can be 
        prevented, the number of Americans who are blind or visually 
        impaired is expected to double by 2030.
            (3) Vision is critical to conducting activities of daily 
        living and affects developmental learning, communicating, 
        working, health, and quality of life.
            (4) Vision problems affect 1 in 20 preschoolers and, if 
        untreated, can affect learning ability, personality, and 
        adjustment in school.
            (5) It is estimated that blindness and visual impairment 
        cost the Federal Government more than $4 billion annually in 
        benefits and lost taxable income.
            (6) The four leading eye diseases affecting older Americans 
        are age-related macular degeneration, cataract, diabetic 
        retinopathy, and glaucoma.
            (7) Age-related macular degeneration is the most common 
        cause of low vision and legal blindness in older Americans. 
        More than 1.6 million Americans age 50 and older live with late 
        stage age-related macular degeneration. It is recommended that 
        individuals age 60 or older have their eyes examined at least 
        once a year to detect age-related macular degeneration.
            (8) The Federal Government spends more than $3.4 billion 
        each year treating cataract through the Medicare program. 
        Cataract affects nearly 20.5 million Americans age 40 and over. 
        By age 80, more than half of all Americans have cataract.
            (9) Diabetic retinopathy affects over 5.3 million Americans 
        age 18 or older and can affect anyone with diabetes. The 
        Centers for Disease Control and Prevention estimate that 10.3 
        million Americans have diagnosed diabetes, while an additional 
        5.4 million have undiagnosed diabetes. Because the number of 
        Americans with diabetes is expected to grow significantly as 
        the number of older Americans continues to increase, more 
        people will be at risk for diabetic retinopathy.
            (10) Glaucoma affects more than 2.2 million Americans age 
        40 and older. Glaucoma cannot be prevented, but most cases can 
        be controlled and vision loss slowed or halted with treatment. 
        Glaucoma disproportionately affects minorities, affecting more 
        than 10 percent of Black men and Hispanic women age 80 or 
        older.
            (11) Vision rehabilitation helps people with a serious 
        vision loss learn to safely navigate within their home 
        environs, avoid medication errors, cook and use kitchen 
        implements safely, and avoid burns, falls, and other injuries. 
        Vision rehabilitation promotes safety and independence for the 
        vision-impaired elderly, and prevents injuries and further 
        disabilities.
            (12) Recognizing that the Nation requires a public health 
        approach to visual impairment, the Department of Health and 
        Human Services dedicated a portion of its Healthy People 2010 
        initiative to vision. The initiative set out as a goal the 
        improvement of the Nation's visual health through prevention, 
        early detection, treatment, and rehabilitation.
            (13) Greater efforts must be made at the Federal, State, 
        and local levels to increase awareness of vision problems, 
        their impact, the importance of early diagnosis, treatment, and 
        rehabilitation, and effective prevention strategies. It is the 
        sense of the Congress that the Nation must have a full-scale 
        public health effort on vision problems that includes the 
        following:
                    (A) Communication and education.
                    (B) Surveillance, epidemiology, and prevention 
                research.
                    (C) Programs, policies, and systems change.

                   TITLE I--PUBLIC HEALTH PROVISIONS

SEC. 101. VISION LOSS PREVENTION.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 317S the following:

``SEC. 317T. PREVENTIVE HEALTH MEASURES WITH RESPECT TO VISION LOSS.

    ``(a) Communication and Education.--
            ``(1) In general.--The Secretary, acting through the 
        Centers for Disease Control and Prevention, the Health 
        Resources and Services Administration, and the National 
        Institutes of Health, shall expand and intensify programs to 
        increase awareness of vision problems, including awareness of--
                    ``(A) the impact of vision problems; and
                    ``(B) the importance of early diagnosis, 
                management, and effective prevention and rehabilitation 
                strategies.
            ``(2) Activities.--In carrying out this subsection, the 
        Secretary may--
                    ``(A) conduct public service announcements and 
                education campaigns;
                    ``(B) enter into partnerships with eye-health 
                professional organizations and other vision-related 
                organizations;
                    ``(C) conduct community disease prevention 
                campaigns; and
                    ``(D) conduct testing, evaluation, and model 
                training for vision screeners based on scientific 
                studies.
            ``(3) Evaluation.--In carrying out this subsection, the 
        Secretary shall--
                    ``(A) establish appropriate measurements for public 
                awareness of vision problems;
                    ``(B) establish appropriate measurements to 
                determine the effectiveness of existing campaigns to 
                increase awareness of vision problems;
                    ``(C) establish quantitative benchmarks for 
                determining the effectiveness of activities carried out 
                under this subsection; and
                    ``(D) not later than 12 months after the date of 
                the enactment of this section, submit a report to the 
                Congress on the results achieved through such 
                activities.
    ``(b) Surveillance, Epidemiology, and Health Services Research.--
            ``(1) In general.--The Secretary shall expand and intensify 
        activities to establish a solid scientific base of knowledge on 
        the prevention and control of vision problems and related 
        disabilities.
            ``(2) Activities.--In carrying out this subsection, the 
        Secretary may--
                    ``(A) create a national ongoing surveillance 
                system;
                    ``(B) identify and test screening modalities;
                    ``(C) evaluate the efficacy and cost-effectiveness 
                of current and future interventions and community 
                strategies;
                    ``(D) update and improve knowledge about the true 
                costs of vision problems and related disabilities; and
                    ``(E) require the Surgeon General to assess the 
                state of vision care and vision rehabilitation in the 
                United States.
    ``(c) Programs, Policies, and Systems.--
            ``(1) In general.--The Secretary shall expand and intensify 
        research within the Centers for Disease Control and Prevention 
        on the prevention and management of vision loss.
            ``(2) Activities.--In carrying out this subsection, the 
        Secretary may--
                    ``(A) build partnerships with voluntary health 
                organizations, nonprofit vision rehabilitation 
                agencies, Federal, State, and local public health 
                agencies, eye health professional organizations, and 
                organizations with an interest in vision issues;
                    ``(B) work with health care systems to better 
                address vision problems and associated disabilities; 
                and
                    ``(C) award grants for community outreach regarding 
                vision loss to national vision organizations with broad 
                community presence.''.

SEC. 102. EXPANSION OF VISION PROGRAMS UNDER THE MATERNAL AND CHILD 
              HEALTH SERVICE BLOCK GRANT PROGRAM.

    Section 501(a)(3) of the Social Security Act (42 U.S.C. 701(a)(3)) 
is amended--
            (1) by striking ``and'' at the end of subparagraph (E);
            (2) by striking the period at the end of subparagraph (F) 
        and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(G) introduce core performance measures on eye 
                health by incorporating vision screening standards into 
                State programs under this title, based on scientific 
                studies.''.

SEC. 103. PREVENTION AND TREATMENT FOR UNDERSERVED, MINORITY, AND OTHER 
              POPULATIONS.

    (a) Expansion and Intensification of Vision Programs.--The 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') shall expand and intensify programs targeted to 
prevent vision loss, treat eye and vision conditions, and rehabilitate 
people of all ages who are blind or partially sighted in underserved 
and minority communities, including the following:
            (1) Vision care services at community health centers 
        receiving assistance under section 330 of the Public Health 
        Service Act (42 U.S.C. 254b).
            (2) Vision rehabilitation programs at vision rehabilitation 
        agencies, eye clinics, and hospitals.
    (b) Voluntary Guidelines for Vision Screening.--The Secretary, in 
consultation with eye-health professional organizations and other 
vision-related organizations, shall develop voluntary guidelines to 
ensure the quality of vision screening.

SEC. 104. NATIONAL INSTITUTES OF HEALTH.

    (a) In General.--The Director of the National Institutes of Health 
(in this section referred to as the ``Director'') shall expand, 
intensify, and coordinate programs for the conduct and support of 
research with respect to vision loss prevention and vision 
rehabilitation.
    (b) Coordination.--The Director shall coordinate vision-related 
activities in consultation with Federal officials, voluntary health 
organizations, medical professional societies, and private entities as 
appropriate.
    (c) Research.--In carrying out this section, the Director shall 
expand the following research activities:
            (1) translational research within the National Eye 
        Institute;
            (2) diabetes and glaucoma related programs of the National 
        Eye Institute;
            (3) creation of an age-related macular degeneration public 
        education program within the National Eye Institute to--
                    (A) increase awareness of age-related macular 
                degeneration in selected high-risk target audiences in 
                the United States;
                    (B) increase awareness of the importance of early 
                detection of age-related macular degeneration in 
                preventing vision loss;
                    (C) increase health care providers' awareness of 
                the need for regular comprehensive dilated eye 
                examinations for those at risk for age-related macular 
                degeneration and other eye diseases, with the ultimate 
                goal of early detection of eye disease and the linkage 
                of patients to appropriate medical treatment and 
                rehabilitation services; and
                    (D) encourage at-risk populations to take 
                appropriate action based on their increased awareness.

                     TITLE II--MEDICARE PROVISIONS

SEC. 201. 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 (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) vision rehabilitation services (as defined in 
        subsection (bbb)(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

    ``(bbb)(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) An 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)(AA),'' after ``(2)(W),''.
            (2) Carve out from hospital outpatient department 
        prospective payment system.--Section 1833(t)(1)(B)(iv) of such 
        Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended by inserting 
        ``vision rehabilitation services (as defined in section 
        1861(bbb)(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(bbb)(1)) furnished 
                by a vision rehabilitation professional (as defined in 
                section 1861(bbb)(2)) while under the general 
                supervision (as defined in section 1861(bbb)(1)(D)) of 
                a qualified physician (as defined in section 
                1861(bbb)(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(bbb)(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.--Not later than 180 days 
        after the date of enactment of this Act, the Secretary of 
        Health and Human Services shall cause to have published in in 
        the Federal Register a rule 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 shall consult with the 
        National Vision Rehabilitation Association, 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.

SEC. 202. STUDY ON OBSTACLES FOR UNDERSERVED POPULATIONS FOR VISION 
              SERVICES UNDER THE MEDICARE PROGRAM.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study on barriers faced by medically underserved populations 
(such as racial or ethnic minorities) to vision services that are 
covered under the medicare program under title XVIII of the Social 
Security Act, including vision rehabilitation and other vision-related 
services. In conducting the study, the Secretary shall consider 
economic barriers posed by cost-sharing requirements, such as 
copayments and deductibles and the awareness of medicare beneficiaries 
of vision services benefits currently covered and those benefit for 
which coverage is not provided under the program.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
on the study conducted under subsection (a). The report may include 
such recommendations for administrative action or legislation as the 
Secretary determines to be appropriate.

SEC. 203. COMPREHENSIVE EYE EXAMINATIONS.

    The Secretary of Health and Human Services shall enter into an 
agreement with the Institute of Medicine of the National Academy of 
Sciences to conduct a study on the cost benefit of providing a 
universal dilated eye exam under the medicare program.
                                 <all>