[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 801 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 801

To amend titles XVIII and XIX of the Social Security Act to provide for 
coverage under the Medicare and Medicaid Programs of certain screening 
  procedures for diabetic retinopathy, and to amend the Public Health 
 Service Act to establish pilot programs to foster such screening, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 15, 2005

 Mr. Cooper (for himself, Mr. Hall, Mrs. McCarthy, Mr. McDermott, Mr. 
McNulty, Ms. Millender-McDonald, Mr. Payne, Mr. Rangel, Mr. Spratt, Mr. 
 Ford, Mr. Tanner, Mr. Towns, Mr. Wilson of South Carolina, Mr. Owens, 
 Mr. Davis of Tennessee, and Mr. Stark) 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 titles XVIII and XIX of the Social Security Act to provide for 
coverage under the Medicare and Medicaid Programs of certain screening 
  procedures for diabetic retinopathy, and to amend the Public Health 
 Service Act to establish pilot programs to foster such screening, 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 ``Diabetic Retinopathy Prevention Act 
of 2005''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Type 2 Diabetes affects 17,000,000 Americans, with over 
        1,000,000 new cases diagnosed each year. Type 1 Diabetes 
        affects over 1,000,000 Americans, with over 13,000 new cases 
        diagnosed each year. Diabetes costs the nation an estimated 
        $138,000,000,000 per year.
            (2) Diabetic retinopathy is the most common complication 
        resulting from diabetes, and causes degradation in visual 
        acuity and eventual blindness. Diabetic retinopathy is the 
        leading cause of blindness in people aged 20 to 74, and up to 
        24,000 diabetics become legally blind each year.
            (3) During the first two decades of disease, nearly all 
        patients with Type 1 and over 60 percent of patients with Type 
        2 Diabetes develop diabetic retinopathy, and the risk of 
        diabetic retinopathy increases with the duration of diabetes. 
        Onset of Type 2 diabetes is today occurring at younger ages, 
        which will increase the prevalence of diabetic retinopathy in 
        the future.
            (4) Clinical trials have demonstrated that early detection 
        and treatment of diabetic retinopathy can reduce vision loss by 
        90 percent, and remote assessment of diabetic retinopathy has 
        the potential to reach large numbers of diabetic patients who 
        live in rural, remote or underserved areas and who lack 
        geographical or financial access to regular, in-office eye 
        examinations by eye specialists.

SEC. 3. MEDICARE COVERAGE OF REMOTE ASSESSMENT OF DIABETIC RETINOPATHY.

    (a) Coverage.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended:
            (1) in subsection (s)(2)--
                    (A) in subparagraph (Y), by striking ``and'' at the 
                end;
                    (B) in subparagraph (Z), by adding ``and'' at the 
                end; and
                    (C) by inserting after subparagraph (Z) the 
                following new subparagraph:
            ``(AA) remote assessment of diabetic retinopathy (as 
        defined in subsection (bbb));''; and
            (2) by adding at the end the following new subsection:

              ``Remote Assessment of Diabetic Retinopathy

    ``(bbb) The term `remote assessment of diabetic retinopathy' means 
a diagnostic examination of the retina for the purpose of early 
detection of diabetic retinopathy that--
            ``(1) is provided not more frequently than on an annual 
        basis to an individual who has been diagnosed with diabetes;
            ``(2) meets technical standards set forth by the Secretary 
        (which shall be determined in consultation with industry and 
        practitioner groups with expertise in ophthalmology, ophthalmic 
        imaging, telemedicine, or related fields);
            ``(3) is furnished via a telecommunications system by a 
        physician (as defined in subsection (r)), a practitioner 
        (described in section 1842(b)(18)(C) of this title), or a non-
        physician technician deemed to be qualified by the Secretary 
        under the regulations promulgated pursuant to this Act, to an 
        eligible patient enrolled under this part, notwithstanding that 
        the individual physician or practitioner providing the service 
        is not at the same location as the beneficiary; and
            ``(4) is conducted under the supervision of a board-
        certified ophthalmologist with retinal fellowship training.''.
    (b) Payment Notwithstanding Limitation on Store and Forward 
Technology.--Notwithstanding any limitations to the contrary that are 
set forth in section 1834(m)(1) of the Social Security Act (42 U.S.C. 
1395m(m)(1)), the amendments made by subsection (a) shall be applicable 
to remote assessments of diabetic retinopathy that are furnished 
through the use of store-and-forward technologies that provide for the 
asynchronous transmission of health care information in single or 
multimedia formats.
    (c) Interim Payment Pending Publication of Final Rule.--For the 
period beginning 30 days after the date of the enactment of this Act 
and ending on the date the Secretary of Health and Human Services 
publishes a final regulation to carry out section 1861(s)(2)(AA) of the 
Social Security Act, as added by subsection (a), the Secretary shall 
provide for payment of retinopathy assessments furnished under such 
section during such period, and assign such temporary HCPCS code as is 
necessary to provide for such payment.
    (d) Study on Reimbursement for Remote Assessments of Diabetic 
Retinopathy.--(1) Not later than 1 year after the date of the enactment 
of this Act, the Secretary of Health and Human Services shall conduct a 
study on the costs incurred by health care providers to provide remote 
assessment of diabetic retinopathy services, including an analysis of--
            (A) per-patient cost, and
            (B) start-up and administrative costs.
    (2) Not later than 2 years after the date of the enactment of this 
Act, the Secretary shall submit a report to Congress on the study 
conducted under paragraph (1) and shall include recommendations with 
respect to--
            (A) the adequacy of reimbursements for remote assessment of 
        diabetic retinopathy under the medicare program; and
            (B) whether the study under paragraph (1) should be 
        repeated, and if so, how frequently.
    (e) Effective Date.--The amendments made by subsection (a) shall 
apply to assessments performed on or after the date that is 30 days 
after the date of the enactment of this Act.

SEC. 4 MEDICAID COVERAGE OF REMOTE ASSESSMENT OF DIABETIC RETINOPATHY.

    (a) Requirement.--Section 1905(a)(13) of the Social Security Act 
(42 U.S.C. 1396d(a)(13)) is amended by inserting ``remote assessment of 
diabetic retinopathy (as defined in section 1861(bbb)),'' after 
``including''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to assessments performed on or after the date of the enactment of 
this Act.
    (c) State Compliance.--In the case of a State plan for medical 
assistance under title XIX of the Social Security Act which the 
Secretary of Health and Human Services determines requires State 
legislation (other than legislation authorizing or appropriating funds) 
in order for the plan to meet the additional requirement imposed by the 
amendments made by subsection (a), the State plan shall not be regarded 
as failing to comply with the requirements of such title solely on the 
basis of its failure to meet this additional requirement before the 
first day of the first calendar quarter beginning after the close of 
the first regular session of the State legislature that begins after 
the date of the enactment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year legislative session, 
each year of such session shall be deemed to be a separate regular 
session of the State legislature.

SEC. 5. MOBILE DIABETIC RETINOPATHY SCREENING PILOT PROGRAM.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by inserting after section 317S the following:

``SEC. 317T. MOBILE DIABETIC RETINOPATHY SCREENING PILOT PROGRAM.

    ``(a) In General.--
            ``(1) Establishment.--The Secretary shall establish a grant 
        program, to be known as the `Mobile Diabetic Retinopathy 
        Screening Pilot Program', to make grants to 5 eligible entities 
        for the purpose of establishing mobile diabetic retinopathy 
        screening programs.
            ``(2) Use of funds.--The Secretary may not make a grant to 
        an eligible entity under this section unless the entity agrees 
        to use the grant to carry out a project consisting of the 
        design, demonstration, and implementation of a mobile diabetic 
        retinopathy screening program.
            ``(3) Maximum amount.--The Secretary may not make any grant 
        under this section in an amount that is greater than $1,000,000 
        for any year.
            ``(4) Solicitation of applications.--Not later than 90 days 
        after the date on which amounts are first made available to 
        carry out this section, the Secretary shall publish a notice of 
        solicitation for applications for grants under this section 
        that specifies the information to be included in each 
        application.
            ``(5) Applications.--To seek a grant under this section, an 
        eligible entity shall submit an application to the Secretary at 
        such time, in such form, and containing such information as the 
        Secretary may require.
            ``(6) Priority.--In making grants under this section, the 
        Secretary shall give priority to any applicant that--
                    ``(A) has experience in evaluating diabetic 
                retinopathy using telecommunications equipment, 
                including store and forward technologies; and
                    ``(B) proposes to serve rural, impoverished, 
                underserved, minority, and remote populations.
            ``(7) Congressional notification.--The Secretary may not 
        make a grant under this section unless, not less than 3 days 
        before making the grant, the Secretary provides notification of 
        the grant to the appropriate committees of the Congress.
    ``(b) Evaluation and Report.--
            ``(1) Evaluation.--Not later than 3 years after making the 
        first grant under this section, the Secretary shall convene an 
        advisory committee for the purposes of conducting an evaluation 
        of the Mobile Diabetic Retinopathy Screening Pilot Program. In 
        conducting the evaluation, the advisory committee shall 
        determine--
                    ``(A) whether the Program has been effective in 
                increasing early detection of diabetic retinopathy, 
                whether preventative measures taken upon such detection 
                have been effective in decreasing the prevalence and 
                severity of diabetic retinopathy, and whether these 
                findings warrant continued or expanded support of the 
                Program; and
                    ``(B) whether the program may serve as a useful 
                model for similar screening programs to detect 
                complications associated with diabetes, high blood 
                pressure, high cholesterol, and other chronic 
                conditions.
            ``(2) Report.--Not later than 54 months after making the 
        first grant under this section, the Secretary shall submit a 
        report to the appropriate committees of the Congress containing 
        the results of the advisory committee's evaluation.
    ``(c) Definitions.--In this section:
            ``(1) Advisory committee.--The term `advisory committee' 
        means the advisory committee convened under subsection (b).
            ``(2) Eligible entity.--The term `eligible entity' means--
                    ``(A) a hospital (as defined in section 1861(e) of 
                the Social Security Act); or
                    ``(B) a State, an institution of higher education, 
                a local government, a tribal government, a nonprofit 
                health organization, or a community health center 
                receiving assistance under section 330.
            ``(3) Mobile diabetic retinopathy screening program.--The 
        term `mobile diabetic retinopathy screening program' means any 
        program--
                    ``(A) that offers remote assessment of diabetic 
                retinopathy as described in Section 1861(bbb) of the 
                Social Security Act;
                    ``(B) whose patients primarily reside in rural, 
                underserved, and remote areas; and
                    ``(C) that is mobile (as determined by the 
                Secretary).
            ``(4) Program.--The term `Program' means the Mobile 
        Diabetic Retinopathy Screening Pilot Program established under 
        this section.
    ``(d) Authorization of Appropriations.--
            ``(1) In general.--There is authorized to be appropriated 
        to carry out this section (except for subsection (b)) 
        $5,000,000 for each of fiscal years 2006 through 2010.
            ``(2) Evaluation and report.--There are authorized to be 
        appropriated to carry out subsection (b) such sums as may be 
        necessary.''.
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