1.This Act may be cited as the
Medicare Preventive Services Coverage
Act of 2007
.
2.Extending the
eligibility period for a Welcome to Medicare
physical
examination from six months to one year
(a)Section 1862(a)(1)(K) of the Social Security Act (42
U.S.C. 1395y(a)(1)(K)) is amended by striking 6 months
and
inserting 1 year
.
(b)The amendment made by subsection (a) shall apply to initial
preventive physician examinations performed on or after January 1, 2008.
3.Coverage and
waiver of cost-sharing for preventive services
(a)Preventive
services defined; coverage of additional preventive
servicesSection 1861 of the Social Security Act (42 U.S.C.
1395x) is amended—
(1)in
subsection (s)(2)—
(A)in subparagraph
(Z), by striking and
after the semicolon at the end;
(B)in subparagraph
(AA), by adding and
after the semicolon at the end; and
(C)by adding at the
end the following new subparagraph:
(BB)additional preventive services
(described in subsection (ccc)(1)(O));
;
and
(2)by adding at the
end the following new subsection:
(ccc)(1)The term
preventive services means the following:
(A)Prostate cancer screening tests (as defined
in subsection (oo)).
(B)Colorectal cancer
screening tests (as defined in subsection (pp)).
(C)Diabetes outpatient
self-management training services (as defined in subsection (qq)).
(D)Screening for
glaucoma for certain individuals (as described in subsection (s)(2)(U)).
(E)Medical nutrition
therapy services for certain individuals (as described in subsection
(s)(2)(V)).
(F)An initial
preventive physical examination (as defined in subsection (ww)).
(G)Cardiovascular
screening blood tests (as defined in subsection (xx)(1)).
(H)Diabetes screening
tests (as defined in subsection (yy)).
(I)Ultrasound
screening for abdominal aortic aneurysm for certain individuals (as described
in subsection (s)(2)(AA)).
(J)Pneumococcal and
influenza vaccine and their administration (as described in subsection
(s)(10)(A)).
(K)Hepatitis B
vaccine and its administration for certain individuals (as described in
subsection (s)(10)(B)).
(L)Screening
mammography (as defined in subsection (jj)).
(M)Screening pap
smear and screening pelvic exam (as described in subsection (s)(14)).
(N)Bone mass
measurement (as defined in subsection (rr)).
(O)Additional
preventive services (as determined under paragraph (2)).
(2)(A)The term
additional preventive services means items and services, including
mental health services, not described in subparagraphs (A) through (N) of
paragraph (1) that the Secretary determines to be reasonable and necessary for
the prevention or early detection of an illness or disability.
(B)In making determinations under
subparagraph (A), the Secretary shall—
(i)take into account evidence-based
recommendations by the United States Preventive Services Task Force and other
appropriate organizations; and
(ii)use the process for making
national coverage determinations (as defined in section 1869(f)(1)(B)) under
this
title.
.
(b)Payment and
Elimination of Cost-sharing
(1)
(A)Section 1833(a)(1) of the Social Security Act (42 U.S.C.
1395l(a)(1)) is amended—
(i)in
clause (T), by striking 80 percent
and inserting 100
percent
;
(ii)by
striking and
before (V)
; and
(iii)by
inserting before the semicolon at the end the following: , and (W) with
respect to additional preventive services (as defined in section 1861(ccc)(2))
and other preventive services for which a payment rate is not otherwise
established under this section, 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
clause
.
(B)Application to
sigmoidoscopies and colonoscopiesSection 1834(d) of the Social
Security Act (42 U.S.C. 1395m(d)) is amended—
(i)in
paragraph (2)(C), by amending clause (ii) to read as follows:
(ii)In the case of a beneficiary who receives services
described in clause (i), there shall be no coinsurance
applied.
;
and
(ii)in
paragraph (3)(C), by amending clause (ii) to read as follows:
(ii)In the case of a beneficiary who receives services
described in clause (i), there shall be no coinsurance
applied.
.
(2)Elimination of
coinsurance in outpatient hospital settings
(A)Exclusion from
OPD fee scheduleSection 1833(t)(1)(B)(iv) of the Social Security
Act (42 U.S.C.
1395l(t)(1)(B)(iv)) is amended by striking screening
mammography (as defined in section 1861(jj)) and diagnostic mammography
and inserting diagnostic mammography and preventive services (as defined
in section 1861(ccc)(1))
.
(B)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 adding and
at the end; and
(iii)by
adding at the end the following new subparagraph:
(H)with respect to
additional preventive services (as defined in section 1861(ccc)(2)) furnished
by an outpatient department of a hospital, the amount determined under
paragraph
(1)(W);
.
(3)Waiver of
application of deductible for all preventive servicesThe first
sentence of section 1833(b) of the Social Security Act (42 U.S.C.
1395l(b)) is amended—
(A)in clause (1), by
striking items and services described in section 1861(s)(10)(A)
and inserting preventive services (as defined in section
1861(ccc)(1))
;
(B)by inserting
and
before (4)
; and
(C)by striking
clauses (5) through (8).
(c)Inclusion as
part of initial preventive physical examinationSection
1861(ww)(2) of the Social Security Act (42 U.S.C. 1395x(ww)(2)) is amended
by adding at the end the following new subparagraph:
(M)Additional
preventive services (as defined in subsection
(ccc)(2)).
.
(d)The amendments made by this section shall apply to services
furnished on or after January 1, 2008.