[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6886 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6886

 To amend title 10, United States Code, to modify the requirement for 
certain former members of the Armed Forces to enroll in Medicare Part B 
 to be eligible for TRICARE for Life, and to amend title XVIII of the 
  Social Security Act to provide for coverage of certain DNA specimen 
           provenance assay tests under the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 25, 2018

 Mr. Sam Johnson of Texas (for himself, Mr. Larson of Connecticut, Mr. 
    Bucshon, and Mr. Rush) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
 the Committees on Ways and Means, and Armed Services, 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 10, United States Code, to modify the requirement for 
certain former members of the Armed Forces to enroll in Medicare Part B 
 to be eligible for TRICARE for Life, and to amend title XVIII of the 
  Social Security Act to provide for coverage of certain DNA specimen 
           provenance assay tests under 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 ``Health Equity and Access for 
Returning Troops and Servicemembers Act of 2018'' or the ``HEARTS Act 
of 2018''.

SEC. 2. MODIFICATION OF REQUIREMENT FOR CERTAIN FORMER MEMBERS OF THE 
              ARMED FORCES TO ENROLL IN MEDICARE PART B TO BE ELIGIBLE 
              FOR TRICARE FOR LIFE.

    (a) TRICARE Eligibility.--
            (1) In general.--Subsection (d) of section 1086 of title 
        10, United States Code, is amended by adding at the end the 
        following new paragraph:
    ``(6)(A) The requirement in paragraph (2)(A) to enroll in the 
supplementary medical insurance program under part B of title XVIII of 
the Social Security Act (42 U.S.C. 1395j et seq.) shall not apply to a 
person described in subparagraph (B) during any month in which such 
person is not entitled to a benefit described in subparagraph (A) of 
section 226(b)(2) of the Social Security Act (42 U.S.C. 426(b)(2)) if 
such person has received the counseling and information under 
subparagraph (C).
    ``(B) A person described in this subparagraph is a person--
            ``(i) who is under 65 years of age;
            ``(ii) who is entitled to hospital insurance benefits under 
        part A of title XVIII of the Social Security Act pursuant to 
        subparagraph (A) or (C) of section 226(b)(2) of such Act (42 
        U.S.C. 426(b)(2));
            ``(iii) whose entitlement to a benefit described in 
        subparagraph (A) of such section has terminated due to 
        performance of substantial gainful activity; and
            ``(iv) who is retired under chapter 61 of this title.
    ``(C) The Secretary of Defense shall coordinate with the Secretary 
of Health and Human Services and the Commissioner of Social Security to 
notify persons described in subparagraph (B) of, and provide 
information and counseling regarding, the effects of not enrolling in 
the supplementary medical insurance program under part B of title XVIII 
of the Social Security Act (42 U.S.C. 1395j et seq.), as described in 
subparagraph (A).''.
            (2) Conforming amendment.--Paragraph (2)(A) of such 
        subsection is amended by striking ``is enrolled'' and inserting 
        ``except as provided by paragraph (6), is enrolled''.
            (3) Identification of persons.--Section 1110a of such title 
        is amended by adding at the end the following new subsection:
    ``(c) Certain Individuals Not Required To Enroll in Medicare Part 
B.--In carrying out subsection (a), the Secretary of Defense shall 
coordinate with the Secretary of Health and Human Services and the 
Commissioner of Social Security to--
            ``(1) identify persons described in subparagraph (B) of 
        section 1086(d)(6) of this title; and
            ``(2) provide information and counseling pursuant to 
        subparagraph (D) of such section.''.
    (b) Non-Application of Medicare Part B Late Enrollment Penalty.--
Section 1839(b) of the Social Security Act (42 U.S.C. 1395r(b)) is 
amended, in the second sentence, by inserting ``or months for which the 
individual can demonstrate that the individual is an individual 
described in paragraph (6)(B) of section 1086(d) of title 10, United 
States Code, who is enrolled in the TRICARE program pursuant to such 
section'' after ``an individual described in section 1837(k)(3)''.
    (c) Report.--Not later than October 1, 2024, the Secretary of 
Defense, the Secretary of Health and Human Services, and the 
Commissioner of Social Security shall jointly submit to the Committees 
on Armed Services of the House of Representatives and the Senate, the 
Committee on Ways and Means of the House of Representatives, and the 
Committee on Finance of the Senate a report on the implementation of 
section 1086(d)(6) of title 10, United States Code, as added by 
subsection (a). Such report shall include, with respect to the period 
covered by the report--
            (1) the number of individuals enrolled in TRICARE for Life 
        who are not enrolled in the supplementary medical insurance 
        program under part B of title XVIII of the Social Security Act 
        (42 U.S.C. 1395j et seq.) by reason of such section 1086(d)(6); 
        and
            (2) the number of individuals who--
                    (A) are retired from the Armed Forces under chapter 
                61 of title 10, United States Code;
                    (B) are entitled to hospital insurance benefits 
                under part A of title XVIII of the Social Security Act 
                pursuant to receiving benefits for 24 months as 
                described in subparagraph (A) or (C) of section 
                226(b)(2) of such Act (42 U.S.C. 426(b)(2)); and
                    (C) because of such entitlement, are no longer 
                enrolled in TRICARE Standard, TRICARE Prime, TRICARE 
                Extra, or TRICARE Select under chapter 55 of title 10, 
                United States Code.
    (d) Deposit of Savings Into Medicare Improvement Fund.--Section 
1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is 
amended by striking ``during and after fiscal year 2021, $0'' and 
inserting ``during and after fiscal year 2024, $5,000,000''.
    (e) Application.--The amendments made by subsections (a) and (b) 
shall apply with respect to a person who, on or after October 1, 2023, 
is a person described in section 1086(d)(6)(B) of title 10, United 
States Code, as added by subsection (a).

SEC. 3. COVERAGE OF CERTAIN DNA SPECIMEN PROVENANCE ASSAY TESTS UNDER 
              MEDICARE.

    (a) Benefit.--
            (1) Coverage.--Section 1861 of the Social Security Act (42 
        U.S.C. 1395x) is amended--
                    (A) in subsection (s)(2)--
                            (i) in subparagraph (FF), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (GG), by inserting 
                        ``and'' at the end; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(HH) a prostate cancer DNA Specimen Provenance Assay test 
        (DSPA test) (as defined in subsection (jjj)); and''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(jjj) Prostate Cancer DNA Specimen Provenance Assay Test.--The 
term `prostate cancer DNA Specimen Provenance Assay Test' (DSPA test) 
means a test that, after a determination of cancer in one or more 
prostate biopsy specimens obtained from an individual, assesses the 
identity of the DNA in such specimens by comparing such DNA with the 
DNA that was separately taken from such individual at the time of the 
biopsy.''.
            (2) Exclusion from coverage.--Section 1862(a)(1) of the 
        Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--
                    (A) in subparagraph (O), by striking ``and'' at the 
                end;
                    (B) in subparagraph (P), by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(Q) in the case of a prostate cancer DNA Specimen 
        Provenance Assay test (DSPA test) (as defined in section 
        1861(jjj)), unless such test is furnished on or after January 
        1, 2020, and before January 1, 2025, and such test is ordered 
        by the physician who furnished the prostate cancer biopsy that 
        obtained the specimen tested;''.
    (b) Payment Amount and Related Requirements.--Section 1834 of the 
Social Security Act (42 U.S.C. 1395m) is amended by adding at the end 
the following new subsection:
    ``(w) Prostate Cancer DNA Specimen Provenance Assay Tests.--
            ``(1) Payment for covered tests.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                payment amount for a prostate cancer DNA Specimen 
                Provenance Assay test (DSPA test) (as defined in 
                section 1861(jjj)) shall be $200. Such payment shall be 
                payment for all of the specimens obtained from the 
                biopsy furnished to an individual that are tested.
                    ``(B) Limitation.--Payment for a DSPA test under 
                subparagraph (A) may only be made on an assignment-
                related basis.
                    ``(C) Prohibition on separate payment.--No separate 
                payment shall be made for obtaining DNA that was 
                separately taken from an individual at the time of a 
                biopsy described in subparagraph (A).
            ``(2) HCPCS code and modifier assignment.--
                    ``(A) In general.--The Secretary shall assign one 
                or more HCPCS codes to a prostate cancer DNA Specimen 
                Provenance Assay test and may use a modifier to 
                facilitate making payment under this section for such 
                test.
                    ``(B) Identification of dna match on claim.--The 
                Secretary shall require an indication on a claim for a 
                prostate cancer DNA Specimen Provenance Assay test of 
                whether the DNA of the prostate biopsy specimens match 
                the DNA of the individual diagnosed with prostate 
                cancer. Such indication may be made through use of a 
                HCPCS code, a modifier, or other means, as determined 
                appropriate by the Secretary.
            ``(3) DNA match review.--
                    ``(A) In general.--The Secretary shall review at 
                least three years of claims under part B for prostate 
                cancer DNA Specimen Provenance Assay tests to identify 
                whether the DNA of the prostate biopsy specimens match 
                the DNA of the individuals diagnosed with prostate 
                cancer.
                    ``(B) Posting on internet website.--Not later than 
                July 1, 2023, the Secretary shall post on the Internet 
                website of the Centers for Medicare & Medicaid Services 
                the findings of the review conducted under subparagraph 
                (A).''.
    (c) Cost-Sharing.--Section 1833(a)(1) of the Social Security Act 
(42 U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and (BB)'' and inserting ``(BB)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (CC) with respect to a prostate cancer DNA 
        Specimen Provenance Assay test (DSPA test) (as defined in 
        section 1861(jjj)), the amount paid shall be an amount equal to 
        80 percent of the lesser of the actual charge for the test or 
        the amount specified under section 1834(w)''.
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