[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5254 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 5254

To amend title XVIII of the Social Security Act to provide for coverage 
   under the Medicare program of digital retinal imaging with remote 
                            interpretation.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 22, 2019

    Ms. Sewell of Alabama (for herself, Mr. Reed, and Ms. DeGette) 
 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 title XVIII of the Social Security Act to provide for coverage 
   under the Medicare program of digital retinal imaging with remote 
                            interpretation.

    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 Vision Loss and Blindness 
Prevention Act of 2019''.

SEC. 2. MEDICARE COVERAGE OF DIGITAL RETINAL IMAGING WITH REMOTE 
              INTERPRETATION.

    (a) Coverage.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) in subparagraph (GG), by striking ``and'' at 
                the end;
                    (B) in subparagraph (HH), by adding ``and'' at the 
                end; and
                    (C) by inserting after subparagraph (HH) the 
                following new subparagraph:
                    ``(II) digital retinal imaging with remote 
                interpretation (as defined in subsection (kkk));''; and
            (2) by adding at the end the following new subsection:
    ``(kkk) Digital Retinal Imaging With Remote Interpretation.--The 
term `digital retinal imaging with remote interpretation' means a 
diagnostic procedure for the purpose of early detection or assessment 
of diabetic retinopathy that--
            ``(1) is provided not more frequently than on an annual 
        basis to an individual who has been diagnosed with diabetes and 
        who does not have prior diabetic retinopathy known to the 
        primary care practitioner of the individual;
            ``(2) is provided by or under the general supervision of a 
        primary care practitioner (as defined in section 1833(x)) or 
        board-certified endocrinologist;
            ``(3) utilizes a retinal camera with optical resolution 
        compliant with the International Organization for 
        Standardization ISO 10940 to take digital images of structures 
        behind the lens of the eye, such as the retina, choroid, and 
        optic nerve; and
            ``(4) involves the electronic transmission of such images 
        for evaluation for diabetic retinopathy and other diseases of 
        the eye by a State-licensed ophthalmologist or optometrist.''.
    (b) Payment.--The payment amount for digital retinal imaging with 
remote interpretation provided pursuant to the amendments made by 
section (a) shall be equal to--
            (1) for the period beginning on October 1, 2019, and ending 
        on December 31, 2019, and for 2020, $51.54; and
            (2) for a subsequent year, the payment amount specified in 
        subparagraph (1) or this subparagraph for the preceding year 
        increased by the percentage increase in the MEI (as defined in 
        section 1842(i)(3) of the Social Security Act (42 U.S.C. 
        1395u(i)(3)) for such subsequent year.
Digital retinal imaging with remote interpretation shall not be 
considered a telehealth service for purposes of section 1834(m) of the 
Social Security Act (42 U.S.C. 1395m(m)).
    (c) Patient Education and Awareness.--
            (1) Annual eye exam recommendation.--The Secretary of 
        Health and Human Services shall ensure that diabetes outpatient 
        self-management training services described in section 1861(qq) 
        of the Social Security Act (42 U.S.C. 1395x(qq)) educate 
        Medicare beneficiaries regarding the importance of receiving an 
        annual comprehensive eye exam.
            (2) Patient awareness.--The Secretary shall undertake 
        efforts to ensure that patients receiving digital retinal 
        imaging with remote interpretation as described in subsection 
        (kkk) of section 1861 of the Social Security Act (42 U.S.C. 
        1395x), as added by subsection (a), are aware of the 
        availability of and coverage for diabetes outpatient self-
        management training services under subsection (s)(2)(S) of such 
        section.
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