[Congressional Record Volume 164, Number 161 (Friday, September 28, 2018)]
[House]
[Pages H9156-H9158]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




HEALTH EQUITY AND ACCESS FOR RETURNING TROOPS AND SERVICEMEMBERS ACT OF 
                                  2018

  Mr. SAM JOHNSON of Texas. Mr. Speaker, I ask unanimous consent that 
the Committee on Energy and Commerce, the Committee on Ways and Means, 
and the Committee on Armed Services be discharged from further 
consideration of the bill (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, and ask for its immediate consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  The text of the bill is as follows:

                               H.R. 6886

       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).

[[Page H9157]]

       ``(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)''.


             Amendment Offered by Mr. Sam Johnson of Texas

  Mr. SAM JOHNSON of Texas. Mr. Speaker, I have an amendment at the 
desk.
  The SPEAKER pro tempore. The Clerk will report the amendment.
  The Clerk read as follows:

       Strike all after the enacting clause and insert the 
     following:

     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));

[[Page H9158]]

       ``(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 and the Committee on Energy and Commerce 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 Speciment 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)''.

  Mr. SAM JOHNSON of Texas (during the reading). Mr. Speaker, I ask 
unanimous consent to dispense with the reading of the amendment.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  The amendment was agreed to.
  The bill was ordered to be engrossed and read a third time, was read 
the third time, and passed, and a motion to reconsider was laid on the 
table.

                          ____________________