Medicare Prevention Benefit Act of 1993

Summary: Medicare Prevention Benefit Act of 1993 - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of:  (1) annual screening mammography for women over age 64; (2) colorectal screening; (3) certain immunizations; and (4) well-child care. 
Directs the Secretary of Health and Human Services to establish demonstration projects for the coverage of other specified preventive services under Medicare.  Authorizes appropriations. 
Requires the Director of the Office of Technology Assessment to conduct a study to develop a process for the review of Medicare coverage of preventive services.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Prevention Benefit Act of 
1993''.

SEC. 2. ANNUAL SCREENING MAMMOGRAPHY.

    (a) Annual Screening Mammography for Women Over Age 64.--Section 
1834(c)(2)(A) of the Social Security Act (42 U.S.C. 1395m(b)(2)(A)) is 
amended--
            (1) in clause (iv), by striking ``but under 65 years of 
        age,''; and
            (2) by striking clause (v).
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to screening mammography performed on or after January 1, 1994.

SEC. 3. COVERAGE OF COLORECTAL SCREENING.

    (a) In General.--Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by inserting after subsection (c) the following new 
subsection:
    ``(d) Frequency and Payment Limits for Screening Fecal-Occult Blood 
Tests and Screening Flexible Sigmoidoscopies.--
            ``(1) Screening fecal-occult blood tests.--
                    ``(A) Payment limit.--In establishing fee schedules 
                under section 1833(h) with respect to screening fecal-
                occult blood tests provided for the purpose of early 
                detection of colon cancer, except as provided by the 
                Secretary under paragraph (3)(A), the payment amount 
                established for tests performed--
                            ``(i) in 1994 shall not exceed $5; and
                            ``(ii) in a subsequent year, shall not 
                        exceed the limit on the payment amount 
                        established under this subsection for such 
                        tests for the preceding year, adjusted by the 
                        applicable adjustment under section 1833(h) for 
                        tests performed in such year.
                    ``(B) Frequency limit.--Subject to revision by the 
                Secretary under paragraph (3)(B), no payment may be 
                made under this part for a screening fecal-occult blood 
                test provided to an individual for the purpose of early 
                detection of colon cancer--
                            ``(i) if the individual is under 50 years 
                        of age; or
                            ``(ii) if the test is performed within 11 
                        months after a previous screening fecal-occult 
                        blood test.
            ``(2) Screening flexible sigmoidoscopies.--
                    ``(A) Payment amount.--The Secretary shall 
                establish a payment amount under section 1848 with 
                respect to screening flexible sigmoidoscopies provided 
                for the purpose of early detection of colon cancer that 
                is consistent with payment amounts under such section 
                for similar or related services, except that such 
                payment amount shall be established without regard to 
                subsection (a)(2)(A) of such section.
                    ``(B) Frequency limit.--Subject to revision by the 
                Secretary under paragraph (3)(B), no payment may be 
                made under this part for a screening flexible 
                sigmoidoscopy provided to an individual for the purpose 
                of early detection of colon cancer--
                            ``(i) if the individual is under 50 years 
                        of age; or
                            ``(ii) if the procedure is performed within 
                        59 months after a previous screening flexible 
                        sigmoidoscopy.
            ``(3) Reductions in payment limit and revision of 
        frequency.--
                    ``(A) Reductions in payment limit.--The Secretary 
                shall review from time to time the appropriateness of 
                the amount of the payment limit established for 
                screening fecal-occult blood tests under paragraph 
                (1)(A). The Secretary may, with respect to tests 
                performed in a year after 1996, reduce the amount of 
                such limit as it applies nationally or in any area to 
                the amount that the Secretary estimates is required to 
                assure that such tests of an appropriate quality are 
                readily and conveniently available during the year.
                    ``(B) Revision of frequency.--
                            ``(i) Review.--The Secretary, in 
                        consultation with the Director of the National 
                        Cancer Institute, shall review periodically the 
                        appropriate frequency for performing screening 
                        fecal-occult blood tests and screening flexible 
                        sigmoidoscopies based on age and such other 
                        factors as the Secretary believes to be 
                        pertinent.
                            ``(ii) Revision of frequency.--The 
                        Secretary, taking into consideration the review 
                        made under clause (i), may revise from time to 
                        time the frequency with which such tests and 
                        procedures may be paid for under this 
                        subsection, but no such revision shall apply to 
                        tests or procedures performed before January 1, 
                        1997.''.
    (b) Conforming Amendments.--(1) Paragraphs (1)(D) and (2)(D) of 
section 1833(a) of such Act (42 U.S.C. 1395l(a)) are each amended by 
striking ``subsection (h)(1),'' and inserting ``subsection (h)(1) or 
section 1834(d)(1),''.
    (2) Section 1833(h)(1)(A) of such Act (42 U.S.C. 1395l(h)(1)(A)) is 
amended by striking ``The Secretary'' and inserting ``Subject to 
paragraphs (1) and (3)(A) of section 1834(d), the Secretary''.
    (3) Clauses (i) and (ii) of section 1848(a)(2)(A) of such Act (42 
U.S.C. 1395w-4(a)(2)(A)) are each amended by striking ``a service'' and 
inserting ``a service (other than a screening flexible sigmoidoscopy 
provided to an individual for the purpose of early detection of colon 
cancer)''.
    (4) Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--
            (A) in paragraph (1)--
                    (i) in subparagraph (E), by striking ``and'' at the 
                end,
                    (ii) in subparagraph (F), by striking the semicolon 
                at the end and inserting ``, and'', and
                    (iii) by adding at the end the following new 
                subparagraph:
                    ``(G) in the case of screening fecal-occult blood 
                tests and screening flexible sigmoidoscopies provided 
                for the purpose of early detection of colon cancer, 
                which are performed more frequently than is covered 
                under section 1834(d);''; and
            (B) in paragraph (7), by striking ``paragraph (1)(B) or 
        under paragraph (1)(F)'' and inserting ``subparagraphs (B), 
        (F), or (G) of paragraph (1)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to screening fecal-occult blood tests and screening flexible 
sigmoidoscopies performed on or after January 1, 1994.

SEC. 4. COVERAGE OF CERTAIN IMMUNIZATIONS.

    (a) In General.--Section 1861(s)(10) of the Social Security Act (42 
U.S.C. 1395x(s)(10)) is amended--
            (1) in subparagraph (A)--
                    (A) by striking ``, subject to section 4071(b) of 
                the Omnibus Budget Reconciliation Act of 1987,'', and
                    (B) by striking ``; and'' and inserting a comma;
            (2) in subparagraph (B), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(C) tetanus-diphtheria booster and its 
                administration;''.
    (b) Limitation on Frequency.--Section 1862(a)(1) of such Act (42 
U.S.C. 1395y(a)(1)), as amended by section 3(b)(4)(A), is amended--
            (1) in subparagraph (F), by striking ``and'' at the end;
            (2) in subparagraph (G), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(H) in the case of an influenza vaccine, which is 
                administered within the 11 months after a previous 
                influenza vaccine, and, in the case of a tetanus-
                diphtheria booster, which is administered within the 
                119 months after a previous tetanus-diphtheria 
                booster;''.
    (c) Conforming Amendment.--Section 1862(a)(7) of such Act (42 
U.S.C. 1395y(a)(7)), as amended by section 3(b)(4)(B), is amended by 
striking ``or (G)'' and inserting ``(G), or (H)''.
    (d) Effective Date.--The amendments made by this section shall 
apply to influenza vaccines and tetanus-diphtheria boosters 
administered on or after January 1, 1994.

SEC. 5. COVERAGE OF WELL-CHILD CARE.

    (a) In General.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (O);
            (2) by striking the semicolon at the end of subparagraph 
        (P) and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(Q) well-child services (as defined in subsection 
        (ll)(1)) provided to an individual entitled to benefits under 
        this title who is under 7 years of age;''.
    (b) Services Defined.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended--
            (1) by redesignating the subsection (jj) as subsection 
        (kk); and
            (2) by inserting after subsection (kk) (as so redesignated) 
        the following new subsection:

                         ``Well-Child Services

    ``(ll)(1) The term `well-child services' means well-child care, 
including routine office visits, routine immunizations (including the 
vaccine itself), routine laboratory tests, and preventive dental care, 
provided in accordance with the periodicity schedule established with 
respect to the services under paragraph (2).
    ``(2) The Secretary, in consultation with the American Academy of 
Pediatrics, the Advisory Committee on Immunization Practices, and other 
entities considered appropriate by the Secretary, shall establish a 
schedule of periodicity which reflects the appropriate frequency with 
which the services referred to in paragraph (1) should be provided to 
healthy children.''.
    (c) Conforming Amendments.--(1) Section 1862(a)(1) of such Act (42 
U.S.C. 1395y(a)(1)), as amended by sections 3(b)(4)(A) and 4(b), is 
amended--
            (A) in subparagraph (G), by striking ``and'' at the end;
            (B) in subparagraph (H), by striking the semicolon at the 
        end and inserting ``, and''; and
            (C) by adding at the end the following new subparagraph:
            ``(I) in the case of well-child services, which are 
        provided more frequently than is provided under the schedule of 
        periodicity established by the Secretary under section 
        1861(ll)(2) for such services;''.
    (2) Section 1862(a)(7) of such Act (42 U.S.C. 1395y(a)(7)), as 
amended by sections 3(b)(4)(B) and 4(c), is amended by striking ``or 
(H)'' and inserting ``(H), or (I)''.
    (d) Effective Date.--The amendments made by this section shall 
apply to well-child services provided on or after January 1, 1994.

SEC. 6. DEMONSTRATION PROJECTS FOR COVERAGE OF OTHER PREVENTIVE 
              SERVICES.

    (a) Establishment.--The Secretary of Health and Human Services 
shall establish and provide for a series of ongoing demonstration 
projects under which the Secretary shall provide for coverage of the 
preventive services described in subsection (c) under the medicare 
program in order to determine--
            (1) the feasibility and desirability of expanding coverage 
        of medical and other health services under the medicare program 
        to include coverage of such services for all individuals 
        enrolled under part B of title XVIII of the Social Security 
        Act; and
            (2) appropriate methods for the delivery of those services 
        to medicare beneficiaries.
    (b) Sites for Project.--The Secretary shall provide for the conduct 
of the demonstration projects established under subsection (a) at the 
sites at which the Secretary conducts the demonstration program 
established under section 9314 of the Consolidated Omnibus Budget 
Reconciliation Act of 1985 and at such other sites as the Secretary 
considers appropriate.
    (c) Services Covered Under Projects.--The Secretary shall cover the 
following services under the series of demonstration projects 
established under subsection (a):
            (1) Glaucoma screening.
            (2) Cholesterol screening and cholesterol-reducing drug 
        therapies.
            (3) Screening and treatment for osteoporosis, including 
        tests for bone-marrow density and hormone replacement therapy.
            (4) Screening services for pregnant women, including ultra-
        sound and clamydial testing and maternal serum alfa-protein.
            (5) One-time comprehensive assessment for individuals 
        beginning at age 65 or 75.
            (6) Prostate-specific antigen (PSA) testing.
            (7) Other services considered appropriate by the Secretary.
    (d) Reports to Congress.--Not later than October 1, 1995, and every 
2 years thereafter, the Secretary shall submit a report to the 
Committee on Finance of the Senate and the Committee on Ways and Means 
and the Committee on Energy and Commerce of the House of 
Representatives describing findings made under the demonstration 
projects conducted pursuant to subsection (a) during the preceding 2-
year period and the Secretary's plans for the demonstration projects 
during the succeeding 2-year period.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated from the Federal Supplementary Medical Insurance Trust 
Fund for expenses incurred in carrying out the series of demonstration 
projects established under subsection (a) the following amounts:
            (1) $4,000,000 for fiscal year 1994.
            (2) $4,000,000 for fiscal year 1995.
            (3) $5,000,000 for fiscal year 1996.
            (4) $5,000,000 for fiscal year 1997.
            (5) $6,000,000 for fiscal year 1998.

SEC. 7. OTA STUDY OF PROCESS FOR REVIEW OF MEDICARE COVERAGE OF 
              PREVENTIVE SERVICES.

    (a) Study.--The Director of the Office of Technology Assessment 
(hereafter referred to as the ``Director'') shall, subject to the 
approval of the Technology Assessment Board, conduct a study to develop 
a process for the regular review for the consideration of coverage of 
preventive services under the medicare program, and shall include in 
such study a consideration of different types of evaluations, the use 
of demonstration projects to obtain data and experience, and the types 
of measures, outcomes, and criteria that should be used in making 
coverage decisions.
    (b) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Director shall submit a report to the Committee on 
Finance of the Senate and the Committee on Ways and Means and the 
Committee on Energy and Commerce of the House of Representatives on the 
study conducted under subsection (a).