I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Diabetic Vision Loss 

5 and Blindness Prevention Act of 2019’’. 


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1 SEC. 2. MEDICARE COVERAGE OF DIGITAL RETINAL IMAG2 ING WITH REMOTE INTERPRETATION. 

3 (a) COVERAGE.—Section 1861 of the Social Security 

4 Act (42 U.S.C. 1395x) is amended— 

5 (1) in subsection (s)(2)— 

6 (A) in subparagraph (GG), by striking 

7 ‘‘and’’ at the end; 

8 (B) in subparagraph (HH), by adding 

9 ‘‘and’’ at the end; and 

10 (C) by inserting after subparagraph (HH) 

11 the following new subparagraph: 

12 ‘‘(II) digital retinal imaging with remote 

13 interpretation (as defined in subsection 

14 (kkk));’’; and 

15 (2) by adding at the end the following new sub16 section: 

17 ‘‘(kkk) DIGITAL RETINAL IMAGING WITH REMOTE

18 INTERPRETATION.—The term ‘digital retinal imaging 

19 with remote interpretation’ means a diagnostic procedure 

20 for the purpose of early detection or assessment of diabetic 

21 retinopathy that— 

22 ‘‘(1) is provided not more frequently than on an 

23 annual basis to an individual who has been diag24 nosed with diabetes and who does not have prior dia25 betic retinopathy known to the primary care practi26 tioner of the individual; 


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1 ‘‘(2) is provided by or under the general super2 vision of a primary care practitioner (as defined in 

3 section 1833(x)) or board-certified endocrinologist; 

4 ‘‘(3) utilizes a retinal camera with optical reso5 lution compliant with the International Organization 

6 for Standardization ISO 10940 to take digital im7 ages of structures behind the lens of the eye, such 

8 as the retina, choroid, and optic nerve; and 

9 ‘‘(4) involves the electronic transmission of such 

10 images for evaluation for diabetic retinopathy and 

11 other diseases of the eye by a State-licensed ophthal12 mologist or optometrist.’’. 

13 (b) PAYMENT.—The payment amount for digital ret14 inal imaging with remote interpretation provided pursuant 

15 to the amendments made by section (a) shall be equal to— 

16 (1) for the period beginning on October 1, 

17 2019, and ending on December 31, 2019, and for 

18 2020, $51.54; and 

19 (2) for a subsequent year, the payment amount 

20 specified in subparagraph (1) or this subparagraph 

21 for the preceding year increased by the percentage 

22 increase in the MEI (as defined in section 

23 1842(i)(3) of the Social Security Act (42 U.S.C. 

24 1395u(i)(3)) for such subsequent year. 


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1 Digital retinal imaging with remote interpretation shall 

2 not be considered a telehealth service for purposes of sec3 tion 1834(m) of the Social Security Act (42 U.S.C. 

4 1395m(m)). 

5 (c) PATIENT EDUCATION AND AWARENESS.— 

6 (1) ANNUAL EYE EXAM RECOMMENDATION.— 

7 The Secretary of Health and Human Services shall 

8 ensure that diabetes outpatient self-management 

9 training services described in section 1861(qq) of the 

10 Social Security Act (42 U.S.C. 1395x(qq)) educate 

11 Medicare beneficiaries regarding the importance of 

12 receiving an annual comprehensive eye exam. 

13 (2) PATIENT AWARENESS.—The Secretary shall 

14 undertake efforts to ensure that patients receiving 

15 digital retinal imaging with remote interpretation as 

16 described in subsection (kkk) of section 1861 of the 

17 Social Security Act (42 U.S.C. 1395x), as added by 

18 subsection (a), are aware of the availability of and 

19 coverage for diabetes outpatient self-management 

20 training services under subsection (s)(2)(S) of such 

21 section. 

Æ 


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