I 

114TH CONGRESS 

2D SESSION H. R. 4642 

To amend title XVIII of the Social Security Act to establish a Medicare 

diabetic eye disease prevention and early treatment demonstration project. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 26, 2016 

Mr. COLLINS of New York (for himself and Mr. MCNERNEY) 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 establish 

a Medicare diabetic eye disease prevention and early 

treatment demonstration project. 

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 Eye Disease 

5 Prevention Act of 2016’’. 


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1 SEC. 2. MEDICARE DIABETIC EYE DISEASE PREVENTION 

2 AND EARLY TREATMENT DEMONSTRATION 

3 PROJECT. 

4 Title XVIII of the Social Security Act is amended by 

5 inserting after section 1866E (42 U.S.C. 1395cc–5) the 

6 following new section: 

7 ‘‘DIABETIC EYE DISEASE PREVENTION AND EARLY

8 TREATMENT DEMONSTRATION PROJECT

9 ‘‘SEC. 1866F. (a) ESTABLISHMENT.—The Secretary 

10 shall conduct, during a 5-year period beginning no later 

11 than January 1, 2017, a diabetic eye disease prevention 

12 and early treatment demonstration project (in this section 

13 referred to as the ‘demonstration project’) to provide in14 centives to primary care practices to refer to local eye doc15 tors for comprehensive dilated eye exams— 

16 ‘‘(1) diabetic Medicare beneficiaries at the time 

17 of their diagnosis of diabetes; and 

18 ‘‘(2) diabetic Medicare beneficiaries who have 

19 been diagnosed with diabetes mellitus and have not 

20 received a comprehensive dilated eye examination in 

21 the previous 5 years. 

22 ‘‘(b) REQUIREMENT.—The demonstration project 

23 shall test the extent to which such incentives result in— 

24 ‘‘(1) improving early detection and treatment of 

25 diabetes-related vision problems and the reduction of 

26 significant eye and vision loss and blindness associVerDate Sep 11 2014 06:04 Feb 27, 2016 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4642.IH H4642

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1 ated with delayed diagnosis and treatment of diabe2 tes-related eye and vision conditions; 

3 ‘‘(2) reducing the cost of health care services 

4 covered under this title; and 

5 ‘‘(3) achieving beneficiary satisfaction. 

6 ‘‘(c) CONDUCT OF PROJECT.—The demonstration 

7 project shall be conducted consistent with the following: 

8 ‘‘(1) IDENTIFICATION OF PRIMARY CARE PRAC9 TICES.—The demonstration project shall identify at 

10 least 100 primary care practices, in each of at least 

11 10 States which have high per capita costs of diabe12 tes care for diabetic Medicare beneficiaries, for par13 ticipation in the demonstration project. 

14 ‘‘(2) LISTING OF PARTICIPATING EYE DOC15 TORS.—Each practice so identified shall be provided 

16 with a list of eye doctors who are located in the area 

17 of such practice and who have agreed to participate 

18 in the demonstration project. 

19 ‘‘(3) REQUIREMENTS FOR PARTICIPATING EYE

20 DOCTORS.—As part of the participation agreement 

21 of an eye doctor under the demonstration project, 

22 the eye doctor agrees— 

23 ‘‘(A) to offer to furnish to each diabetic 

24 Medicare beneficiary referred to the doctor by a 

25 primary care practice so identified a comVerDate Sep 11 2014 06:04 Feb 27, 2016 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4642.IH H4642

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1 prehensive dilated eye examination and needed 

2 diabetes-related eye care covered under this 

3 title; and 

4 ‘‘(B) to report back to such practice on the 

5 results of such an examination or care within 

6 72 hours after the time of conducting such ex7 amination or furnishing such care. 

8 ‘‘(d) INCENTIVE PAYMENT METHODOLOGY.— 

9 ‘‘(1) IN GENERAL.—Under the demonstration 

10 project, subject to paragraph (2), the Secretary shall 

11 pay an incentive on an annual basis to each primary 

12 care practice participating in the demonstration 

13 project for each beneficiary the practice refers in the 

14 year for an eye examination under the demonstra15 tion project. Such amount shall be set at a level so 

16 as to encourage primary care practices to participate 

17 in the demonstration project. 

18 ‘‘(2) BUDGET NEUTRALITY.—The Secretary 

19 shall ensure that the aggregate payments made 

20 under this title, including incentive payments made 

21 under this section, with respect to individuals par22 ticipating in the demonstration project do not exceed 

23 the aggregate amounts that the Secretary estimates 

24 would have been paid under title with respect to 

25 such individuals if the demonstration project had not 


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1 been implemented. In order to carry out the previous 

2 sentence, the Secretary is authorized to reduce pay3 ment rates under part B for eye care services for di4 abetic Medicare beneficiaries (other than those de5 scribed in subsection (a)) to take into account the 

6 costs of comprehensive dilated eye examinations fur7 nished to individuals otherwise eligible to participate 

8 in the demonstration project. 

9 ‘‘(3) FUNDING.—The costs, including incentive 

10 payments, of carrying out the demonstration project 

11 shall be paid from the Federal Supplementary Med12 ical Insurance Trust Fund established under section 

13 1841. 

14 ‘‘(e) WAIVER.—The Secretary may waive such provi15 sions of this title and title XI as the Secretary determines 

16 necessary in order to implement the demonstration 

17 project. 

18 ‘‘(f) EVALUATION AND REPORTS.— 

19 ‘‘(1) EVALUATION.—The Secretary shall con20 duct an independent evaluation of the demonstration 

21 project to assess whether the project has the results 

22 described in subsection (b). 

23 ‘‘(2) REPORTS.— 

24 ‘‘(A) PRELIMINARY REPORT.—Not later 

25 than 60 days after the completion of the first 


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1 year of the demonstration project, the Secretary 

2 shall submit to Congress a preliminary report 

3 on the results of the project. 

4 ‘‘(B) FINAL REPORT.—No later than 6 

5 months after the date of the completion of the 

6 demonstration project, the Secretary shall sub7 mit to Congress a final report on the results of 

8 the project and shall include in such report the 

9 findings of the evaluation conducted under 

10 paragraph (1). 

11 ‘‘(g) DEFINITIONS.—In this section: 

12 ‘‘(1) DIABETIC MEDICARE BENEFICIARY.—The 

13 term ‘diabetic Medicare beneficiary’ means, with re14 spect to a primary care practice, an individual 

15 who— 

16 ‘‘(A) is entitled to benefits under part A 

17 and enrolled for benefits under part B; 

18 ‘‘(B) is not enrolled in a Medicare Advan19 tage plan under part C or a PACE program 

20 under section 1894; 

21 ‘‘(C) has been determined to have diabetes 

22 mellitus; and 

23 ‘‘(D) is receiving primary care services 

24 through one or more physicians or nurse practi25 tioners in such practice. 


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1 ‘‘(2) EYE DOCTOR.—The term ‘eye doctor’ 

2 means a participating physician who is a State-li3 censed optometrist or ophthalmologist. 

4 ‘‘(3) PRIMARY CARE PRACTICE.—The term ‘pri5 mary care practice’— 

6 ‘‘(A) means a physician (as described in 

7 section 1861(r)(1)) who has a primary specialty 

8 designation of family medicine, internal medi9 cine, or geriatric medicine; and 

10 ‘‘(B) includes a group practice the physi11 cians within which are primarily physicians with 

12 such a specialty designation and may also in13 clude physician assistants and nurse practi14 tioners.’’. 

Æ 


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