I 

108TH CONGRESS 

1ST SESSION H. R. 1860

To promote primary and secondary health promotion and disease prevention 

services and activities among the elderly, to amend title XVIII of the 

Social Security Act to add preventive health benefits, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 29, 2003

Mr. LEVIN (for himself and Mr. FOLEY) 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 promote primary and secondary health promotion and 

disease prevention services and activities among the elderly, to amend title XVIII of the Social Security Act 

to add preventive health benefits, and for other purposes.

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare Wellness Act of 2003’’. 
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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows:

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

TITLE I—HEALTHY SENIORS PROMOTION PROGRAM 

Sec. 101. Definitions. 

Sec. 102. Working Group on Disease Self-Management and Health Promotion. 

Sec. 103. Healthy seniors promotion grants. 

Sec. 104. Disease self-management demonstration projects. 

TITLE II—MEDICARE COVERAGE OF PREVENTIVE HEALTH 

BENEFITS 

Sec. 201. Therapy and counseling for cessation of tobacco use. 

Sec. 202. Counseling for post-menopausal women. 

Sec. 203. Screening for diminished visual acuity. 

Sec. 204. Screening for type II diabetes mellitus for certain at-risk individuals. 

Sec. 205. Screening for cholesterol. 

Sec. 206. Screening for depression. 

Sec. 207. Expansion of eligibility for bone mass measurement. 

Sec. 208. Coverage of medical nutrition therapy services for beneficiaries with 

cardiovascular diseases. 

Sec. 209. Payment for office visit in connection with screening colonoscopy. 

Sec. 210. Program integrity. 

Sec. 211. Effective date. 

TITLE III—INCREASING UTILIZATION OF MEDICARE PREVENTIVE 

SERVICES 

Sec. 301. Elimination of deductibles and coinsurance for existing preventive 

health benefits. 

Sec. 302. Coverage of initial preventive physical examination. 

Sec. 303. Promotion of preventive health benefits. 

TITLE IV—NATIONAL FALLS PREVENTION EDUCATION AND 

AWARENESS CAMPAIGN 

Sec. 401. National Falls Prevention Education and Awareness Campaign.

3 SEC. 2. DEFINITIONS. 

4 In this Act: 

5 (1) MEDICARE BENEFICIARY.—The term 

6 ‘‘medicare beneficiary’’ means any individual who is 

7 entitled to benefits under part A or enrolled under 

8 part B of the medicare program, including any indi-
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1 vidual enrolled in a Medicare+Choice plan offered 

2 by a Medicare+Choice organization under part C of 

3 such program. 

4 (2) MEDICARE PROGRAM.—The term ‘‘medicare 

5 program’’ means the health benefits program under 

6 title XVIII of the Social Security Act (42 U.S.C. 

7 1395 et seq.). 

8 (3) SECRETARY.—The term ‘‘Secretary’’ means 

9 the Secretary of Health and Human Services. 

10 TITLE I—HEALTHY SENIORS 

11 PROMOTION PROGRAM 

12 SEC. 101. DEFINITIONS. 

13 In this title: 

14 (1) COST-EFFECTIVE BENEFIT.—The term 

15 ‘‘cost-effective benefit’’ means a benefit or technique 

16 that has—

17 (A) been subject to peer review; 

18 (B) been described in scientific journals; 

19 and 

20 (C) demonstrated value as measured by 

21 unit costs relative to health outcomes achieved. 

22 (2) COST-SAVING BENEFIT.—The term ‘‘cost23 saving benefit’’ means a benefit or technique that 

24 has—

25 (A) been subject to peer review; 
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1 (B) been described in scientific journals; 

2 and 

3 (C) caused a net reduction in health care 

4 costs for medicare beneficiaries. 

5 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti6 ty’’ means an entity that the Working Group (as de7 fined in paragraph (6)) determines has dem8 onstrated expertise regarding health promotion and 

9 disease prevention among medicare beneficiaries. 

10 (4) MEDICALLY EFFECTIVE.—The term ‘‘medi11 cally effective’’ means, with respect to a benefit or 

12 technique, that the benefit or technique has been—

13 (A) subject to peer review; 

14 (B) described in scientific journals; and 

15 (C) determined to achieve an intended goal 

16 under normal programmatic conditions. 

17 (5) MEDICALLY EFFICACIOUS.—The term 

18 ‘‘medically efficacious’’ means, with respect to a ben19 efit or technique, that the benefit or technique has 

20 been—

21 (A) subject to peer review; 

22 (B) described in scientific journals; and 

23 (C) determined to achieve an intended goal 

24 under controlled conditions.
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1 (6) WORKING GROUP.—The term ‘‘Working 

2 Group’’ means the Working Group on Disease Self3 Management and Health Promotion established 

4 under section 102. 

5 SEC. 102. WORKING GROUP ON DISEASE SELF-MANAGE6 MENT AND HEALTH PROMOTION. 

7 (a) ESTABLISHMENT.—There is established within 

8 the Department of Health and Human Services a Working 

9 Group on Disease Self-Management and Health Pro10 motion. 

11 (b) COMPOSITION.—

12 (1) IN GENERAL.—Subject to paragraph (2), 

13 the Working Group shall be composed of 5 members 

14 as follows: 

15 (A) The Administrator of the Health Care 

16 Financing Administration. 

17 (B) The Director of the Centers for Dis18 ease Control and Prevention. 

19 (C) The Director of the Agency for 

20 Healthcare Research and Quality. 

21 (D) The Assistant Secretary for Aging. 

22 (E) The Director of the National Institutes 

23 of Health. 

24 (2) ALTERNATIVE MEMBERSHIP.—Any member 

25 of the Working Group described in a subparagraph 
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1 of paragraph (1) may appoint an individual who is 

2 an officer or employee of the Federal Government to 

3 serve as a member of the Working Group instead of 

4 the member described in such subparagraph. 

5 (c) DUTIES.—The duties of the Working Group are 

6 as follows: 

7 (1) HEALTHY SENIORS PROMOTION GRANTS.—

8 The Working Group shall establish general policies 

9 and criteria with respect to the functions of the Sec10 retary under section 103, including—

11 (A) priorities for the approval of applica12 tions submitted under subsection (c) of such 

13 section; 

14 (B) procedures for monitoring and evalu15 ating research efforts conducted under such 

16 section; and 

17 (C) such other matters relating to the 

18 grant program established under such section 

19 as are recommended by the Working Group and 

20 approved by the Secretary. 

21 (2) DISEASE SELF-MANAGEMENT DEMONSTRA22 TION PROJECTS.—The Working Group shall estab23 lish general policies and criteria with respect to the 

24 functions of the Secretary under section 104, includ25 ing—
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1 (A) the identification of medical conditions 

2 for which a demonstration project under such 

3 section may be implemented; 

4 (B) the prioritization of the conditions 

5 identified under subparagraph (A) based on the 

6 potential for the self-management of such con7 dition to be medically effective and for such 

8 self-management to be a cost-effective benefit 

9 or cost-saving benefit; 

10 (C) the identification of target individuals 

11 (as defined in section 104(a)(2)); 

12 (D) the development of procedures for se13 lecting areas in which such a demonstration 

14 project may be implemented; and 

15 (E) such other matters relating to such 

16 demonstration projects as are recommended by 

17 the Working Group and approved by the Sec18 retary. 

19 (d) CHAIRPERSON.—The Secretary shall designate 1 

20 of the members of the Working Group to be the chair21 person of the Group. 

22 (e) QUORUM.—A majority of the members of the 

23 Working Group shall constitute a quorum, but, subject to 

24 subsection (f), a lesser number of members may hold 

25 meetings. 
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1 (f) MEETINGS.—The Working Group shall meet at 

2 the call of the chairperson, except that—

3 (1) it shall meet not less than 4 times each 

4 year; and 

5 (2) it shall meet upon the written request of a 

6 majority of the members. 

7 (g) COMPENSATION OF MEMBERS.—Each member of 

8 the Working Group shall serve without compensation in 

9 addition to that received for their service as an officer or 

10 employee of the Federal Government. 

11 (h) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated such sums as may be 

13 necessary for the purpose of carrying out this section. 

14 SEC. 103. HEALTHY SENIORS PROMOTION GRANTS. 

15 (a) PROGRAM AUTHORIZED.—The Secretary, using 

16 the general policies and criteria established by the Work17 ing Group under section 102(c)(1) and in accordance with 

18 the provisions of this section, is authorized to make grants 

19 to eligible entities (as defined in section 101(3)) to pay 

20 for the costs of the activities described in subsection (b). 

21 (b) USE OF FUNDS.—An eligible entity may use pay22 ments received under this section in any fiscal year to con23 duct a program to—

24 (1) study whether using different types of pro25 viders of care and alternative settings (including
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1 community-based senior centers) for the implemen2 tation of a successful health promotion and disease 

3 prevention strategy, including the implications re4 garding the payment of such providers, is medically 

5 efficacious or medically effective; 

6 (2) determine the most effective means of edu7 cating medicare beneficiaries, either directly or 

8 through providers of care, regarding the importance 

9 of health promotion and disease prevention among 

10 such beneficiaries; 

11 (3) identify incentives that would increase the 

12 use of new and existing preventive health benefits 

13 and healthy behaviors by medicare beneficiaries; 

14 (4) promote—

15 (A) the use of preventive health benefits by 

16 medicare beneficiaries, including such services 

17 that are covered under the medicare program; 

18 (B) the proper use by medicare bene19 ficiaries of prescription and over-the-counter 

20 drugs in order to reduce the number of hospital 

21 stays and physician visits that are a result of 

22 improper use of such drugs; and 

23 (C) the utilization by medicare bene24 ficiaries of the steps (including exercise, mainte25 nance of a proper diet, and the utilization of ac-
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1 cident prevention techniques) that research has 

2 shown to promote and safeguard individual 

3 health; and 

4 (5) address other topics designated by the Sec5 retary. 

6 (c) APPLICATION.—

7 (1) IN GENERAL.—Each eligible entity that de8 sires to receive a grant under this section shall sub9 mit an application to the Secretary, at such time, in 

10 such manner, and accompanied by such additional 

11 information as the Secretary may reasonably re12 quire. 

13 (2) CONTENTS.—Each application submitted 

14 under paragraph (1) shall—

15 (A) describe the activities for which assist16 ance under this section is sought; 

17 (B) describe how such activities will— 

18 (i) reflect the medical, behavioral, and 

19 social aspects of care for medicare bene20 ficiaries; 

21 (ii) lead to the development of cost-ef22 fective benefits and cost-saving benefits; 

23 and 

24 (iii) impact the quality of life of medi25 care beneficiaries; 
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1 (C) provide assurances that such activities 

2 will focus on broad medicare populations rather 

3 than unique local medicare populations; 

4 (D) provide evidence that the eligible entity 

5 meets the general policies and criteria estab6 lished by the Working Group under section 

7 102(c)(1); 

8 (E) provide assurances that the eligible en9 tity will take such steps as may be available to 

10 the entity in order to continue the activities for 

11 which the entity is making application after the 

12 period for which assistance is sought; and 

13 (F) provide such additional assurances as 

14 the Secretary determines to be essential to en15 sure compliance with the requirements of this 

16 title. 

17 (3) JOINT APPLICATION.—A consortium of eli18 gible entities may file a joint application under the 

19 provisions of paragraph (1). 

20 (d) APPROVAL OF APPLICATION.—The Secretary 

21 shall approve applications in accordance with the general 

22 policies and criteria established by the Working Group 

23 under section 102(c)(1). 

24 (e) PAYMENTS.—Subject to amounts appropriated 

25 under subsection (g), the Secretary shall pay to each eligi-
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1 ble entity having an application approved under subsection 

2 (d) the cost of the activities described in the application. 

3 (f) EVALUATION AND REPORT.—

4 (1) EVALUATION.—The Secretary shall conduct 

5 an annual evaluation of grants made under this sec6 tion to determine—

7 (A) the results of the activities conducted 

8 under the programs for which grants were 

9 made under this section; 

10 (B) the extent to which research assisted 

11 under this section has improved or expanded 

12 the general research for health promotion and 

13 disease prevention among medicare beneficiaries 

14 and identified practical interventions based 

15 upon such research; 

16 (C) a list of specific recommendations 

17 based upon the activities conducted under the 

18 programs for which grants were made under 

19 this section which show promise as practical 

20 interventions for health promotion and disease 

21 prevention among medicare beneficiaries; 

22 (D) whether or not, as a result of the ac23 tivities conducted under the programs for which 

24 grants were made under this section, certain 

25 health promotion and disease prevention bene-
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1 fits or education efforts should be added to the 

2 medicare program, including discussions of 

3 quality of life, translating the applied research 

4 results into a benefit under the medicare pro5 gram, and whether each additional benefit 

6 would be a cost-effective benefit or a cost-saving 

7 benefit for each proposed addition; and 

8 (E) how best to increase utilization of ex9 isting and recommended health promotion and 

10 disease prevention services, such as an edu11 cation and public awareness campaign, pro12 viding financial incentives for providers of care 

13 and medicare beneficiaries, or utilizing other 

14 administrative means. 

15 (2) ANNUAL REPORT.—Not later than Decem16 ber 31, 2005, and annually thereafter through 2007, 

17 the Secretary, in consultation with the Working 

18 Group, shall submit a report to Congress on the 

19 evaluation conducted under paragraph (1), together 

20 with such recommendations for such legislation and 

21 administrative actions as the Secretary considers ap22 propriate. 

23 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

24 are authorized to be appropriated for the purpose of car-
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1 rying out this section $50,000,000 for each of fiscal years 

2 2004, 2005, 2006, and 2007. 

3 SEC. 104. DISEASE SELF-MANAGEMENT DEMONSTRATION 

4 PROJECTS. 

5 (a) DEMONSTRATION PROJECTS.—

6 (1) IN GENERAL.—The Secretary shall conduct 

7 demonstration projects for the purpose of promoting 

8 disease self-management for conditions identified by 

9 the Working Group under section 102(c)(2) for tar10 get individuals (as defined in paragraph (2)). 

11 (2) TARGET INDIVIDUAL DEFINED.—In this 

12 section, the term ‘‘target individual’’ means an indi13 vidual who—

14 (A) is at risk for, or has, 1 or more of the 

15 conditions identified by the Working Group 

16 under section 102(c)(2); and 

17 (B) is enrolled under the original medicare 

18 fee-for-service program under parts A and B of 

19 title XVIII of the Social Security Act (42 

20 U.S.C. 1395c et seq.; 1395j et seq.) or is en21 rolled under the Medicare+Choice program 

22 under part C of title XVIII of such Act (42 

23 U.S.C. 1395w–21 et seq.). 

24 (b) NUMBER; PROJECT AREAS; DURATION.—
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1 (1) NUMBER.—Not later than 2 years after the 

2 date of enactment of this Act, the Secretary shall 

3 implement a series of demonstration projects to 

4 carry out the purpose described in subsection (a)(1). 

5 (2) PROJECT AREAS.—The Secretary shall im6 plement the demonstration projects described in 

7 paragraph (1) in urban, suburban, and rural areas. 

8 (3) DURATION.—The demonstration projects 

9 under this section shall be conducted during the 3-

10 year period beginning on the date on which the ini11 tial demonstration project is implemented. 

12 (c) REPORT TO CONGRESS.—

13 (1) IN GENERAL.—Not later than 18 months 

14 after the conclusion of the demonstration projects 

15 under this section, the Secretary shall submit a re16 port to Congress on such projects. 

17 (2) CONTENTS OF REPORT.—The report re18 quired under paragraph (1) shall include the fol19 lowing: 

20 (A) A description of the demonstration 

21 projects. 

22 (B) An evaluation of—

23 (i) whether each benefit provided 

24 under the demonstration projects is a cost25 effective benefit or a cost-saving benefit; 
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1 (ii) the level of the disease self-man2 agement attained by target individuals 

3 under the demonstration projects; and 

4 (iii) the satisfaction of target individ5 uals under the demonstration projects. 

6 (C) Recommendations of the Secretary re7 garding whether to conduct the demonstration 

8 projects on a permanent basis. 

9 (D) Such recommendations for legislation 

10 and administrative action as the Secretary de11 termines to be appropriate. 

12 (E) Any other information regarding the 

13 demonstration projects that the Secretary de14 termines to be appropriate. 

15 (d) FUNDING.—The Secretary shall provide for the 

16 transfer from the Federal Hospital Insurance Trust Fund 

17 under section 1817 of the Social Security Act (42 U.S.C. 

18 1395i) an amount not to exceed $30,000,000 for the costs 

19 of carrying out this section. 
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1 TITLE II—MEDICARE COVERAGE 

2 OF PREVENTIVE HEALTH 

3 BENEFITS 

4 SEC. 201. THERAPY AND COUNSELING FOR CESSATION OF 

5 TOBACCO USE. 

6 (a) COVERAGE.—Section 1861(s)(2) of the Social Se7 curity Act (42 U.S.C. 1395x(s)(2)) is amended—

8 (1) in subparagraph (U), by striking ‘‘and’’ at 

9 the end; 

10 (2) in subparagraph (V), by inserting ‘‘and’’ at 

11 the end; and 

12 (3) by adding at the end the following new sub13 paragraph: 

14 ‘‘(W) supplemental preventive health services 

15 (as defined in subsection (ww));’’. 

16 (b) SERVICES DESCRIBED.—Section 1861 of the So17 cial Security Act (42 U.S.C. 1395x) is amended by adding 

18 at the end the following new subsection: 

19 ‘‘Supplemental Preventive Health Services 

20 ‘‘(ww) The term ‘supplemental preventive health serv21 ices’ means the following: 

22 ‘‘(1)(A) Therapy and counseling for cessation of 

23 tobacco use for individuals who use tobacco products 

24 or who are being treated for tobacco use that is fur25 nished—
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1 ‘‘(i) by or under the supervision of a physi2 cian; or 

3 ‘‘(ii) by any other health care professional 

4 who— 

5 ‘‘(I) is legally authorized to furnish 

6 such services under State law (or the State 

7 regulatory mechanism provided by State 

8 law) of the State in which the services are 

9 furnished; and 

10 ‘‘(II) is authorized to receive payment 

11 for other services under this title or is des12 ignated by the Secretary for this purpose. 

13 ‘‘(B) Subject to subparagraph (C), such term is 

14 limited to—

15 ‘‘(i) therapy and counseling services rec16 ommended in ‘Treating Tobacco Use and De17 pendence: A Clinical Practice Guideline’, pub18 lished by the Public Health Service in June 

19 2000, or any subsequent modification of such 

20 Guideline; and 

21 ‘‘(ii) such other therapy and counseling 

22 services that the Secretary recognizes to be ef23 fective. 
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1 ‘‘(C) Such term shall not include coverage for 

2 drugs or biologicals that are not otherwise covered 

3 under this title.’’. 

4 (c) PAYMENT AND ELIMINATION OF COST-SHARING

5 FOR ALL SUPPLEMENTAL PREVENTIVE HEALTH SERV6 ICES.—

7 (1) PAYMENT AND ELIMINATION OF COINSUR8 ANCE.—Section 1833(a)(1) of the Social Security 

9 Act (42 U.S.C. 1395l(a)(1)) is amended—

10 (A) in subparagraph (N), by inserting 

11 ‘‘other than supplemental preventive health 

12 services (as defined in section 1861(ww))’’ after 

13 ‘‘(as defined in section 1848(j)(3))’’

14 (B) by striking ‘‘and’’ before ‘‘(U)’’; and 

15 (C) by inserting before the semicolon at 

16 the end the following: ‘‘, and (V) with respect 

17 to supplemental preventive health services (as 

18 defined in section 1861(ww)), the amount paid 

19 shall be 100 percent of the lesser of the actual 

20 charge for the services or the amount deter21 mined under the payment basis determined 

22 under section 1848 by the Secretary for the 

23 particular supplemental preventive health serv24 ice involved’’.
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1 (2) PAYMENT UNDER PHYSICIAN FEE SCHED2 ULE.—Section 1848(j)(3) (42 U.S.C. 1395w–

3 4(j)(3)) is amended by inserting ‘‘(2)(W),’’ after 

4 ‘‘(2)(S),’’. 

5 (3) ELIMINATION OF COINSURANCE IN OUT6 PATIENT HOSPITAL SETTINGS.—The third sentence 

7 of section 1866(a)(2)(A) of the Social Security Act 

8 (42 U.S.C. 1395cc(a)(2)(A)) is amended by insert9 ing after ‘‘1861(s)(10)(A)’’ the following: ‘‘, with re10 spect to supplemental preventive health services (as 

11 defined in section 1861(ww)),’’. 

12 (4) ELIMINATION OF DEDUCTIBLE.—The first 

13 sentence of section 1833(b) of the Social Security 

14 Act (42 U.S.C. 1395l(b)) is amended—

15 (A) by striking ‘‘and’’ before ‘‘(6)’’; and 

16 (B) by inserting before the period the fol17 lowing: ‘‘, and (7) such deductible shall not 

18 apply with respect to supplemental preventive 

19 health services (as defined in section 

20 1861(ww))’’. 

21 (d) APPLICATION OF LIMITS ON BILLING.—Section 

22 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 

23 1395u(b)(18)(C)) is amended by adding at the end the 

24 following new clause: 
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1 ‘‘(vii) Any health care professional with respect 

2 to the furnishing of supplemental preventive health 

3 services.’’. 

4 SEC. 202. COUNSELING FOR POST-MENOPAUSAL WOMEN. 

5 Section 1861(ww) of the Social Security Act (42 

6 U.S.C. 1395x(s)(2)), as added by section 201(b), is 

7 amended by adding at the end the following new para8 graph: 

9 ‘‘(2)(A) Counseling for post-menopausal 

10 women. 

11 ‘‘(B) For purposes of subparagraph (A), the 

12 term ‘counseling for post-menopausal women’ means 

13 counseling provided to a post-menopausal woman re14 garding—

15 ‘‘(i) the symptoms, risk factors, and condi16 tions associated with menopause; 

17 ‘‘(ii) appropriate treatment options for 

18 post-menopausal women, including hormone re19 placement therapy; and 

20 ‘‘(iii) other interventions that can be imple21 mented to prevent or delay the onset of health 

22 risks associated with menopause. 

23 ‘‘(C) Such term does not include coverage for 

24 drugs or biologicals that are not otherwise covered 

25 under this title.’’. 
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1 SEC. 203. SCREENING FOR DIMINISHED VISUAL ACUITY. 

2 Section 1861(ww) of the Social Security Act (42 

3 U.S.C. 1395x(s)(2)), as amended by section 202(a), is 

4 amended by adding at the end the following new para5 graph: 

6 ‘‘(3)(A) Screening for diminished visual acuity. 

7 ‘‘(B) For purposes of subparagraph (A), the 

8 term ‘screening for diminished visual acuity’ means 

9 a screening for diminished visual acuity that is fur10 nished by or under the supervision of an optometrist 

11 or ophthalmologist who is legally authorized to fur12 nish such services under State law (or the State reg13 ulatory mechanism provided by State law) of the 

14 State in which the services are furnished.’’. 

15 SEC. 204. SCREENING FOR TYPE II DIABETES MELLITUS 

16 FOR CERTAIN AT-RISK INDIVIDUALS. 

17 Section 1861(ww) of the Social Security Act (42 

18 U.S.C. 1395x(s)(2)), as amended by section 203(a), is 

19 amended by adding at the end the following new para20 graph: 

21 ‘‘(4) Screening for diabetes II mellitus for indi22 viduals with hypertension or hyperlipidenia if the in23 dividual involved has not had such a screening dur24 ing the preceding 3 years.’’. 
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1 SEC. 205. SCREENING FOR CHOLESTEROL. 

2 (a) IN GENERAL.—Section 1861(ww) of the Social 

3 Security Act (42 U.S.C. 1395x(s)(2)), as amended by sec4 tion 204(a), is amended by adding at the end the following 

5 new paragraph: 

6 ‘‘(5)(A) Screening for cholesterol if the indi7 vidual involved has not had such a screening during 

8 the preceding 5 years. 

9 ‘‘(B) Notwithstanding subparagraph (A), pay10 ment may be made under this part for a screening 

11 for cholesterol with respect to an individual even if 

12 the individual has had such a screening during the 

13 preceding 5 years if the individual exhibits major 

14 risk factors for coronary heart disease or a stroke, 

15 including, but not limited to, smoking, hypertension, 

16 and diabetes.’’. 

17 (b) CONFORMING AMENDMENT APPLYING FRE18 QUENCY LIMITATIONS.—Section 1862(a)(1) of the Social 

19 Security Act (42 U.S.C. 1395y(a)(1)) is amended—

20 (1) in subparagraph (H), by striking ‘‘and’’ at 

21 the end; 

22 (2) in subparagraph (I), by striking the semi23 colon at the end and inserting ‘‘, and’’; and 

24 (3) by adding at the end the following new sub25 paragraph: 
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1 ‘‘(J) in the case of supplemental preventive 

2 health services, which is performed more fre3 quently than is covered under section 

4 1861(ww);’’. 

5 SEC. 206. SCREENING FOR DEPRESSION. 

6 Section 1861(ww) of the Social Security Act (42 

7 U.S.C. 1395x(s)(2)), as amended by section 205(a), is 

8 amended by adding at the end the following new para9 graph: 

10 ‘‘(6)(A) Screenings for clinical depression to an 

11 individual through qualified health professionals in 

12 accordance with the requirements of this paragraph, 

13 if the individual has not had such a screening per14 formed during the preceding 12 months. 

15 ‘‘(B) In this paragraph, the term ‘qualified 

16 health professional’ means an individual that—

17 ‘‘(i) is—

18 ‘‘(I) a physician (as defined in sub19 section (r)(1)); 

20 ‘‘(II) a nurse practitioner (as defined 

21 in subsection (aa)(5)); or 

22 ‘‘(III) a mental health care profes23 sional (including a clinical social worker, as 

24 defined in subsection 1861(hh)) that is li25 censed to perform mental health services
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1 by the State in which a screening for clin2 ical depression is furnished; and 

3 ‘‘(ii) is a participating physician or sup4 plier and has an agreement in effect with the 

5 Secretary under which the individual agrees to 

6 accept the amount determined under part B as 

7 full payment for such screening and to accept 

8 an assignment described in section 

9 1842(b)(3)(B)(ii) of the Social Security Act (42 

10 U.S.C. 1395u(b)(3)(B)(ii)) with respect to pay11 ment for each screening furnished by the pro12 fessional to an eligible beneficiary. 

13 ‘‘(C)(i) The term ‘screening for clinical depres14 sion’ means a consultation during which a self-ad15 ministered written screening test (or an alternative 

16 format for such test pursuant to subparagraph (D)) 

17 is made available to an individual and a qualified 

18 health professional—

19 ‘‘(I) interprets the results of such test; 

20 ‘‘(II) discusses the beneficiary’s responses 

21 to the questions on the test with the bene22 ficiary; 

23 ‘‘(III) assesses the beneficiary’s risk of 

24 clinical depression; and 
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1 ‘‘(IV) if the qualified health professional 

2 determines that the beneficiary is at high risk 

3 for clinical depression, refers the eligible bene4 ficiary for a full diagnostic evaluation and such 

5 additional treatment as may be required. 

6 ‘‘(ii) Nothing in clause (i)(IV) shall be con7 strued as prohibiting a qualified health professional 

8 performing the screening for clinical depression with 

9 respect to an individual from directly providing the 

10 diagnostic evaluation and additional treatment de11 scribed in such clause to such individual if legally 

12 authorized under State law to do so. 

13 ‘‘(D) For purposes of this paragraph, the term 

14 ‘self-administered written screening test’ means an 

15 instrument on which an individual writes answers to 

16 questions designed to enable a qualified health pro17 fessional to establish the level of risk of such eligible 

18 beneficiary for clinical depression. 

19 ‘‘(E)(i) The Secretary, in consultation with pro20 fessionals experienced in conducting large-scale de21 pression screening projects, shall—

22 ‘‘(I) establish or identify a self-adminis23 tered written screening test to be used under 

24 this paragraph; and 
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1 ‘‘(II) not later than the date that is 3 

2 months before the date on which this paragraph 

3 is implemented, distribute such test to qualified 

4 health professionals that provide services, to5 gether with guidelines for making the test avail6 able to individuals. 

7 ‘‘(ii) The Secretary shall also establish and 

8 distribute alternative formats for the self-ad9 ministered written screening test under clause 

10 (i) which shall be available for use when cir11 cumstances do not permit an individual to com12 plete the self-administered written screening 

13 test.’’. 

14 SEC. 207. EXPANSION OF ELIGIBILITY FOR BONE MASS 

15 MEASUREMENT. 

16 (a) EXPANSION.—Section 1861(rr)(2) of the Social 

17 Security Act (42 U.S.C. 1395x(rr)(2)) is amended to read 

18 as follows: 

19 ‘‘(2) For purposes of this subsection, the term ‘quali20 fied individual’ means an individual who is (in accordance 

21 with regulations prescribed by the Secretary)—

22 ‘‘(A) an estrogen-deficient woman (including 

23 those receiving hormone replacement therapy); 
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1 ‘‘(B) an individual with low trauma or fragility 

2 fractures (including vertebral abnormalities and hip, 

3 rib, wrist, pelvic, or proximal humeral fractures); 

4 ‘‘(C) an individual receiving long-term medica5 tions that have associations to bone loss or 

6 osteoporosis (including glucocorticoid therapy and 

7 androgen deprivation therapy); 

8 ‘‘(D) an individual with a long-term medical 

9 condition that has association to osteoporosis (in10 cluding primary hyperparathyroidism); 

11 ‘‘(E) a man with risk factors for osteoporosis 

12 such as hypogonadism; and 

13 ‘‘(F) an individual being monitored to assess 

14 the response to, or efficacy of, an approved 

15 osteoporosis therapy.’’. 

16 (b) REFERENCE TO ELIMINATION OF COINSURANCE

17 AND WAIVER OF APPLICATION OF DEDUCTIBLE.—For 

18 the elimination of the coinsurance for bone mass measure19 ment and for the waiver of the application of the part B 

20 deductible for such measurement, see section 301. 
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1 SEC. 208. COVERAGE OF MEDICAL NUTRITION THERAPY 

2 SERVICES FOR BENEFICIARIES WITH CAR3 DIOVASCULAR DISEASES. 

4 (a) IN GENERAL.—Section 1861(s)(2)(V) of the So5 cial Security Act (42 U.S.C. 1395x(s)(2)(V)) is amended 

6 to read as follows: 

7 ‘‘(V) medical nutrition therapy services (as de8 fined in subsection (vv)(1)) in the case of a bene9 ficiary—

10 ‘‘(i) with a cardiovascular disease (includ11 ing congestive heart failure, arteriosclerosis, 

12 hyperlipidemia, hypertension, and 

13 hypercholesterolemia), diabetes, or a renal dis14 ease (or a combination of such conditions) 

15 who—

16 ‘‘(I) has not received diabetes out17 patient self-management training services 

18 within a time period determined by the 

19 Secretary; 

20 ‘‘(II) is not receiving maintenance di21 alysis for which payment is made under 

22 section 1881; and 

23 ‘‘(III) meets such other criteria deter24 mined by the Secretary after consideration 

25 of protocols established by dietitian or nu26 trition professional organizations; or 
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1 ‘‘(ii) with a combination of such conditions 

2 who—

3 ‘‘(I) is not described in clause (i) be4 cause of the application of subclause (I) or 

5 (II) of such clause; 

6 ‘‘(II) receives such medical nutrition 

7 therapy services in a coordinated manner 

8 (as determined appropriate by the Sec9 retary) with any services described in such 

10 subclauses that the beneficiary is receiving; 

11 and 

12 ‘‘(III) meets such other criteria deter13 mined by the Secretary after consideration 

14 of protocols established by dietitian or nu15 trition professional organizations;’’. 

16 (b) ELIMINATION OF COINSURANCE.—Section 

17 1833(a)(1)(T) of the Social Security Act (42 U.S.C. 

18 1395l(a)(1)(T)) is amended by striking ‘‘80 percent’’ and 

19 inserting ‘‘100 percent’’. 

20 (c) REFERENCE TO WAIVER OF APPLICATION OF DE21 DUCTIBLE.—For the waiver of the application of the part 

22 B deductible for medical nutrition therapy services, see 

23 section 301. 
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1 SEC. 209. PAYMENT FOR OFFICE VISIT IN CONNECTION 

2 WITH SCREENING COLONOSCOPY. 

3 (a) INCLUSION OF OFFICE VISIT IN BENEFIT.—Sec4 tion 1861(pp)(1) of the Social Security Act (42 U.S.C. 

5 1395x(pp)(1)) is amended by inserting ‘‘(and includes, in 

6 the case of screening colonoscopy, the office visit associ7 ated with the colonoscopy)’’ after ‘‘for the purpose of early 

8 detection of colorectal cancer’’. 

9 (b) CONFORMING PAYMENT.—Section 1834(d)(3)(B) 

10 of such Act (42 U.S.C. 1395m(d)(3)(B)) is amended by 

11 adding at the end the following: ‘‘Such payment shall take 

12 into account payment for the office visit associated with 

13 the colonoscopy.’’. 

14 SEC. 210. PROGRAM INTEGRITY. 

15 The Secretary, in consultation with the Inspector 

16 General of the Department of Health and Human Serv17 ices, shall integrate supplemental preventive health serv18 ices (as defined in section 1861(ww) of the Social Security 

19 Act (as added by the preceding provisions of this title)) 

20 with existing program integrity measures. 

21 SEC. 211. EFFECTIVE DATE. 

22 Except as otherwise provided in this title, the amend23 ments made by this title shall apply to services furnished 

24 on or after January 1, 2004. 
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1 TITLE III—INCREASING UTILIZA2 TION OF MEDICARE PREVEN3 TIVE SERVICES 

4 SEC. 301. ELIMINATION OF DEDUCTIBLES AND COINSUR5 ANCE FOR EXISTING PREVENTIVE HEALTH 

6 BENEFITS. 

7 (a) IN GENERAL.—Section 1833 of the Social Secu8 rity Act (42 U.S.C. 1395l) is amended by inserting after 

9 subsection (o) the following new subsection: 

10 ‘‘(p) DEDUCTIBLES AND COINSURANCE WAIVED FOR

11 PREVENTIVE HEALTH ITEMS AND SERVICES.—The Sec12 retary may not require the payment of any deductible or 

13 coinsurance under subsection (a) or (b), respectively, of 

14 any individual enrolled for coverage under this part for 

15 any of the following preventive health items and services: 

16 ‘‘(1) Blood-testing strips, lancets, and blood 

17 glucose monitors for individuals with diabetes de18 scribed in section 1861(n). 

19 ‘‘(2) Diabetes outpatient self-management 

20 training services (as defined in section 1861(qq)(1)). 

21 ‘‘(3) Pneumococcal, influenza, and hepatitis B 

22 vaccines and administration described in section 

23 1861(s)(10). 

24 ‘‘(4) Screening mammography (as defined in 

25 section 1861(jj)). 
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1 ‘‘(5) Screening pap smear and screening pelvic 

2 exam (as defined in paragraphs (1) and (2) of sec3 tion 1861(nn), respectively). 

4 ‘‘(6) Bone mass measurement (as defined in 

5 section 1861(rr)(1)). 

6 ‘‘(7) Prostate cancer screening test (as defined 

7 in section 1861(oo)(1)). 

8 ‘‘(8) Colorectal cancer screening test (as de9 fined in section 1861(pp)(1)). 

10 ‘‘(9) Screening for glaucoma (as defined in sec11 tion 1861(uu)). 

12 ‘‘(10) Medical nutrition therapy services (as de13 fined in section 1861(vv)(1)).’’. 

14 (b) WAIVER OF COINSURANCE.—

15 (1) IN GENERAL.—Section 1833(a)(1)(B) of the 

16 Social Security Act (42 U.S.C. 1395l(a)(1)(B)) is 

17 amended to read as follows: ‘‘(B) with respect to 

18 preventive health items and services described in 

19 subsection (p), the amounts paid shall be 100 per20 cent of the fee schedule or other basis of payment 

21 under this title for the particular item or service,’’. 

22 (2) ELIMINATION OF COINSURANCE IN OUT23 PATIENT HOSPITAL SETTINGS.—The third sentence 

24 of section 1866(a)(2)(A) of the Social Security Act 

25 (42 U.S.C. 1395cc(a)(2)(A)), as amended by section 
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1 201(c)(3), is amended by inserting after ‘‘section 

2 1861(ww)’’ the following: ‘‘and preventive health 

3 items and services described in section 1833(p)’’. 

4 (c) WAIVER OF APPLICATION OF DEDUCTIBLE.—

5 Section 1833(b)(1) of the Social Security Act (42 U.S.C. 

6 1395l(b)(1)) is amended to read as follows: ‘‘(1) such de7 ductible shall not apply with respect to preventive health 

8 items and services described in subsection (p),’’. 

9 (d) ADDING ‘‘LANCET’’ TO DEFINITION OF DME.—

10 Section 1861(n) of the Social Security Act (42 U.S.C. 

11 1395x(n)) is amended by striking ‘‘blood-testing strips

12 and blood glucose monitors’’ and inserting ‘‘blood-testing 

13 strips, lancets, and blood glucose monitors’’. 

14 (e) CONFORMING AMENDMENTS.—

15 (1) ELIMINATION OF COINSURANCE FOR CLIN16 ICAL DIAGNOSTIC LABORATORY TESTS.—Paragraphs 

17 (1)(D)(i) and (2)(D)(i) of section 1833(a) of the So18 cial Security Act (42 U.S.C. 1395l(a)) are each 

19 amended by inserting ‘‘or which are described in 

20 subsection (p)’’ after ‘‘assignment-related basis’’. 

21 (2) ELIMINATION OF COINSURANCE FOR CER22 TAIN DME.—Section 1834(a)(1)(A) of the Social Se23 curity Act (42 U.S.C. 1395m(a)(1)(A)) is amended 

24 by inserting ‘‘(or 100 percent, in the case of such an 
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1 item described in section 1833(p))’’ after ‘‘80 per2 cent’’. 

3 (3) ELIMINATION OF DEDUCTIBLES AND COIN4 SURANCE FOR COLORECTAL CANCER SCREENING

5 TESTS.—Section 1834(d) of the Social Security Act 

6 (42 U.S.C. 1395m(d)) is amended—

7 (A) in paragraph (2)(C)—

8 (i) by striking ‘‘(C) FACILITY PAY9 MENT LIMIT.—’’ and all that follows 

10 through ‘‘Notwithstanding subsections’’ 

11 and inserting the following: 

12 ‘‘(C) FACILITY PAYMENT LIMIT.—Notwith13 standing subsections’’; 

14 (ii) by striking ‘‘(I) in accordance’’ 

15 and inserting the following: 

16 ‘‘(i) in accordance’’; 

17 (iii) by striking ‘‘(II) are performed’’ 

18 and all that follows through ‘‘payment 

19 under’’ and inserting the following: 

20 ‘‘(ii) are performed in an ambulatory 

21 surgical center or hospital outpatient de22 partment, 

23 payment under’’; and 

24 (iv) by striking clause (ii); and 

25 (B) in paragraph (3)(C)—
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1 (i) by striking ‘‘(C) FACILITY PAY2 MENT LIMIT.—’’ and all that follows 

3 through ‘‘Notwithstanding subsections’’ 

4 and inserting the following: 

5 ‘‘(C) FACILITY PAYMENT LIMIT.—Notwith6 standing subsections’’; and 

7 (ii) by striking clause (ii). 

8 (f) EFFECTIVE DATE.—The amendments made by 

9 this section shall apply to services furnished on or after 

10 the day that is 1 year after the date of enactment of this 

11 Act. 

12 SEC. 302. COVERAGE OF INITIAL PREVENTIVE PHYSICAL 

13 EXAMINATION. 

14 (a) IN GENERAL.—Section 1861(ww) of the Social 

15 Security Act (42 U.S.C. 1395x(s)(2)), as amended by sec16 tion 206(a), is amended by adding at the end the following 

17 new paragraph: 

18 ‘‘(7)(A) An initial preventive physical examina19 tion. 

20 ‘‘(B) For purposes of subparagraph (A), the 

21 term ‘initial preventive physical examination’ means 

22 physicians’ services consisting of a physical examina23 tion with the goal of health promotion and disease 

24 detection and includes a history and physical exam, 

25 a health risk appraisal, and health risk counseling, 
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1 and laboratory tests or other items and services as 

2 determined by the Secretary in consultation with the 

3 United States Preventive Services Task Force. 

4 ‘‘(C) In the case of any item or service that is 

5 included as part of an initial preventive physical ex6 amination and that is otherwise separately covered 

7 under a preceding paragraph of this subsection, the 

8 item or service shall be treated for purposes of that 

9 preceding paragraph as having been received at the 

10 time of such examination.’’. 

11 (b) CONFORMING AMENDMENT APPLYING FRE12 QUENCY LIMITATIONS.—Section 1862(a) of such Act (42 

13 U.S.C. 1395y(a)), as amended by section 205(b), is 

14 amended—

15 (1) in paragraph (1)—

16 (A) by striking ‘‘and’’ at the end of sub17 paragraph (I); 

18 (B) by striking the semicolon at the end of 

19 subparagraph (J) and inserting ‘‘, and’’; and 

20 (C) by adding at the end the following new 

21 subparagraph: 

22 ‘‘(K) in the case of an initial preventive physical 

23 examination (as defined in section 1861(ww)(7)(B)), 

24 which is performed not later than 6 months after 
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1 the date the individual’s first coverage period begins 

2 under part B;’’; and 

3 (2) in paragraph (7), by striking ‘‘or (H)’’ and 

4 inserting ‘‘(H), or (K)’’. 

5 (c) APPLICATION OF PAYMENT PROVISIONS.—For 

6 provisions providing payment for supplemental preventive 

7 health services (including an initial preventive physical ex8 amination) without application of any deductible or coin9 surance, see the amendments made by section 201(c). 

10 (d) EFFECTIVE DATE.—The amendments made by 

11 this section shall apply to services furnished on or after 

12 January 1, 2004, but only for individuals whose coverage 

13 period begins on or after such date. 

14 SEC. 303. PROMOTION OF PREVENTIVE HEALTH BENEFITS. 

15 In order to promote the use by medicare beneficiaries 

16 of preventive health benefits, including preventive health 

17 services (as defined in section 1861(ww) of the Social Se18 curity Act (as added by the preceding provisions of this 

19 title)) and preventive health items and services described 

20 in section 1833(p) of such Act (as added by section 301), 

21 the Secretary shall do the following: 

22 (1) MEDICARE HANDBOOK AND OTHER ANNUAL

23 NOTICES.—Include in any medicare handbook and 

24 any other annual notice provided to medicare bene25 ficiaries a detailed description of—
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1 (A) the preventive health benefits that are 

2 covered under the medicare program; and 

3 (B) the importance of using such benefits. 

4 (2) FISCAL INTERMEDIARIES AND CARRIERS.—

5 Require that fiscal intermediaries with a contract 

6 under section 1816 of the Social Security Act (42 

7 U.S.C. 1395h) and carriers with a contract under 

8 section 1842 of such Act (42 U.S.C. 1395u) include 

9 preventive health benefits messages on Medicare 

10 Summary Notice Statements and Explanations of 

11 Medicare Benefits distributed by such entities. 

12 (3) MEDICARE+CHOICE PLANS.—Require that 

13 Medicare+Choice organizations offering a 

14 Medicare+Choice plan disclose under section

15 1852(c)(1)(B) of the Social Security Act (42 U.S.C. 

16 1395w–22(c)(1)(B)) information regarding the pre17 ventive health benefits that are covered under the 

18 plan. 

19 (4) OTHER ACTIVITIES.—Conduct activities in 

20 addition to those described in paragraphs (1) 

21 through (3) that the Secretary determines to be use22 ful in disseminating information to medicare bene23 ficiaries regarding—

24 (A) the preventive health benefits that are 

25 covered under the medicare program; 
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1 (B) the importance of using such benefits; 

2 and 

3 (C) general health promotion. 

4 TITLE IV—NATIONAL FALLS 

5 PREVENTION EDUCATION 

6 AND AWARENESS CAMPAIGN 

7 SEC. 401. NATIONAL FALLS PREVENTION EDUCATION AND 

8 AWARENESS CAMPAIGN. 

9 (a) IN GENERAL.—The Director of the Centers for 

10 Disease Control and Prevention, in consultation with the 

11 Administrator of the Health Care Financing Administra12 tion, shall conduct a national falls prevention and aware13 ness campaign to reduce fall-related injuries among medi14 care beneficiaries. 

15 (b) REPORT TO CONGRESS.—

16 (1) IN GENERAL.—The Director of the Centers 

17 for Disease Control and Prevention, in consultation 

18 with the Administrator of the Health Care Financ19 ing Administration, shall submit to Congress a re20 port on the campaign conducted under this section. 

21 (2) DEADLINE FOR REPORT.—The report re22 quired under paragraph (1) shall be submitted not 

23 later than the earlier of—

24 (A) 6 months after the campaign is com25 pleted; or 
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1 (B) 3 years after the campaign is imple2 mented. 

3 (3) CONTENTS OF REPORT.—The report re4 quired under paragraph (1) shall include the fol5 lowing: 

6 (A) A description of the campaign. 

7 (B) An evaluation of—

8 (i) whether the campaign has effec9 tively reached its target population; and 

10 (ii) the cost-effectiveness of the cam11 paign. 

12 (C) An assessment of whether the cam13 paign has been effective, as measured by wheth14 er—

15 (i) the target population has adopted 

16 the interventions suggested in the cam17 paign, and if not, the reasons why such 

18 interventions have not been adopted; and 

19 (ii) the fall rates among the target 

20 population have decreased since the cam21 paign was implemented, and if not, the 

22 reasons why such fall rates have not de23 creased. 

24 (D) Any other information regarding the 

25 campaign that the Director of the Centers for 
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1 Disease Control and Prevention determines to 

2 be appropriate. 

3 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated such sums as may be 

5 necessary for the purpose of carrying out this section.

Æ