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[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1860 Introduced in House (IH)]

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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Wellness 
Act of 2003''.
    (b) Table of Contents.--The table of contents of 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.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Medicare beneficiary.--The term ``medicare 
        beneficiary'' means any individual who is entitled to benefits 
        under part A or enrolled under part B of the medicare program, 
        including any individual enrolled in a Medicare+Choice plan 
        offered by a Medicare+Choice organization under part C of such 
        program.
            (2) Medicare program.--The term ``medicare program'' means 
        the health benefits program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

               TITLE I--HEALTHY SENIORS PROMOTION PROGRAM

SEC. 101. DEFINITIONS.

    In this title:
            (1) Cost-effective benefit.--The term ``cost-effective 
        benefit'' means a benefit or technique that has--
                    (A) been subject to peer review;
                    (B) been described in scientific journals; and
                    (C) demonstrated value as measured by unit costs 
                relative to health outcomes achieved.
            (2) Cost-saving benefit.--The term ``cost-saving benefit'' 
        means a benefit or technique that has--
                    (A) been subject to peer review;
                    (B) been described in scientific journals; and
                    (C) caused a net reduction in health care costs for 
                medicare beneficiaries.
            (3) Eligible entity.--The term ``eligible entity'' means an 
        entity that the Working Group (as defined in paragraph (6)) 
        determines has demonstrated expertise regarding health 
        promotion and disease prevention among medicare beneficiaries.
            (4) Medically effective.--The term ``medically effective'' 
        means, with respect to a benefit or technique, that the benefit 
        or technique has been--
                    (A) subject to peer review;
                    (B) described in scientific journals; and
                    (C) determined to achieve an intended goal under 
                normal programmatic conditions.
            (5) Medically efficacious.--The term ``medically 
        efficacious'' means, with respect to a benefit or technique, 
        that the benefit or technique has been--
                    (A) subject to peer review;
                    (B) described in scientific journals; and
                    (C) determined to achieve an intended goal under 
                controlled conditions.
            (6) Working group.--The term ``Working Group'' means the 
        Working Group on Disease Self-Management and Health Promotion 
        established under section 102.

SEC. 102. WORKING GROUP ON DISEASE SELF-MANAGEMENT AND HEALTH 
              PROMOTION.

    (a) Establishment.--There is established within the Department of 
Health and Human Services a Working Group on Disease Self-Management 
and Health Promotion.
    (b) Composition.--
            (1) In general.--Subject to paragraph (2), the Working 
        Group shall be composed of 5 members as follows:
                    (A) The Administrator of the Health Care Financing 
                Administration.
                    (B) The Director of the Centers for Disease Control 
                and Prevention.
                    (C) The Director of the Agency for Healthcare 
                Research and Quality.
                    (D) The Assistant Secretary for Aging.
                    (E) The Director of the National Institutes of 
                Health.
            (2) Alternative membership.--Any member of the Working 
        Group described in a subparagraph of paragraph (1) may appoint 
        an individual who is an officer or employee of the Federal 
        Government to serve as a member of the Working Group instead of 
        the member described in such subparagraph.
    (c) Duties.--The duties of the Working Group are as follows:
            (1) Healthy seniors promotion grants.--The Working Group 
        shall establish general policies and criteria with respect to 
        the functions of the Secretary under section 103, including--
                    (A) priorities for the approval of applications 
                submitted under subsection (c) of such section;
                    (B) procedures for monitoring and evaluating 
                research efforts conducted under such section; and
                    (C) such other matters relating to the grant 
                program established under such section as are 
                recommended by the Working Group and approved by the 
                Secretary.
            (2) Disease self-management demonstration projects.--The 
        Working Group shall establish general policies and criteria 
        with respect to the functions of the Secretary under section 
        104, including--
                    (A) the identification of medical conditions for 
                which a demonstration project under such section may be 
                implemented;
                    (B) the prioritization of the conditions identified 
                under subparagraph (A) based on the potential for the 
                self-management of such condition to be medically 
                effective and for such self-management to be a cost-
                effective benefit or cost-saving benefit;
                    (C) the identification of target individuals (as 
                defined in section 104(a)(2));
                    (D) the development of procedures for selecting 
                areas in which such a demonstration project may be 
                implemented; and
                    (E) such other matters relating to such 
                demonstration projects as are recommended by the 
                Working Group and approved by the Secretary.
    (d) Chairperson.--The Secretary shall designate 1 of the members of 
the Working Group to be the chairperson of the Group.
    (e) Quorum.--A majority of the members of the Working Group shall 
constitute a quorum, but, subject to subsection (f), a lesser number of 
members may hold meetings.
    (f) Meetings.--The Working Group shall meet at the call of the 
chairperson, except that--
            (1) it shall meet not less than 4 times each year; and
            (2) it shall meet upon the written request of a majority of 
        the members.
    (g) Compensation of Members.--Each member of the Working Group 
shall serve without compensation in addition to that received for their 
service as an officer or employee of the Federal Government.
    (h) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for the purpose of carrying 
out this section.

SEC. 103. HEALTHY SENIORS PROMOTION GRANTS.

    (a) Program Authorized.--The Secretary, using the general policies 
and criteria established by the Working Group under section 102(c)(1) 
and in accordance with the provisions of this section, is authorized to 
make grants to eligible entities (as defined in section 101(3)) to pay 
for the costs of the activities described in subsection (b).
    (b) Use of Funds.--An eligible entity may use payments received 
under this section in any fiscal year to conduct a program to--
            (1) study whether using different types of providers of 
        care and alternative settings (including community-based senior 
centers) for the implementation of a successful health promotion and 
disease prevention strategy, including the implications regarding the 
payment of such providers, is medically efficacious or medically 
effective;
            (2) determine the most effective means of educating 
        medicare beneficiaries, either directly or through providers of 
        care, regarding the importance of health promotion and disease 
        prevention among such beneficiaries;
            (3) identify incentives that would increase the use of new 
        and existing preventive health benefits and healthy behaviors 
        by medicare beneficiaries;
            (4) promote--
                    (A) the use of preventive health benefits by 
                medicare beneficiaries, including such services that 
                are covered under the medicare program;
                    (B) the proper use by medicare beneficiaries of 
                prescription and over-the-counter drugs in order to 
                reduce the number of hospital stays and physician 
                visits that are a result of improper use of such drugs; 
                and
                    (C) the utilization by medicare beneficiaries of 
                the steps (including exercise, maintenance of a proper 
                diet, and the utilization of accident prevention 
                techniques) that research has shown to promote and 
                safeguard individual health; and
            (5) address other topics designated by the Secretary.
    (c) Application.--
            (1) In general.--Each eligible entity that desires to 
        receive a grant under this section shall submit an application 
        to the Secretary, at such time, in such manner, and accompanied 
        by such additional information as the Secretary may reasonably 
        require.
            (2) Contents.--Each application submitted under paragraph 
        (1) shall--
                    (A) describe the activities for which assistance 
                under this section is sought;
                    (B) describe how such activities will--
                            (i) reflect the medical, behavioral, and 
                        social aspects of care for medicare 
                        beneficiaries;
                            (ii) lead to the development of cost-
                        effective benefits and cost-saving benefits; 
                        and
                            (iii) impact the quality of life of 
                        medicare beneficiaries;
                    (C) provide assurances that such activities will 
                focus on broad medicare populations rather than unique 
                local medicare populations;
                    (D) provide evidence that the eligible entity meets 
                the general policies and criteria established by the 
                Working Group under section 102(c)(1);
                    (E) provide assurances that the eligible entity 
                will take such steps as may be available to the entity 
                in order to continue the activities for which the 
                entity is making application after the period for which 
                assistance is sought; and
                    (F) provide such additional assurances as the 
                Secretary determines to be essential to ensure 
                compliance with the requirements of this title.
            (3) Joint application.--A consortium of eligible entities 
        may file a joint application under the provisions of paragraph 
        (1).
    (d) Approval of Application.--The Secretary shall approve 
applications in accordance with the general policies and criteria 
established by the Working Group under section 102(c)(1).
    (e) Payments.--Subject to amounts appropriated under subsection 
(g), the Secretary shall pay to each eligible entity having an 
application approved under subsection (d) the cost of the activities 
described in the application.
    (f) Evaluation and Report.--
            (1) Evaluation.--The Secretary shall conduct an annual 
        evaluation of grants made under this section to determine--
                    (A) the results of the activities conducted under 
                the programs for which grants were made under this 
                section;
                    (B) the extent to which research assisted under 
                this section has improved or expanded the general 
                research for health promotion and disease prevention 
                among medicare beneficiaries and identified practical 
                interventions based upon such research;
                    (C) a list of specific recommendations based upon 
                the activities conducted under the programs for which 
                grants were made under this section which show promise 
                as practical interventions for health promotion and 
                disease prevention among medicare beneficiaries;
                    (D) whether or not, as a result of the activities 
                conducted under the programs for which grants were made 
                under this section, certain health promotion and 
                disease prevention benefits or education efforts should 
                be added to the medicare program, including discussions 
                of quality of life, translating the applied research 
                results into a benefit under the medicare program, and 
                whether each additional benefit would be a cost-
                effective benefit or a cost-saving benefit for each 
                proposed addition; and
                    (E) how best to increase utilization of existing 
                and recommended health promotion and disease prevention 
                services, such as an education and public awareness 
                campaign, providing financial incentives for providers 
                of care and medicare beneficiaries, or utilizing other 
                administrative means.
            (2) Annual report.--Not later than December 31, 2005, and 
        annually thereafter through 2007, the Secretary, in 
        consultation with the Working Group, shall submit a report to 
        Congress on the evaluation conducted under paragraph (1), 
        together with such recommendations for such legislation and 
        administrative actions as the Secretary considers appropriate.
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated for the purpose of carrying out this section $50,000,000 
for each of fiscal years 2004, 2005, 2006, and 2007.

SEC. 104. DISEASE SELF-MANAGEMENT DEMONSTRATION PROJECTS.

    (a) Demonstration Projects.--
            (1) In general.--The Secretary shall conduct demonstration 
        projects for the purpose of promoting disease self-management 
        for conditions identified by the Working Group under section 
        102(c)(2) for target individuals (as defined in paragraph (2)).
            (2) Target individual defined.--In this section, the term 
        ``target individual'' means an individual who--
                    (A) is at risk for, or has, 1 or more of the 
                conditions identified by the Working Group under 
                section 102(c)(2); and
                    (B) is enrolled under the original medicare fee-
                for-service program under parts A and B of title XVIII 
                of the Social Security Act (42 U.S.C. 1395c et seq.; 
                1395j et seq.) or is enrolled under the Medicare+Choice 
                program under part C of title XVIII of such Act (42 
                U.S.C. 1395w-21 et seq.).
    (b) Number; Project Areas; Duration.--
            (1) Number.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall implement a series 
        of demonstration projects to carry out the purpose described in 
        subsection (a)(1).
            (2) Project areas.--The Secretary shall implement the 
        demonstration projects described in paragraph (1) in urban, 
        suburban, and rural areas.
            (3) Duration.--The demonstration projects under this 
        section shall be conducted during the 3-year period beginning 
        on the date on which the initial demonstration project is 
        implemented.
    (c) Report to Congress.--
            (1) In general.--Not later than 18 months after the 
        conclusion of the demonstration projects under this section, 
        the Secretary shall submit a report to Congress on such 
        projects.
            (2) Contents of report.--The report required under 
        paragraph (1) shall include the following:
                    (A) A description of the demonstration projects.
                    (B) An evaluation of--
                            (i) whether each benefit provided under the 
                        demonstration projects is a cost-effective 
                        benefit or a cost-saving benefit;
                            (ii) the level of the disease self-
                        management attained by target individuals under 
                        the demonstration projects; and
                            (iii) the satisfaction of target 
                        individuals under the demonstration projects.
                    (C) Recommendations of the Secretary regarding 
                whether to conduct the demonstration projects on a 
                permanent basis.
                    (D) Such recommendations for legislation and 
                administrative action as the Secretary determines to be 
                appropriate.
                    (E) Any other information regarding the 
                demonstration projects that the Secretary determines to 
                be appropriate.
    (d) Funding.--The Secretary shall provide for the transfer from the 
Federal Hospital Insurance Trust Fund under section 1817 of the Social 
Security Act (42 U.S.C. 1395i) an amount not to exceed $30,000,000 for 
the costs of carrying out this section.

       TITLE II--MEDICARE COVERAGE OF PREVENTIVE HEALTH BENEFITS

SEC. 201. THERAPY AND COUNSELING FOR CESSATION OF TOBACCO USE.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (U), by striking ``and'' at the end;
            (2) in subparagraph (V), by inserting ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
            ``(W) supplemental preventive health services (as defined 
        in subsection (ww));''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended by adding at the end the following new 
subsection:

               ``Supplemental Preventive Health Services

    ``(ww) The term `supplemental preventive health services' means the 
following:
            ``(1)(A) Therapy and counseling for cessation of tobacco 
        use for individuals who use tobacco products or who are being 
        treated for tobacco use that is furnished--
                    ``(i) by or under the supervision of a physician; 
                or
                    ``(ii) by any other health care professional who--
                            ``(I) is legally authorized to furnish such 
                        services under State law (or the State 
                        regulatory mechanism provided by State law) of 
                        the State in which the services are furnished; 
                        and
                            ``(II) is authorized to receive payment for 
                        other services under this title or is 
                        designated by the Secretary for this purpose.
            ``(B) Subject to subparagraph (C), such term is limited 
        to--
                    ``(i) therapy and counseling services recommended 
                in `Treating Tobacco Use and Dependence: A Clinical 
                Practice Guideline', published by the Public Health 
                Service in June 2000, or any subsequent modification of 
                such Guideline; and
                    ``(ii) such other therapy and counseling services 
                that the Secretary recognizes to be effective.
            ``(C) Such term shall not include coverage for drugs or 
        biologicals that are not otherwise covered under this title.''.
    (c) Payment and Elimination of Cost-Sharing for All Supplemental 
Preventive Health Services.--
            (1) Payment and elimination of coinsurance.--Section 
        1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) 
        is amended--
                    (A) in subparagraph (N), by inserting ``other than 
                supplemental preventive health services (as defined in 
                section 1861(ww))'' after ``(as defined in section 
                1848(j)(3))''
                    (B) by striking ``and'' before ``(U)''; and
                    (C) by inserting before the semicolon at the end 
                the following: ``, and (V) with respect to supplemental 
                preventive health services (as defined in section 
                1861(ww)), the amount paid shall be 100 percent of the 
                lesser of the actual charge for the services or the 
                amount determined under the payment basis determined 
                under section 1848 by the Secretary for the particular 
                supplemental preventive health service involved''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by inserting 
        ``(2)(W),'' after ``(2)(S),''.
            (3) Elimination of coinsurance in outpatient hospital 
        settings.--The third sentence of section 1866(a)(2)(A) of the 
        Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by 
        inserting after ``1861(s)(10)(A)'' the following: ``, with 
        respect to supplemental preventive health services (as defined 
        in section 1861(ww)),''.
            (4) Elimination of deductible.--The first sentence of 
        section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) 
        is amended--
                    (A) by striking ``and'' before ``(6)''; and
                    (B) by inserting before the period the following: 
                ``, and (7) such deductible shall not apply with 
                respect to supplemental preventive health services (as 
                defined in section 1861(ww))''.
    (d) Application of Limits on Billing.--Section 1842(b)(18)(C) of 
the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by 
adding at the end the following new clause:
            ``(vii) Any health care professional with respect to the 
        furnishing of supplemental preventive health services.''.

SEC. 202. COUNSELING FOR POST-MENOPAUSAL WOMEN.

    Section 1861(ww) of the Social Security Act (42 U.S.C. 
1395x(s)(2)), as added by section 201(b), is amended by adding at the 
end the following new paragraph:
            ``(2)(A) Counseling for post-menopausal women.
            ``(B) For purposes of subparagraph (A), the term 
        `counseling for post-menopausal women' means counseling 
        provided to a post-menopausal woman regarding--
                    ``(i) the symptoms, risk factors, and conditions 
                associated with menopause;
                    ``(ii) appropriate treatment options for post-
                menopausal women, including hormone replacement 
                therapy; and
                    ``(iii) other interventions that can be implemented 
                to prevent or delay the onset of health risks 
                associated with menopause.
            ``(C) Such term does not include coverage for drugs or 
        biologicals that are not otherwise covered under this title.''.

SEC. 203. SCREENING FOR DIMINISHED VISUAL ACUITY.

    Section 1861(ww) of the Social Security Act (42 U.S.C. 
1395x(s)(2)), as amended by section 202(a), is amended by adding at the 
end the following new paragraph:
            ``(3)(A) Screening for diminished visual acuity.
            ``(B) For purposes of subparagraph (A), the term `screening 
        for diminished visual acuity' means a screening for diminished 
        visual acuity that is furnished by or under the supervision of 
        an optometrist or ophthalmologist who is legally authorized to 
        furnish such services under State law (or the State regulatory 
        mechanism provided by State law) of the State in which the 
        services are furnished.''.

SEC. 204. SCREENING FOR TYPE II DIABETES MELLITUS FOR CERTAIN AT-RISK 
              INDIVIDUALS.

    Section 1861(ww) of the Social Security Act (42 U.S.C. 
1395x(s)(2)), as amended by section 203(a), is amended by adding at the 
end the following new paragraph:
            ``(4) Screening for diabetes II mellitus for individuals 
        with hypertension or hyperlipidenia if the individual involved 
        has not had such a screening during the preceding 3 years.''.

SEC. 205. SCREENING FOR CHOLESTEROL.

    (a) In General.--Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 204(a), is amended by adding 
at the end the following new paragraph:
            ``(5)(A) Screening for cholesterol if the individual 
        involved has not had such a screening during the preceding 5 
        years.
            ``(B) Notwithstanding subparagraph (A), payment may be made 
        under this part for a screening for cholesterol with respect to 
        an individual even if the individual has had such a screening 
        during the preceding 5 years if the individual exhibits major 
        risk factors for coronary heart disease or a stroke, including, 
        but not limited to, smoking, hypertension, and diabetes.''.
    (b) Conforming Amendment Applying Frequency Limitations.--Section 
1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is 
amended--
            (1) in subparagraph (H), by striking ``and'' at the end;
            (2) in subparagraph (I), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(J) in the case of supplemental preventive health 
                services, which is performed more frequently than is 
                covered under section 1861(ww);''.

SEC. 206. SCREENING FOR DEPRESSION.

    Section 1861(ww) of the Social Security Act (42 U.S.C. 
1395x(s)(2)), as amended by section 205(a), is amended by adding at the 
end the following new paragraph:
            ``(6)(A) Screenings for clinical depression to an 
        individual through qualified health professionals in accordance 
        with the requirements of this paragraph, if the individual has 
        not had such a screening performed during the preceding 12 
        months.
            ``(B) In this paragraph, the term `qualified health 
        professional' means an individual that--
                    ``(i) is--
                            ``(I) a physician (as defined in subsection 
                        (r)(1));
                            ``(II) a nurse practitioner (as defined in 
                        subsection (aa)(5)); or
                            ``(III) a mental health care professional 
                        (including a clinical social worker, as defined 
                        in subsection 1861(hh)) that is licensed to 
                        perform mental health services by the State in 
which a screening for clinical depression is furnished; and
                    ``(ii) is a participating physician or supplier and 
                has an agreement in effect with the Secretary under 
                which the individual agrees to accept the amount 
                determined under part B as full payment for such 
                screening and to accept an assignment described in 
                section 1842(b)(3)(B)(ii) of the Social Security Act 
                (42 U.S.C. 1395u(b)(3)(B)(ii)) with respect to payment 
                for each screening furnished by the professional to an 
                eligible beneficiary.
            ``(C)(i) The term `screening for clinical depression' means 
        a consultation during which a self-administered written 
        screening test (or an alternative format for such test pursuant 
        to subparagraph (D)) is made available to an individual and a 
        qualified health professional--
                    ``(I) interprets the results of such test;
                    ``(II) discusses the beneficiary's responses to the 
                questions on the test with the beneficiary;
                    ``(III) assesses the beneficiary's risk of clinical 
                depression; and
                    ``(IV) if the qualified health professional 
                determines that the beneficiary is at high risk for 
                clinical depression, refers the eligible beneficiary 
                for a full diagnostic evaluation and such additional 
                treatment as may be required.
            ``(ii) Nothing in clause (i)(IV) shall be construed as 
        prohibiting a qualified health professional performing the 
        screening for clinical depression with respect to an individual 
        from directly providing the diagnostic evaluation and 
        additional treatment described in such clause to such 
        individual if legally authorized under State law to do so.
            ``(D) For purposes of this paragraph, the term `self-
        administered written screening test' means an instrument on 
        which an individual writes answers to questions designed to 
        enable a qualified health professional to establish the level 
        of risk of such eligible beneficiary for clinical depression.
            ``(E)(i) The Secretary, in consultation with professionals 
        experienced in conducting large-scale depression screening 
        projects, shall--
                    ``(I) establish or identify a self-administered 
                written screening test to be used under this paragraph; 
                and
                    ``(II) not later than the date that is 3 months 
                before the date on which this paragraph is implemented, 
                distribute such test to qualified health professionals 
                that provide services, together with guidelines for 
                making the test available to individuals.
                    ``(ii) The Secretary shall also establish and 
                distribute alternative formats for the self-
                administered written screening test under clause (i) 
                which shall be available for use when circumstances do 
                not permit an individual to complete the self-
                administered written screening test.''.

SEC. 207. EXPANSION OF ELIGIBILITY FOR BONE MASS MEASUREMENT.

    (a) Expansion.--Section 1861(rr)(2) of the Social Security Act (42 
U.S.C. 1395x(rr)(2)) is amended to read as follows:
    ``(2) For purposes of this subsection, the term `qualified 
individual' means an individual who is (in accordance with regulations 
prescribed by the Secretary)--
            ``(A) an estrogen-deficient woman (including those 
        receiving hormone replacement therapy);
            ``(B) an individual with low trauma or fragility fractures 
        (including vertebral abnormalities and hip, rib, wrist, pelvic, 
        or proximal humeral fractures);
            ``(C) an individual receiving long-term medications that 
        have associations to bone loss or osteoporosis (including 
        glucocorticoid therapy and androgen deprivation therapy);
            ``(D) an individual with a long-term medical condition that 
        has association to osteoporosis (including primary 
        hyperparathyroidism);
            ``(E) a man with risk factors for osteoporosis such as 
        hypogonadism; and
            ``(F) an individual being monitored to assess the response 
        to, or efficacy of, an approved osteoporosis therapy.''.
    (b) Reference To Elimination of Coinsurance and Waiver of 
Application of Deductible.--For the elimination of the coinsurance for 
bone mass measurement and for the waiver of the application of the part 
B deductible for such measurement, see section 301.

SEC. 208. COVERAGE OF MEDICAL NUTRITION THERAPY SERVICES FOR 
              BENEFICIARIES WITH CARDIOVASCULAR DISEASES.

    (a) In General.--Section 1861(s)(2)(V) of the Social Security Act 
(42 U.S.C. 1395x(s)(2)(V)) is amended to read as follows:
            ``(V) medical nutrition therapy services (as defined in 
        subsection (vv)(1)) in the case of a beneficiary--
                    ``(i) with a cardiovascular disease (including 
                congestive heart failure, arteriosclerosis, 
                hyperlipidemia, hypertension, and 
                hypercholesterolemia), diabetes, or a renal disease (or 
                a combination of such conditions) who--
                            ``(I) has not received diabetes outpatient 
                        self-management training services within a time 
                        period determined by the Secretary;
                            ``(II) is not receiving maintenance 
                        dialysis for which payment is made under 
                        section 1881; and
                            ``(III) meets such other criteria 
                        determined by the Secretary after consideration 
                        of protocols established by dietitian or 
                        nutrition professional organizations; or
                    ``(ii) with a combination of such conditions who--
                            ``(I) is not described in clause (i) 
                        because of the application of subclause (I) or 
                        (II) of such clause;
                            ``(II) receives such medical nutrition 
                        therapy services in a coordinated manner (as 
                        determined appropriate by the Secretary) with 
                        any services described in such subclauses that 
                        the beneficiary is receiving; and
                            ``(III) meets such other criteria 
                        determined by the Secretary after consideration 
                        of protocols established by dietitian or 
                        nutrition professional organizations;''.
    (b) Elimination of Coinsurance.--Section 1833(a)(1)(T) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)(T)) is amended by striking 
``80 percent'' and inserting ``100 percent''.
    (c) Reference to Waiver of Application of Deductible.--For the 
waiver of the application of the part B deductible for medical 
nutrition therapy services, see section 301.

SEC. 209. PAYMENT FOR OFFICE VISIT IN CONNECTION WITH SCREENING 
              COLONOSCOPY.

    (a) Inclusion of Office Visit in Benefit.--Section 1861(pp)(1) of 
the Social Security Act (42 U.S.C. 1395x(pp)(1)) is amended by 
inserting ``(and includes, in the case of screening colonoscopy, the 
office visit associated with the colonoscopy)'' after ``for the purpose 
of early detection of colorectal cancer''.
    (b) Conforming Payment.--Section 1834(d)(3)(B) of such Act (42 
U.S.C. 1395m(d)(3)(B)) is amended by adding at the end the following: 
``Such payment shall take into account payment for the office visit 
associated with the colonoscopy.''.

SEC. 210. PROGRAM INTEGRITY.

    The Secretary, in consultation with the Inspector General of the 
Department of Health and Human Services, shall integrate supplemental 
preventive health services (as defined in section 1861(ww) of the 
Social Security Act (as added by the preceding provisions of this 
title)) with existing program integrity measures.

SEC. 211. EFFECTIVE DATE.

    Except as otherwise provided in this title, the amendments made by 
this title shall apply to services furnished on or after January 1, 
2004.

   TITLE III--INCREASING UTILIZATION OF MEDICARE PREVENTIVE SERVICES

SEC. 301. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR EXISTING 
              PREVENTIVE HEALTH BENEFITS.

    (a) In General.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by inserting after subsection (o) the following new 
subsection:
    ``(p) Deductibles and Coinsurance Waived for Preventive Health 
Items and Services.--The Secretary may not require the payment of any 
deductible or coinsurance under subsection (a) or (b), respectively, of 
any individual enrolled for coverage under this part for any of the 
following preventive health items and services:
            ``(1) Blood-testing strips, lancets, and blood glucose 
        monitors for individuals with diabetes described in section 
        1861(n).
            ``(2) Diabetes outpatient self-management training services 
        (as defined in section 1861(qq)(1)).
            ``(3) Pneumococcal, influenza, and hepatitis B vaccines and 
        administration described in section 1861(s)(10).
            ``(4) Screening mammography (as defined in section 
        1861(jj)).
            ``(5) Screening pap smear and screening pelvic exam (as 
        defined in paragraphs (1) and (2) of section 1861(nn), 
        respectively).
            ``(6) Bone mass measurement (as defined in section 
        1861(rr)(1)).
            ``(7) Prostate cancer screening test (as defined in section 
        1861(oo)(1)).
            ``(8) Colorectal cancer screening test (as defined in 
        section 1861(pp)(1)).
            ``(9) Screening for glaucoma (as defined in section 
        1861(uu)).
            ``(10) Medical nutrition therapy services (as defined in 
        section 1861(vv)(1)).''.
    (b) Waiver of Coinsurance.--
            (1) In general.--Section 1833(a)(1)(B) of the Social 
        Security Act (42 U.S.C. 1395l(a)(1)(B)) is amended to read as 
        follows: ``(B) with respect to preventive health items and 
        services described in subsection (p), the amounts paid shall be 
        100 percent of the fee schedule or other basis of payment under 
        this title for the particular item or service,''.
            (2) Elimination of coinsurance in outpatient hospital 
        settings.--The third sentence of section 1866(a)(2)(A) of the 
        Social Security Act (42 U.S.C. 1395cc(a)(2)(A)), as amended by 
        section 201(c)(3), is amended by inserting after ``section 
        1861(ww)'' the following: ``and preventive health items and 
        services described in section 1833(p)''.
    (c) Waiver of Application of Deductible.--Section 1833(b)(1) of the 
Social Security Act (42 U.S.C. 1395l(b)(1)) is amended to read as 
follows: ``(1) such deductible shall not apply with respect to 
preventive health items and services described in subsection (p),''.
    (d) Adding ``Lancet'' to Definition of DME.--Section 1861(n) of the 
Social Security Act (42 U.S.C. 1395x(n)) is amended by striking 
``blood-testing strips and blood glucose monitors'' and inserting 
``blood-testing strips, lancets, and blood glucose monitors''.
    (e) Conforming Amendments.--
            (1) Elimination of coinsurance for clinical diagnostic 
        laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of 
        section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) 
        are each amended by inserting ``or which are described in 
        subsection (p)'' after ``assignment-related basis''.
            (2) Elimination of coinsurance for certain dme.--Section 
        1834(a)(1)(A) of the Social Security Act (42 U.S.C. 
        1395m(a)(1)(A)) is amended by inserting ``(or 100 percent, in 
        the case of such an item described in section 1833(p))'' after 
        ``80 percent''.
            (3) Elimination of deductibles and coinsurance for 
        colorectal cancer screening tests.--Section 1834(d) of the 
        Social Security Act (42 U.S.C. 1395m(d)) is amended--
                    (A) in paragraph (2)(C)--
                            (i) by striking ``(C) Facility payment 
                        limit.--'' and all that follows through 
                        ``Notwithstanding subsections'' and inserting 
                        the following:
                    ``(C) Facility payment limit.--Notwithstanding 
                subsections'';
                            (ii) by striking ``(I) in accordance'' and 
                        inserting the following:
                            ``(i) in accordance'';
                            (iii) by striking ``(II) are performed'' 
                        and all that follows through ``payment under'' 
                        and inserting the following:
                            ``(ii) are performed in an ambulatory 
                        surgical center or hospital outpatient 
                        department,
                payment under''; and
                            (iv) by striking clause (ii); and
                    (B) in paragraph (3)(C)--
                            (i) by striking ``(C) Facility payment 
                        Limit.--'' and all that follows through 
                        ``Notwithstanding subsections'' and inserting 
                        the following:
                    ``(C) Facility payment limit.--Notwithstanding 
                subsections''; and
                            (ii) by striking clause (ii).
    (f) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the day that is 1 year after 
the date of enactment of this Act.

SEC. 302. COVERAGE OF INITIAL PREVENTIVE PHYSICAL EXAMINATION.

    (a) In General.--Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 206(a), is amended by adding 
at the end the following new paragraph:
            ``(7)(A) An initial preventive physical examination.
            ``(B) For purposes of subparagraph (A), the term `initial 
        preventive physical examination' means physicians' services 
        consisting of a physical examination with the goal of health 
        promotion and disease detection and includes a history and 
        physical exam, a health risk appraisal, and health risk 
        counseling, and laboratory tests or other items and services as 
        determined by the Secretary in consultation with the United 
        States Preventive Services Task Force.
            ``(C) In the case of any item or service that is included 
        as part of an initial preventive physical examination and that 
        is otherwise separately covered under a preceding paragraph of 
        this subsection, the item or service shall be treated for 
        purposes of that preceding paragraph as having been received at 
        the time of such examination.''.
    (b) Conforming Amendment Applying Frequency Limitations.--Section 
1862(a) of such Act (42 U.S.C. 1395y(a)), as amended by section 205(b), 
is amended--
            (1) in paragraph (1)--
                    (A) by striking ``and'' at the end of subparagraph 
                (I);
                    (B) by striking the semicolon at the end of 
                subparagraph (J) and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(K) in the case of an initial preventive physical 
        examination (as defined in section 1861(ww)(7)(B)), which is 
        performed not later than 6 months after the date the 
        individual's first coverage period begins under part B;''; and
            (2) in paragraph (7), by striking ``or (H)'' and inserting 
        ``(H), or (K)''.
    (c) Application of Payment Provisions.--For provisions providing 
payment for supplemental preventive health services (including an 
initial preventive physical examination) without application of any 
deductible or coinsurance, see the amendments made by section 201(c).
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2004, but only for 
individuals whose coverage period begins on or after such date.

SEC. 303. PROMOTION OF PREVENTIVE HEALTH BENEFITS.

    In order to promote the use by medicare beneficiaries of preventive 
health benefits, including preventive health services (as defined in 
section 1861(ww) of the Social Security Act (as added by the preceding 
provisions of this title)) and preventive health items and services 
described in section 1833(p) of such Act (as added by section 301), the 
Secretary shall do the following:
            (1) Medicare handbook and other annual notices.--Include in 
        any medicare handbook and any other annual notice provided to 
        medicare beneficiaries a detailed description of--
                    (A) the preventive health benefits that are covered 
                under the medicare program; and
                    (B) the importance of using such benefits.
            (2) Fiscal intermediaries and carriers.--Require that 
        fiscal intermediaries with a contract under section 1816 of the 
        Social Security Act (42 U.S.C. 1395h) and carriers with a 
        contract under section 1842 of such Act (42 U.S.C. 1395u) 
        include preventive health benefits messages on Medicare Summary 
        Notice Statements and Explanations of Medicare Benefits 
        distributed by such entities.
            (3) Medicare+choice plans.--Require that Medicare+Choice 
        organizations offering a Medicare+Choice plan disclose under 
        section 1852(c)(1)(B) of the Social Security Act (42 U.S.C. 
1395w-22(c)(1)(B)) information regarding the preventive health benefits 
that are covered under the plan.
            (4) Other activities.--Conduct activities in addition to 
        those described in paragraphs (1) through (3) that the 
        Secretary determines to be useful in disseminating information 
        to medicare beneficiaries regarding--
                    (A) the preventive health benefits that are covered 
                under the medicare program;
                    (B) the importance of using such benefits; and
                    (C) general health promotion.

  TITLE IV--NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN

SEC. 401. NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN.

    (a) In General.--The Director of the Centers for Disease Control 
and Prevention, in consultation with the Administrator of the Health 
Care Financing Administration, shall conduct a national falls 
prevention and awareness campaign to reduce fall-related injuries among 
medicare beneficiaries.
    (b) Report to Congress.--
            (1) In general.--The Director of the Centers for Disease 
        Control and Prevention, in consultation with the Administrator 
        of the Health Care Financing Administration, shall submit to 
        Congress a report on the campaign conducted under this section.
            (2) Deadline for report.--The report required under 
        paragraph (1) shall be submitted not later than the earlier 
        of--
                    (A) 6 months after the campaign is completed; or
                    (B) 3 years after the campaign is implemented.
            (3) Contents of report.--The report required under 
        paragraph (1) shall include the following:
                    (A) A description of the campaign.
                    (B) An evaluation of--
                            (i) whether the campaign has effectively 
                        reached its target population; and
                            (ii) the cost-effectiveness of the 
                        campaign.
                    (C) An assessment of whether the campaign has been 
                effective, as measured by whether--
                            (i) the target population has adopted the 
                        interventions suggested in the campaign, and if 
                        not, the reasons why such interventions have 
                        not been adopted; and
                            (ii) the fall rates among the target 
                        population have decreased since the campaign 
                        was implemented, and if not, the reasons why 
                        such fall rates have not decreased.
                    (D) Any other information regarding the campaign 
                that the Director of the Centers for Disease Control 
                and Prevention determines to be appropriate.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for the purpose of carrying 
out this section.
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