I 

109TH CONGRESS 

1ST SESSION H. R. 2671

To provide for the expansion of Federal programs to prevent and manage 

vision loss, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 26, 2005

Mr. GENE GREEN of Texas (for himself, Ms. ROS-LEHTINEN, Mr. PRICE of 

North Carolina, and Mr. TIBERI) 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 provide for the expansion of Federal programs to prevent 

and manage vision loss, 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. 

4 This Act may be cited as the ‘‘Vision Preservation 

5 Act of 2005’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 
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1 (1) An estimated 80 million Americans have a 

2 potentially blinding eye disease. Three million Amer3 icans have low vision, 1.1 million Americans are le4 gally blind, and 200,000 Americans are more se5 verely visually impaired. Visual impairment is one of 

6 the 10 more frequent causes of disability in the 

7 United States. 

8 (2) While it is believed that half of all blindness 

9 can be prevented, the number of Americans who are 

10 blind or visually impaired is expected to double by 

11 2030. 

12 (3) Vision is critical to conducting activities of 

13 daily living and affects developmental learning, com14 municating, working, health, and quality of life. 

15 (4) Vision problems affect 1 in 20 preschoolers 

16 and, if untreated, can affect learning ability, person17 ality, and adjustment in school. 

18 (5) It is estimated that blindness and visual im19 pairment cost the Federal Government more than $4 

20 billion annually in benefits and lost taxable income. 

21 (6) The four leading eye diseases affecting older 

22 Americans are age-related macular degeneration, 

23 cataract, diabetic retinopathy, and glaucoma. 

24 (7) Age-related macular degeneration is the 

25 most common cause of low vision and legal blindness 
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1 in older Americans. More than 1.6 million Ameri2 cans age 50 and older live with late stage age-re3 lated macular degeneration. It is recommended that 

4 individuals age 60 or older have their eyes examined 

5 at least once a year to detect age-related macular 

6 degeneration. 

7 (8) The Federal Government spends more than 

8 $3.4 billion each year treating cataract through the 

9 Medicare program. Cataract affects nearly 20.5 mil10 lion Americans age 40 and over. By age 80, more 

11 than half of all Americans have cataract. 

12 (9) Diabetic retinopathy affects over 5.3 million 

13 Americans age 18 or older and can affect anyone 

14 with diabetes. The Centers for Disease Control and 

15 Prevention estimate that 10.3 million Americans 

16 have diagnosed diabetes, while an additional 5.4 mil17 lion have undiagnosed diabetes. Because the number 

18 of Americans with diabetes is expected to grow sig19 nificantly as the number of older Americans con20 tinues to increase, more people will be at risk for di21 abetic retinopathy. 

22 (10) Glaucoma affects more than 2.2 million 

23 Americans age 40 and older. Glaucoma cannot be 

24 prevented, but most cases can be controlled and vi25 sion loss slowed or halted with treatment. Glaucoma 
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1 disproportionately affects minorities, affecting more 

2 than 10 percent of Black men and Hispanic women 

3 age 80 or older. 

4 (11) Vision rehabilitation helps people with a 

5 serious vision loss learn to safely navigate within 

6 their home environs, avoid medication errors, cook 

7 and use kitchen implements safely, and avoid burns, 

8 falls, and other injuries. Vision rehabilitation pro9 motes safety and independence for the vision-im10 paired elderly, and prevents injuries and further dis11 abilities. 

12 (12) Recognizing that the Nation requires a 

13 public health approach to visual impairment, the De14 partment of Health and Human Services dedicated 

15 a portion of its Healthy People 2010 initiative to vi16 sion. The initiative set out as a goal the improve17 ment of the Nation’s visual health through preven18 tion, early detection, treatment, and rehabilitation. 

19 (13) Greater efforts must be made at the Fed20 eral, State, and local levels to increase awareness of 

21 vision problems, their impact, the importance of 

22 early diagnosis, treatment, and rehabilitation, and 

23 effective prevention strategies. It is the sense of the 

24 Congress that the Nation must have a full-scale pub-
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1 lic health effort on vision problems that includes the 

2 following: 

3 (A) Communication and education. 

4 (B) Surveillance, epidemiology, and preven5 tion research. 

6 (C) Programs, policies, and systems 

7 change. 

8 TITLE I—PUBLIC HEALTH 

9 PROVISIONS 

10 SEC. 101. VISION LOSS PREVENTION. 

11 Part B of title III of the Public Health Service Act 

12 (42 U.S.C. 243 et seq.) is amended by inserting after sec13 tion 317S the following: 

14 ‘‘SEC. 317T. PREVENTIVE HEALTH MEASURES WITH RE15 SPECT TO VISION LOSS. 

16 ‘‘(a) COMMUNICATION AND EDUCATION.—

17 ‘‘(1) IN GENERAL.—The Secretary, acting 

18 through the Centers for Disease Control and Preven19 tion, the Health Resources and Services Administra20 tion, and the National Institutes of Health, shall ex21 pand and intensify programs to increase awareness 

22 of vision problems, including awareness of—

23 ‘‘(A) the impact of vision problems; and 
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1 ‘‘(B) the importance of early diagnosis, 

2 management, and effective prevention and reha3 bilitation strategies. 

4 ‘‘(2) ACTIVITIES.—In carrying out this sub5 section, the Secretary may—

6 ‘‘(A) conduct public service announcements 

7 and education campaigns; 

8 ‘‘(B) enter into partnerships with eye9 health professional organizations and other vi10 sion-related organizations; 

11 ‘‘(C) conduct community disease preven12 tion campaigns; and 

13 ‘‘(D) conduct testing, evaluation, and 

14 model training for vision screeners based on sci15 entific studies. 

16 ‘‘(3) EVALUATION.—In carrying out this sub17 section, the Secretary shall—

18 ‘‘(A) establish appropriate measurements 

19 for public awareness of vision problems; 

20 ‘‘(B) establish appropriate measurements 

21 to determine the effectiveness of existing cam22 paigns to increase awareness of vision problems; 

23 ‘‘(C) establish quantitative benchmarks for 

24 determining the effectiveness of activities car25 ried out under this subsection; and 
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1 ‘‘(D) not later than 12 months after the 

2 date of the enactment of this section, submit a 

3 report to the Congress on the results achieved 

4 through such activities. 

5 ‘‘(b) SURVEILLANCE, EPIDEMIOLOGY, AND HEALTH

6 SERVICES RESEARCH.—

7 ‘‘(1) IN GENERAL.—The Secretary shall expand 

8 and intensify activities to establish a solid scientific 

9 base of knowledge on the prevention and control of 

10 vision problems and related disabilities. 

11 ‘‘(2) ACTIVITIES.—In carrying out this sub12 section, the Secretary may—

13 ‘‘(A) create a national ongoing surveillance 

14 system; 

15 ‘‘(B) identify and test screening modalities; 

16 ‘‘(C) evaluate the efficacy and cost-effec17 tiveness of current and future interventions and 

18 community strategies; 

19 ‘‘(D) update and improve knowledge about 

20 the true costs of vision problems and related 

21 disabilities; and 

22 ‘‘(E) require the Surgeon General to assess 

23 the state of vision care and vision rehabilitation 

24 in the United States. 

25 ‘‘(c) PROGRAMS, POLICIES, AND SYSTEMS.—
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1 ‘‘(1) IN GENERAL.—The Secretary shall expand 

2 and intensify research within the Centers for Dis3 ease Control and Prevention on the prevention and 

4 management of vision loss. 

5 ‘‘(2) ACTIVITIES.—In carrying out this sub6 section, the Secretary may—

7 ‘‘(A) build partnerships with voluntary 

8 health organizations, nonprofit vision rehabilita9 tion agencies, Federal, State, and local public 

10 health agencies, eye health professional organi11 zations, and organizations with an interest in 

12 vision issues; 

13 ‘‘(B) work with health care systems to bet14 ter address vision problems and associated dis15 abilities; and 

16 ‘‘(C) award grants for community outreach 

17 regarding vision loss to national vision organi18 zations with broad community presence.’’. 

19 SEC. 102. EXPANSION OF VISION PROGRAMS UNDER THE 

20 MATERNAL AND CHILD HEALTH SERVICE 

21 BLOCK GRANT PROGRAM. 

22 Section 501(a)(3) of the Social Security Act (42 

23 U.S.C. 701(a)(3)) is amended—

24 (1) by striking ‘‘and’’ at the end of subpara25 graph (E); 
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1 (2) by striking the period at the end of sub2 paragraph (F) and inserting ‘‘, and’’; and 

3 (3) by adding at the end the following new sub4 paragraph: 

5 ‘‘(G) introduce core performance measures 

6 on eye health by incorporating vision screening 

7 standards into State programs under this title, 

8 based on scientific studies.’’. 

9 SEC. 103. PREVENTION AND TREATMENT FOR UNDER10 SERVED, MINORITY, AND OTHER POPU11 LATIONS. 

12 (a) EXPANSION AND INTENSIFICATION OF VISION

13 PROGRAMS.—The Secretary of Health and Human Serv14 ices (in this section referred to as the ‘‘Secretary’’) shall 

15 expand and intensify programs targeted to prevent vision 

16 loss, treat eye and vision conditions, and rehabilitate peo17 ple of all ages who are blind or partially sighted in under18 served and minority communities, including the following: 

19 (1) Vision care services at community health 

20 centers receiving assistance under section 330 of the 

21 Public Health Service Act (42 U.S.C. 254b). 

22 (2) Vision rehabilitation programs at vision re23 habilitation agencies, eye clinics, and hospitals. 

24 (b) VOLUNTARY GUIDELINES FOR VISION SCREEN25 ING.—The Secretary, in consultation with eye-health pro-
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1 fessional organizations and other vision-related organiza2 tions, shall develop voluntary guidelines to ensure the 

3 quality of vision screening. 

4 SEC. 104. NATIONAL INSTITUTES OF HEALTH. 

5 (a) IN GENERAL.—The Director of the National In6 stitutes of Health (in this section referred to as the ‘‘Di7 rector’’) shall expand, intensify, and coordinate programs 

8 for the conduct and support of research with respect to 

9 vision loss prevention and vision rehabilitation. 

10 (b) COORDINATION.—The Director shall coordinate 

11 vision-related activities in consultation with Federal offi12 cials, voluntary health organizations, medical professional 

13 societies, and private entities as appropriate. 

14 (c) RESEARCH.—In carrying out this section, the Di15 rector shall expand the following research activities: 

16 (1) translational research within the National 

17 Eye Institute; 

18 (2) diabetes and glaucoma related programs of 

19 the National Eye Institute; 

20 (3) creation of an age-related macular degen21 eration public education program within the Na22 tional Eye Institute to—

23 (A) increase awareness of age-related 

24 macular degeneration in selected high-risk tar25 get audiences in the United States; 
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1 (B) increase awareness of the importance 

2 of early detection of age-related macular degen3 eration in preventing vision loss; 

4 (C) increase health care providers’ aware5 ness of the need for regular comprehensive di6 lated eye examinations for those at risk for age7 related macular degeneration and other eye dis8 eases, with the ultimate goal of early detection 

9 of eye disease and the linkage of patients to ap10 propriate medical treatment and rehabilitation 

11 services; and 

12 (D) encourage at-risk populations to take 

13 appropriate action based on their increased 

14 awareness. 

15 TITLE II—MEDICARE 

16 PROVISIONS 

17 SEC. 201. IMPROVEMENT OF OUTPATIENT VISION SERV18 ICES UNDER PART B. 

19 (a) COVERAGE UNDER PART B.—Section 1861(s)(2) 

20 of the Social Security Act (42 U.S.C. 1395x(s)(2)) is 

21 amended—

22 (1) in subparagraph (Y), by striking ‘‘and’’ 

23 after the semicolon at the end; 

24 (2) in subparagraph (Z), by adding ‘‘and’’ after 

25 the semicolon at the end; and 
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1 (3) by adding at the end the following new sub2 paragraph: 

3 ‘‘(AA) vision rehabilitation services (as defined 

4 in subsection (bbb)(1));’’. 

5 (b) SERVICES DESCRIBED.—Section 1861 of the So6 cial Security Act (42 U.S.C. 1395x) is amended by adding 

7 at the end the following new subsection: 

8 ‘‘Vision Rehabilitation Services: Vision Rehabilitation 

9 Professional 

10 ‘‘(bbb)(1)(A) The term ‘vision rehabilitation services’ 

11 means rehabilitative services (as determined by the Sec12 retary in regulations) furnished—

13 ‘‘(i) to an individual diagnosed with a vision im14 pairment (as defined in paragraph (6)); 

15 ‘‘(ii) pursuant to a plan of care established by 

16 a qualified physician (as defined in subparagraph 

17 (C)) or by a qualified occupational therapist that is 

18 periodically reviewed by a qualified physician; 

19 ‘‘(iii) in an appropriate setting (including the 

20 home of the individual receiving such services if 

21 specified in the plan of care); and 

22 ‘‘(iv) by any of the following individuals: 

23 ‘‘(I) A qualified physician. 

24 ‘‘(II) An occupational therapist. 
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1 ‘‘(III) A vision rehabilitation professional 

2 (as defined in paragraph (2)) while under the 

3 general supervision (as defined in subparagraph 

4 (D)) of a qualified physician. 

5 ‘‘(B) In the case of vision rehabilitation services fur6 nished by a vision rehabilitation professional, the plan of 

7 care may only be established and reviewed by a qualified 

8 physician. 

9 ‘‘(C) The term ‘qualified physician’ means—

10 ‘‘(i) a physician (as defined in subsection 

11 (r)(1)) who is an ophthalmologist; or 

12 ‘‘(ii) a physician (as defined in subsection (r)(4) 

13 (relating to a doctor of optometry)). 

14 ‘‘(D) The term ‘general supervision’ means, with re15 spect to a vision rehabilitation professional, overall direc16 tion and control of that professional by the qualified physi17 cian who established the plan of care for the individual, 

18 but the presence of the qualified physician is not required 

19 during the furnishing of vision rehabilitation services by 

20 that professional to the individual. 

21 ‘‘(2) The term ‘vision rehabilitation professional’ 

22 means any of the following individuals: 

23 ‘‘(A) An orientation and mobility specialist (as 

24 defined in paragraph (3)). 
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1 ‘‘(B) A rehabilitation teacher (as defined in 

2 paragraph (4)). 

3 ‘‘(C) A low vision therapist (as defined in para4 graph (5)). 

5 ‘‘(3) The term ‘orientation and mobility specialist’ 

6 means an individual who—

7 ‘‘(A) if a State requires licensure or certifi8 cation of orientation and mobility specialists, is li9 censed or certified by that State as an orientation 

10 and mobility specialist; 

11 ‘‘(B)(i) holds a baccalaureate or higher degree 

12 from an accredited college or university in the 

13 United States (or an equivalent foreign degree) with 

14 a concentration in orientation and mobility; and 

15 ‘‘(ii) has successfully completed 350 hours of 

16 clinical practicum under the supervision of an ori17 entation and mobility specialist and has furnished 

18 not less than 9 months of supervised full-time ori19 entation and mobility services; 

20 ‘‘(C) has successfully completed the national ex21 amination in orientation and mobility administered 

22 by the Academy for Certification of Vision Rehabili23 tation and Education Professionals; and 

24 ‘‘(D) meets such other criteria as the Secretary 

25 establishes. 
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1 ‘‘(4) The term ‘rehabilitation teacher’ means an indi2 vidual who—

3 ‘‘(A) if a State requires licensure or certifi4 cation of rehabilitation teachers, is licensed or cer5 tified by the State as a rehabilitation teacher; 

6 ‘‘(B)(i) holds a baccalaureate or higher degree 

7 from an accredited college or university in the 

8 United States (or an equivalent foreign degree) with 

9 a concentration in rehabilitation teaching, or holds 

10 such a degree in a health field; and 

11 ‘‘(ii) has successfully completed 350 hours of 

12 clinical practicum under the supervision of a reha13 bilitation teacher and has furnished not less than 9 

14 months of supervised full-time rehabilitation teach15 ing services; 

16 ‘‘(C) has successfully completed the national ex17 amination in rehabilitation teaching administered by 

18 the Academy for Certification of Vision Rehabilita19 tion and Education Professionals; and 

20 ‘‘(D) meets such other criteria as the Secretary 

21 establishes. 

22 ‘‘(5) The term ‘low vision therapist’ means an indi23 vidual who—
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1 ‘‘(A) if a State requires licensure or certifi2 cation of low vision therapists, is licensed or certified 

3 by the State as a low vision therapist; 

4 ‘‘(B)(i) holds a baccalaureate or higher degree 

5 from an accredited college or university in the 

6 United States (or an equivalent foreign degree) with 

7 a concentration in low vision therapy, or holds such 

8 a degree in a health field; and 

9 ‘‘(ii) has successfully completed 350 hours of 

10 clinical practicum under the supervision of a physi11 cian, and has furnished not less than 9 months of 

12 supervised full-time low vision therapy services; 

13 ‘‘(C) has successfully completed the national ex14 amination in low vision therapy administered by the 

15 Academy for Certification of Vision Rehabilitation 

16 and Education Professionals; and 

17 ‘‘(D) meets such other criteria as the Secretary 

18 establishes. 

19 ‘‘(6) The term ‘vision impairment’ means vision loss 

20 that constitutes a significant limitation of visual capability 

21 resulting from disease, trauma, or a congenital or degen22 erative condition that cannot be corrected by conventional 

23 means, including refractive correction, medication, or sur24 gery, and that is manifested by 1 or more of the following: 
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1 ‘‘(A) Best corrected visual acuity of less than 

2 20/60, or significant central field defect. 

3 ‘‘(B) Significant peripheral field defect includ4 ing homonymous or heteronymous bilateral visual 

5 field defect or generalized contraction or constriction 

6 of field. 

7 ‘‘(C) Reduced peak contrast sensitivity in con8 junction with a condition described in subparagraph 

9 (A) or (B). 

10 ‘‘(D) Such other diagnoses, indications, or other 

11 manifestations as the Secretary may determine to be 

12 appropriate.’’. 

13 (c) PAYMENT UNDER PART B.—

14 (1) PHYSICIAN FEE SCHEDULE.—Section 

15 1848(j)(3) of the Social Security Act (42 U.S.C. 

16 1395w–4(j)(3)) is amended by inserting ‘‘(2)(AA),’’ 

17 after ‘‘(2)(W),’’. 

18 (2) CARVE OUT FROM HOSPITAL OUTPATIENT

19 DEPARTMENT PROSPECTIVE PAYMENT SYSTEM.—

20 Section 1833(t)(1)(B)(iv) of such Act (42 U.S.C. 

21 1395l(t)(1)(B)(iv)) is amended by inserting ‘‘vision 

22 rehabilitation services (as defined in section 

23 1861(bbb)(1)) or’’ after ‘‘does not include’’. 
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1 (3) CLARIFICATION OF BILLING REQUIRE2 MENTS.—The first sentence of section 1842(b)(6) of 

3 such Act (42 U.S.C. 1395u(b)(6)) is amended—

4 (A) by striking ‘‘and’’ before ‘‘(G)’’; and 

5 (B) by inserting before the period the fol6 lowing: ‘‘, and (H) in the case of vision rehabili7 tation services (as defined in section 

8 1861(bbb)(1)) furnished by a vision rehabilita9 tion professional (as defined in section 

10 1861(bbb)(2)) while under the general super11 vision (as defined in section 1861(bbb)(1)(D)) 

12 of a qualified physician (as defined in section 

13 1861(bbb)(1)(C)), payment shall be made to (i) 

14 the qualified physician or (ii) the facility (such 

15 as a rehabilitation agency, a clinic, or other fa16 cility) through which such services are fur17 nished under the plan of care if there is a con18 tractual arrangement between the vision reha19 bilitation professional and the facility under 

20 which the facility submits the bill for such serv21 ices’’. 

22 (d) PLAN OF CARE.—Section 1835(a)(2) of the So23 cial Security Act (42 U.S.C. 1395n(a)(2)) is amended—

24 (1) in subparagraph (E), by striking ‘‘and’’ 

25 after the semicolon at the end; 
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1 (2) in subparagraph (F), by striking the period 

2 at the end and inserting ‘‘; and’’; and 

3 (3) by inserting after subparagraph (F) the fol4 lowing new subparagraph: 

5 ‘‘(G) in the case of vision rehabilitation 

6 services, (i) such services are or were required 

7 because the individual needed vision rehabilita8 tion services, (ii) an individualized, written plan 

9 for furnishing such services has been estab10 lished (I) by a qualified physician (as defined in 

11 section 1861(bbb)(1)(C)), (II) by a qualified oc12 cupational therapist, or (III) in the case of such 

13 services furnished by a vision rehabilitation pro14 fessional, by a qualified physician, (iii) the plan 

15 is periodically reviewed by the qualified physi16 cian, and (iv) such services are or were fur17 nished while the individual is or was under the 

18 care of the qualified physician.’’. 

19 (e) RELATIONSHIP TO REHABILITATION ACT OF

20 1973.—The provision of vision rehabilitation services 

21 under the medicare program under title XVIII of the So22 cial Security Act (42 U.S.C. 1395 et seq.) shall not be 

23 taken into account for any purpose under the Rehabilita24 tion Act of 1973 (29 U.S.C. 701 et seq.). 

25 (f) EFFECTIVE DATE.—
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1 (1) INTERIM, FINAL REGULATIONS.—Not later 

2 than 180 days after the date of enactment of this 

3 Act, the Secretary of Health and Human Services 

4 shall cause to have published in in the Federal Reg5 ister a rule to carry out the provisions of this sec6 tion. Such rule shall be effective and final imme7 diately on an interim basis, but is subject to change 

8 and revision after public notice and opportunity for 

9 a period (of not less than 60 days) for public com10 ment. 

11 (2) CONSULTATION.—The Secretary shall con12 sult with the National Vision Rehabilitation Associa13 tion, the Association for Education and Rehabilita14 tion of the Blind and Visually Impaired, the Acad15 emy for Certification of Vision Rehabilitation and 

16 Education Professionals, the American Academy of 

17 Ophthalmology, the American Occupational Therapy 

18 Association, the American Optometric Association, 

19 and such other qualified professional and consumer 

20 organizations as the Secretary determines appro21 priate in promulgating regulations to carry out this 

22 Act. 
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1 SEC. 202. STUDY ON OBSTACLES FOR UNDERSERVED POPU2 LATIONS FOR VISION SERVICES UNDER THE 

3 MEDICARE PROGRAM. 

4 (a) STUDY.—The Secretary of Health and Human 

5 Services shall conduct a study on barriers faced by medi6 cally underserved populations (such as racial or ethnic mi7 norities) to vision services that are covered under the 

8 medicare program under title XVIII of the Social Security 

9 Act, including vision rehabilitation and other vision-related 

10 services. In conducting the study, the Secretary shall con11 sider economic barriers posed by cost-sharing require12 ments, such as copayments and deductibles and the aware13 ness of medicare beneficiaries of vision services benefits 

14 currently covered and those benefit for which coverage is 

15 not provided under the program. 

16 (b) REPORT.—Not later than one year after the date 

17 of the enactment of this Act, the Secretary shall submit 

18 to Congress a report on the study conducted under sub19 section (a). The report may include such recommendations 

20 for administrative action or legislation as the Secretary 

21 determines to be appropriate. 

22 SEC. 203. COMPREHENSIVE EYE EXAMINATIONS. 

23 The Secretary of Health and Human Services shall 

24 enter into an agreement with the Institute of Medicine of 

25 the National Academy of Sciences to conduct a study on 
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1 the cost benefit of providing a universal dilated eye exam 

2 under the medicare program.

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