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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2942 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  1st Session
                                S. 2942

 To amend title XVIII of the Social Security Act to improve the annual 
               wellness visit under the Medicare program.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

           September 27 (legislative day, September 22), 2023

   Mr. King introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
 To amend title XVIII of the Social Security Act to improve the annual 
               wellness visit under the Medicare program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Wellness and Education for Longer 
Lives for Seniors Act of 2023'' or the ``WELL Seniors Act of 2023''.

SEC. 2. IMPROVEMENTS TO THE MEDICARE ANNUAL WELLNESS VISIT.

    (a) Additional Elements.--
            (1) In general.--Section 1861(hhh)(2) of the Social 
        Security Act (42 U.S.C. 1395x(hhh)(2)) is amended--
                    (A) in subparagraph (F), by striking ``and 
                nutrition'' and inserting ``nutrition, mobility, food 
                security, housing security, transportation access, 
                social support, and other social determinants of health 
                as determined by the Secretary'';
                    (B) by moving subparagraphs (G) and (H) 2 ems to 
                the left;
                    (C) by redesignating subparagraph (I) as 
                subparagraph (J); and
                    (D) by inserting after subparagraph (H) the 
                following new subparagraph:
                    ``(I) Screening for balance to identify risk for 
                falls and referral for treatment as appropriate.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to items and services furnished on or after January 
        1, 2024.
    (b) Incentive Payments.--Section 1833 of the Social Security Act 
(42 U.S.C. 1395l) is amended by adding at the end the following new 
subsection:
    ``(ee) Incentive Payments for Annual Wellness Visits That Include 
Certain Elements.--
            ``(1) In general.--In the case of personalized prevention 
        plan services (as defined in paragraph (1) of section 
        1861(hhh)) that are furnished on or after January 1, 2024, and 
        that include the element described in subparagraph (F) of 
        paragraph (2) of such section 1861(hhh) and at least 2 
        additional elements described in subparagraphs (A) through (E) 
        and (G) through (J) of such paragraph (2), in addition to the 
        amount of payment that would otherwise be made for such 
        personalized prevention plan services under this part, there 
        also shall be paid an amount equal to 10 percent of the payment 
        amount for the service under this part.
            ``(2) Coordination with other payments.--The amount of the 
        additional payment for a service under this subsection and 
        subsection (m) shall be determined without regard to any 
        additional payment for the service under subsection (m) and 
        this subsection, respectively. The amount of the additional 
        payment for a service under this subsection and subsection (z) 
        shall be determined without regard to any additional payment 
        for the service under subsection (z) and this subsection, 
        respectively.''.
    (c) Education and Outreach.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        conduct education and outreach activities regarding the 
        coverage of annual wellness visits under the Medicare program, 
        including changes to such visits under the amendments made by 
        subsections (a) and (b).
            (2) National outreach campaign.--Not later than 1 year 
        after the date of enactment of this Act, the Secretary shall 
        conduct a national outreach campaign to educate beneficiaries 
        on the annual wellness visit under the Medicare program. In 
        conducting such outreach campaign, the Secretary may prioritize 
        education and outreach to low-income beneficiaries, non-
        physician providers, and to providers working and beneficiaries 
        living in rural areas or health professional shortage areas.
            (3) Authorization of appropriations.--There is authorized 
        to be appropriated for fiscal years 2024 through 2028 such sums 
        as may be necessary to carry out this subsection.
    (d) Inclusion as Telehealth Service.--Section 1834(m)(4)(F)(i) of 
the Social Security Act (42 U.S.C. 1395m(m)(4)(F)(i)) is amended by 
adding at the end the following new sentence: ``Such term includes, 
with respect to telehealth services furnished on or after January 1, 
2024, an annual wellness visit (as defined in section 1861(hhh)).''
    (e) Provider Eligibility.--
            (1) In general.--Section 1861(hhh)(3) of the Social 
        Security Act (42 U.S.C. 1395x(hhh)(3)) is amended:
                    (A) by striking ``or'' at the end of subparagraph 
                (B);
                    (B) by redesignating subparagraph (C) as 
                subparagraph (D); and
                    (C) by inserting after subparagraph (B) the 
                following new subparagraph:
                    ``(C) a physical therapist, an occupational 
                therapist, or a pharmacist; or''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to items and services furnished on or after January 
        1, 2024.
    (f) Guidance Revision.--Not later than 1 year after the date of 
enactment of this Act, the Secretary shall issue guidance amending 
section 410.15 of title 42, Code of Federal Regulations, (or any 
successor regulations) to include guidance on processes, oversight, and 
standards for the post-visit follow-up to ensure consistency and 
compliance with the Health Risk Assessment, personalized prevention 
plan, and referrals.
    (g) Research and Evaluation.--
            (1) Report.--
                    (A) In general.--Not later than 1 year after the 
                date of enactment of this Act, the Secretary, acting 
                through the Administrator of the Centers for Medicare & 
                Medicaid Services (in this subsection referred to as 
                the ``Administrator''), shall analyze and publish a 
                report on the prevalence in use of the annual wellness 
                visit as defined under section 1861(hhh) of the Social 
                Security Act (42 U.S.C. 1395x(hhh)) by Medicare 
                beneficiaries, including current practices and 
                recommendations for increasing the use and 
                effectiveness of the annual wellness visit under the 
                Medicare program under title XVIII of the Social 
                Security Act (42 U.S.C. 1395 et seq.). Such report 
                shall include--
                            (i) information regarding the interviews 
                        conducted under subparagraph (B);
                            (ii) data on the prevalence of annual 
                        wellness visits furnished to Medicare 
                        beneficiaries via telehealth during the COVID-
                        19 public health emergency;
                            (iii) utilization and claims data for 
                        annual wellness visits over the preceding 10 
                        years broken down by State, demographic groups 
                        (including age, race, ethnicity, income, and 
                        education), the type of provider furnishing the 
                        annual wellness visit, and whether the 
                        beneficiary is enrolled for benefits under the 
                        original Medicare-fee-for-service program under 
                        parts A and B of title XVIII of the Social 
                        Security Act or the Medicare Advantage program 
                        under part C of title XVIII of the Social 
                        Security Act.
                    (B) Interviews with stakeholders.--The 
                Administrator shall conduct interviews with 
                stakeholders, including provider groups, on their 
                concerns regarding billing for and using the annual 
                wellness visit under the Medicare program, including 
                whether and to what extent personalized prevention plan 
                services and appropriate referrals and follow-up are 
                taking place for beneficiaries who are at particular 
                risk and which referral models are most effective.
            (2) Focus group study.--Not later than 6 months after the 
        date of enactment of this Act, the Secretary, acting through 
        the Administrator, shall conduct a focus group study among 
        providers, community-based organizations, and beneficiaries 
        towards increasing use of the annual wellness visit by Medicare 
        beneficiaries. The Secretary shall work with beneficiary and 
        stakeholder groups to develop the interview questions for such 
        focus group study, and shall include questions on--
                    (A) improving referrals to community services;
                    (B) barriers to utilization and recommendations to 
                increase uptake; and
                    (C) the types of providers in practices that 
                furnish the visits.
            (3) Authorization of appropriations.--There is authorized 
        to be appropriated for fiscal years 2024 through 2028 such sums 
        as may be necessary to carry out this subsection.
                                 <all>
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