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103D CONGRESS

1ST SESSION H. R. 2916

To amend title XVIII of the Social Security Act to provide for coverage

of a comprehensive health assessment and certain immunizations under

part B of the medicare program, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 6, 1993

Mr. BILIRAKIS introduced the following bill; which was referred jointly to the

Committees on Ways and Means and Energy and Commerce

A BILL

To amend title XVIII of the Social Security Act to provide

for coverage of a comprehensive health assessment and

certain immunizations under part B of the medicare

program, 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 ‘‘Older Americans Pre5 ventive Health Act of 1993’’.
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1 SEC. 2. MEDICARE COVERAGE OF COMPREHENSIVE

2 HEALTH ASSESSMENT.

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

4 Security Act (42 U.S.C. 1395x(s)(2)) is amended—

5 (1) by striking ‘‘and’’ at the end of subpara6 graph (O);

7 (2) by striking the semicolon at the end of sub8 paragraph (P) and inserting ‘‘; and’’; and

9 (3) by adding at the end the following new sub10 paragraph:

11 ‘‘(Q) comprehensive health assessment (as de12 fined in subsection (oo));’’.

13 (b) COMPREHENSIVE HEALTH ASSESSMENT DE14 FINED.—Section 1861 of such Act (42 U.S.C. 1395x) is

15 amended by adding at the end the following new sub16 section:

17 ‘‘COMPREHENSIVE HEALTH ASSESSMENT

18 ‘‘(oo)(1) The term ‘comprehensive health assessment’

19 means a procedure conducted by a primary care physician

20 (as defined in paragraph (3)) that is provided to an indi21 vidual enrolled under part B who elects to receive coverage

22 for such assessment (at such time and in such manner

23 as the Secretary may provide by regulation) and that con24 sists of the following examinations, tests, and procedures:

25 ‘‘(A) The taking of a health history.
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1 ‘‘(B) A physical examination, including an ex2 amination for height, weight, blood pressure, visual

3 acuity, hearing, and palpation for pre-clinical dis4 ease.

5 ‘‘(C) Laboratory and screening procedures, in6 cluding—

7 ‘‘(i) nonfasting total blood cholesterol;

8 ‘‘(ii) fecal occult blood testing, and

9 ‘‘(iii) sigmoidoscopy (in accordance with a

10 periodicity schedule established by the Sec11 retary).

12 ‘‘(D) Counseling services, including counseling

13 relating to—

14 ‘‘(i) exercise;

15 ‘‘(ii) smoking cessation;

16 ‘‘(iii) substance abuse prevention;

17 ‘‘(iv) injury prevention;

18 ‘‘(v) dental health;

19 ‘‘(vi) prescription drug use;

20 ‘‘(vii) the need to visit eye specialists for

21 glaucoma testing;

22 ‘‘(viii) diet;

23 ‘‘(ix) in the case of women, the need for

24 regular mammograms and pap smears; and
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1 ‘‘(x) in the case of individuals identified as

2 being at high risk for specific medical condi3 tions, counseling for—

4 ‘‘(I) estrogen replacement therapy,

5 ‘‘(II) aspirin therapy, and

6 ‘‘(III) skin protection from ultraviolet

7 light.

8 ‘‘(2) For purposes of this subsection, the term ‘pri9 mary care physician’ includes a physician (described in

10 section 1861(r)(1)) who is a family practitioner, general

11 practitioner, internal medicine specialist, general preven12 tive medicine specialist, obstetrical or gynecological spe13 cialist, pediatrician.’’.

14 (c) AMOUNT OF PAYMENT; WAIVER OF

15 COPAYMENT.—(1) Section 1833(a)(1) of such Act (42

16 U.S.C. 1395l(a)(1)) is amended—

17 (A) by striking ‘‘1834(h)(1), (M)’’ and inserting

18 ‘‘1834(h)(1), (N)’’;

19 (B) by striking ‘‘(r)(2)) and (N)’’ and inserting

20 ‘‘(r)(2)), (O)’’; and

21 (C) by striking the semicolon at the end and in22 serting the following: ‘‘, and (P) with respect to ex23 penses incurred for a comprehensive health assess24 ment (as described in section 1861(oo)), the

25 amounts paid shall be 100 percent of the reasonable
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1 charge for such assessment or the fee schedule

2 amount determined under section 1848 for such as3 sessment;’’.

4 (2) The second to last sentence of section

5 1866(a)(2)(A) of such Act (42 U.S.C. 1395cc(a)(2)(A))

6 is amended by inserting after ‘‘with the first opinion),’’

7 the following: ‘‘with respect to a comprehensive health as8 sessment (as described in section 1861(oo)),’’.

9 (d) FINANCING THROUGH INCREASE IN PART B

10 PREMIUM.—Section 1839 of such Act (42 U.S.C. 1395r)

11 is amended by adding at the end the following new sub12 section:

13 ‘‘(g) Notwithstanding any other provision of this sec14 tion, in the case of an individual enrolled under this part

15 who elects to receive coverage for a comprehensive health

16 assessment pursuant to section 1861(oo)(1) for months in

17 a calendar year, the amount of the monthly premium oth18 erwise applicable to the individual under this section for

19 months in such year shall be increased by such amount

20 as the Secretary determines to be necessary to ensure that

21 the amount of expenditures made under this part during

22 the year as a result of the enactment of the Older Ameri23 cans Preventive Health Act of 1993 will not exceed the

24 amount of expenditures that would have been made under
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1 this part during the year if such Act had not been enacted

2 into law.’’.

3 (e) EFFECTIVE DATE.—The amendments made by

4 this sections shall apply to services furnished on or after

5 January 1, 1994.

6 SEC. 2. MEDICARE COVERAGE OF CERTAIN IMMUNIZA7 TIONS.

8 (a) IN GENERAL.—Section 1861(s)(10) of the Social

9 Security Act (42 U.S.C. 1395x(s)(10)) is amended—

10 (1) in subparagraph (A), by striking ‘‘; and’’

11 and inserting a comma;

12 (2) in subparagraph (B), by striking the semi13 colon at the end and inserting ‘‘, and’’; and

14 (3) by adding at the end the following new sub15 paragraph:

16 ‘‘(C) such immunizations as the Secretary des17 ignates for prevention or treatment of tuberculosis,

18 meningococcal meningitis, tetanus, diptheria, and

19 such other infectious diseases as the Secretary deter20 mines present a public health problem, furnished to

21 individuals who, as determined in accordance with

22 regulations promulgated by the Secretary, are at

23 high risk of contracting any of such diseases;’’.

24 (b) WAIVER OF COPAYMENT.—(1) Section

25 1833(a)(1)(B) of such Act (42 U.S.C. 1395l(a)(1)(B)) is
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1 amended by striking ‘‘1861(s)(10)(A)’’ and inserting

2 ‘‘1861(s)(10)’’.

3 (2) The third sentence of section 1866(a)(2)(A) of

4 such Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by

5 striking ‘‘1861(s)(10)(A)’’ and inserting ‘‘1861(s)(10)’’.

6 (c) EFFECTIVE DATE.—The amendments made by

7 subsections (a) and (b) shall apply to items and services

8 furnished on or after January 1, 1994.

9 SEC. 3. ADDITIONAL AUTHORIZATION OF APPROPRIATIONS

10 FOR PROVISION OF EDUCATION AND INFOR11 MATION REGARDING CANCER.

12 Section 408(a)(1) of the Public Health Service Act

13 (42 U.S.C. 284c(a)(1)) is amended by adding at the end

14 the following new subparagraph:

15 ‘‘(C)(i) Subject to clause (ii), for the purpose of

16 providing under sections 412 and 413 education and

17 information regarding cancer to health professionals

18 and the public, there are authorized to be appro19 priated such sums as may be necessary for each of

20 the fiscal years 1994 through 1996. The authoriza21 tion of appropriations established in the preceding

22 sentence is in addition to any other authorization of

23 appropriations that is available for such purpose.

24 ‘‘(ii) In carrying out the purpose described in

25 clause (i) with amounts appropriated under such
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1 clause, the Director of the Cancer Institute shall

2 give priority to carrying out the purpose with respect

3 to low-income individuals.’’.

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