I 

116TH CONGRESS 

1ST SESSION H. R. 2371 

To amend title 10, United States Code, to modify the requirement for certain 

former members of the Armed Forces to enroll in Medicare Part B 

to be eligible for TRICARE for Life, and to amend title XVIII of 

the Social Security Act to provide for coverage of certain DNA specimen 

provenance assay tests under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 25, 2019 

Mr. THOMPSON of California (for himself and Mr. FERGUSON) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and 

Armed Services, 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 amend title 10, United States Code, to modify the requirement for certain former members of the Armed 

Forces to enroll in Medicare Part B to be eligible for 

TRICARE for Life, and to amend title XVIII of the 

Social Security Act to provide for coverage of certain 

DNA specimen provenance assay tests under the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Health Equity and 

3 Access for Returning Troops and Servicemembers Act of 

4 2019’’ or the ‘‘HEARTS Act of 2019’’. 

5 SEC. 2. MODIFICATION OF REQUIREMENT FOR CERTAIN 

6 FORMER MEMBERS OF THE ARMED FORCES 

7 TO ENROLL IN MEDICARE PART B TO BE ELI8 GIBLE FOR TRICARE FOR LIFE. 

9 (a) TRICARE ELIGIBILITY.— 

10 (1) IN GENERAL.—Subsection (d) of section 

11 1086 of title 10, United States Code, is amended by 

12 adding at the end the following new paragraph: 

13 ‘‘(6)(A) The requirement in paragraph (2)(A) 

14 to enroll in the supplementary medical insurance 

15 program under part B of title XVIII of the Social 

16 Security Act (42 U.S.C. 1395j et seq.) shall not 

17 apply to a person described in subparagraph (B) 

18 during any month in which such person is not enti19 tled to a benefit described in subparagraph (A) of 

20 section 226(b)(2) of the Social Security Act (42 

21 U.S.C. 426(b)(2)) if such person has received the 

22 counseling and information under subparagraph (C). 

23 ‘‘(B) A person described in this subpara24 graph is a person— 

25 ‘‘(i) who is under 65 years of age; 


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1 ‘‘(ii) who is entitled to hospital insur2 ance benefits under part A of title XVIII 

3 of the Social Security Act pursuant to sub4 paragraph (A) or (C) of section 226(b)(2) 

5 of such Act (42 U.S.C. 426(b)(2)); 

6 ‘‘(iii) whose entitlement to a benefit 

7 described in subparagraph (A) of such sec8 tion has terminated due to performance of 

9 substantial gainful activity; and 

10 ‘‘(iv) who is retired under chapter 61 

11 of this title. 

12 ‘‘(C) The Secretary of Defense shall co13 ordinate with the Secretary of Health and 

14 Human Services and the Commissioner of So15 cial Security to notify persons described in sub16 paragraph (B) of, and provide information and 

17 counseling regarding, the effects of not enroll18 ing in the supplementary medical insurance 

19 program under part B of title XVIII of the So20 cial Security Act (42 U.S.C. 1395j et seq.), as 

21 described in subparagraph (A).’’. 

22 (2) CONFORMING AMENDMENT.—Paragraph 

23 (2)(A) of such subsection is amended by striking ‘‘is 

24 enrolled’’ and inserting ‘‘except as provided by para25 graph (6), is enrolled’’. 


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1 (3) IDENTIFICATION OF PERSONS.—Section 

2 1110a of such title is amended by adding at the end 

3 the following new subsection: 

4 ‘‘(c) CERTAIN INDIVIDUALS NOT REQUIRED TO EN5 ROLL IN MEDICARE PART B.—In carrying out subsection 

6 (a), the Secretary of Defense shall coordinate with the 

7 Secretary of Health and Human Services and the Commis8 sioner of Social Security to— 

9 ‘‘(1) identify persons described in subparagraph 

10 (B) of section 1086(d)(6) of this title; and 

11 ‘‘(2) provide information and counseling pursu12 ant to subparagraph (D) of such section.’’. 

13 (b) NON-APPLICATION OF MEDICARE PART B LATE

14 ENROLLMENT PENALTY.—Section 1839(b) of the Social 

15 Security Act (42 U.S.C. 1395r(b)) is amended, in the sec16 ond sentence, by inserting ‘‘or months for which the indi17 vidual can demonstrate that the individual is an individual 

18 described in paragraph (6)(B) of section 1086(d) of title 

19 10, United States Code, who is enrolled in the TRICARE 

20 program pursuant to such section’’ after ‘‘an individual 

21 described in section 1837(k)(3)’’. 

22 (c) REPORT.—Not later than October 1, 2024, the 

23 Secretary of Defense, the Secretary of Health and Human 

24 Services, and the Commissioner of Social Security shall 

25 jointly submit to the Committees on Armed Services of 


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1 the House of Representatives and the Senate, the Com2 mittee on Ways and Means and the Committee on Energy 

3 and Commerce of the House of Representatives, and the 

4 Committee on Finance of the Senate a report on the im5 plementation of section 1086(d)(6) of title 10, United 

6 States Code, as added by subsection (a). Such report shall 

7 include, with respect to the period covered by the report— 

8 (1) the number of individuals enrolled in 

9 TRICARE for Life who are not enrolled in the sup10 plementary medical insurance program under part B 

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

12 1395j et seq.) by reason of such section 1086(d)(6); 

13 and 

14 (2) the number of individuals who— 

15 (A) are retired from the Armed Forces 

16 under chapter 61 of title 10, United States 

17 Code; 

18 (B) are entitled to hospital insurance bene19 fits under part A of title XVIII of the Social 

20 Security Act pursuant to receiving benefits for 

21 24 months as described in subparagraph (A) or 

22 (C) of section 226(b)(2) of such Act (42 U.S.C. 

23 426(b)(2)); and 

24 (C) because of such entitlement, are no 

25 longer enrolled in TRICARE Standard, 


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1 TRICARE Prime, TRICARE Extra, or 

2 TRICARE Select under chapter 55 of title 10, 

3 United States Code. 

4 (d) DEPOSIT OF SAVINGS INTO MEDICARE IMPROVE5 MENT FUND.—Section 1898(b)(1) of the Social Security 

6 Act (42 U.S.C. 1395iii(b)(1)) is amended by striking 

7 ‘‘during and after fiscal year 2021, $0’’ and inserting 

8 ‘‘during and after fiscal year 2024, $5,000,000’’. 

9 (e) APPLICATION.—The amendments made by sub10 sections (a) and (b) shall apply with respect to a person 

11 who, on or after October 1, 2023, is a person described 

12 in section 1086(d)(6)(B) of title 10, United States Code, 

13 as added by subsection (a). 

14 SEC. 3. COVERAGE OF CERTAIN DNA SPECIMEN PROVE15 NANCE ASSAY TESTS UNDER MEDICARE. 

16 (a) BENEFIT.— 

17 (1) COVERAGE.—Section 1861 of the Social Se18 curity Act (42 U.S.C. 1395x) is amended— 

19 (A) in subsection (s)(2)— 

20 (i) in subparagraph (GG), by striking 

21 ‘‘and’’ at the end; 

22 (ii) in subparagraph (HH), by insert23 ing ‘‘and’’ at the end; and 

24 (iii) by adding at the end the fol25 lowing new subparagraph: 


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1 ‘‘(II) a prostate cancer DNA Specimen Prove2 nance Assay test (DSPA test) (as defined in sub3 section (kkk)); and’’; and 

4 (B) by adding at the end the following new 

5 subsection: 

6 ‘‘(kkk) PROSTATE CANCER DNA SPECIMEN PROVE7 NANCE ASSAY TEST.—The term ‘prostate cancer DNA 

8 Specimen Provenance Assay Test’ (DSPA test) means a 

9 test that, after a determination of cancer in one or more 

10 prostate biopsy specimens obtained from an individual, as11 sesses the identity of the DNA in such specimens by com12 paring such DNA with the DNA that was separately taken 

13 from such individual at the time of the biopsy.’’. 

14 (2) EXCLUSION FROM COVERAGE.—Section 

15 1862(a)(1) of the Social Security Act (42 U.S.C. 

16 1395y(a)(1)) is amended— 

17 (A) in subparagraph (O), by striking 

18 ‘‘and’’ at the end; 

19 (B) in subparagraph (P), by striking the 

20 semicolon at the end and inserting ‘‘, and’’; and 

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

22 subparagraph: 

23 ‘‘(Q) in the case of a prostate cancer DNA 

24 Specimen Provenance Assay test (DSPA test) (as 

25 defined in section 1861(kkk)), unless such test is 


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1 furnished on or after January 1, 2020, and before 

2 January 1, 2025, and such test is ordered by the 

3 physician who furnished the prostate cancer biopsy 

4 that obtained the specimen tested;’’. 

5 (b) PAYMENT AMOUNT AND RELATED REQUIRE6 MENTS.—Section 1834 of the Social Security Act (42 

7 U.S.C. 1395m) is amended by adding at the end the fol8 lowing new subsection: 

9 ‘‘(x) PROSTATE CANCER DNA SPECIMEN PROVE10 NANCE ASSAY TESTS.— 

11 ‘‘(1) PAYMENT FOR COVERED TESTS.— 

12 ‘‘(A) IN GENERAL.—Subject to subpara13 graph (B), the payment amount for a prostate 

14 cancer DNA Specimen Provenance Assay test 

15 (DSPA test) (as defined in section 1861(kkk)) 

16 shall be $200. Such payment shall be payment 

17 for all of the specimens obtained from the bi18 opsy furnished to an individual that are tested. 

19 ‘‘(B) LIMITATION.—Payment for a DSPA 

20 test under subparagraph (A) may only be made 

21 on an assignment-related basis. 

22 ‘‘(C) PROHIBITION ON SEPARATE PAY23 MENT.—No separate payment shall be made for 

24 obtaining DNA that was separately taken from 


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1 an individual at the time of a biopsy described 

2 in subparagraph (A). 

3 ‘‘(2) HCPCS CODE AND MODIFIER ASSIGN4 MENT.— 

5 ‘‘(A) IN GENERAL.—The Secretary shall 

6 assign one or more HCPCS codes to a prostate 

7 cancer DNA Specimen Provenance Assay test 

8 and may use a modifier to facilitate making 

9 payment under this section for such test. 

10 ‘‘(B) IDENTIFICATION OF DNA MATCH ON

11 CLAIM.—The Secretary shall require an indica12 tion on a claim for a prostate cancer DNA 

13 Specimen Provenance Assay test of whether the 

14 DNA of the prostate biopsy specimens match 

15 the DNA of the individual diagnosed with pros16 tate cancer. Such indication may be made 

17 through use of a HCPCS code, a modifier, or 

18 other means, as determined appropriate by the 

19 Secretary. 

20 ‘‘(3) DNA MATCH REVIEW.— 

21 ‘‘(A) IN GENERAL.—The Secretary shall 

22 review at least three years of claims under part 

23 B for prostate cancer DNA Specimen Prove24 nance Assay tests to identify whether the DNA 

25 of the prostate biopsy specimens match the 


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1 DNA of the individuals diagnosed with prostate 

2 cancer. 

3 ‘‘(B) POSTING ON INTERNET WEBSITE.— 

4 Not later than July 1, 2023, the Secretary shall 

5 post on the internet website of the Centers for 

6 Medicare & Medicaid Services the findings of 

7 the review conducted under subparagraph 

8 (A).’’. 

9 (c) COST-SHARING.—Section 1833(a)(1) of the So10 cial Security Act (42 U.S.C. 1395l(a)(1)) is amended— 

11 (1) by striking ‘‘and (CC)’’ and inserting 

12 ‘‘(CC)’’; and 

13 (2) by inserting before the semicolon at the end 

14 the following: ‘‘, and (DD) with respect to a prostate 

15 cancer DNA Specimen Provenance Assay test 

16 (DSPA test) (as defined in section 1861(kkk)), the 

17 amount paid shall be an amount equal to 80 percent 

18 of the lesser of the actual charge for the test or the 

19 amount specified under section 1834(x)’’. 

Æ 


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