IB 

Union Calendar No. 304 

116TH CONGRESS 

2D SESSION H. R. 4665 

[Report No. 116–327, Parts I and II] 

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

certain vision items and services under part B of the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 11, 2019 

Ms. SCHRIER (for herself, Mr. O’HALLERAN, Ms. SLOTKIN, and Ms. 

DELBENE) 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 

DECEMBER 6, 2019 

Reported from the Committee on Ways and Means with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

JANUARY 24, 2020 

Additional sponsors: Ms. CASTOR of Florida, Ms. NORTON, Mr. CUELLAR, and 

Mr. WELCH

JANUARY 24, 2020 

Reported from the Committee on Energy and Commerce, committed to the 

Committee of the Whole House on the State of the Union, and ordered 

to be printed 

[For text of introduced bill, see copy of bill as introduced on October 11, 2019] 


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A BILL 

To amend title XVIII of the Social Security Act to provide 

coverage for certain vision items and services under part 

B of the Medicare program. 


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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 ‘‘Medicare Vision Act of 

5 2019’’. 

6 SEC. 2. PROVIDING COVERAGE FOR VISION CARE UNDER 

7 THE MEDICARE PROGRAM. 

8 (a) COVERAGE.—Section 1861(s)(2) of the Social Secu9 rity Act (42 U.S.C. 1395x(s)(2)) is amended— 

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

11 after the semicolon at the end; 

12 (2) in subparagraph (HH), by striking the pe13 riod at the end and adding ‘‘; and’’; and 

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

16 ‘‘(II) vision services (as defined in subsection 

17 (kkk));’’. 

18 (b) VISION SERVICES DEFINED.—Section 1861 of the 

19 Social Security Act (42 U.S.C. 1395x) is amended by add20 ing at the end the following new subsection: 

21 ‘‘(kkk) VISION SERVICES.—The term ‘vision services’ 

22 means— 

23 ‘‘(1) routine eye examinations to determine the 

24 refractive state of the eyes, including procedures per25 formed during the course of such examination; and 


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1 ‘‘(2) contact lens fitting services; 

2 furnished on or after January 1, 2022, by or under the di3 rect supervision of an optometrist or ophthalmologist who 

4 is legally authorized to furnish such examinations, proce5 dures, or fitting services (as applicable) under State law 

6 (or the State regulatory mechanism provided by State law) 

7 of the State in which the examinations, procedures, or fit8 ting services are furnished.’’. 

9 (c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 

10 (1) IN GENERAL.—Section 1833(a)(1) of the So11 cial Security Act (42 U.S.C. 1395l(a)(1)) is amend12 ed— 

13 (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 

14 (B) by inserting before the semicolon at the 

15 end the following: ‘‘, and (DD) with respect to 

16 vision services (as defined in section 1861(kkk)), 

17 the amount paid shall be equal to 80 percent of 

18 the lesser of the actual charge or the amount de19 termined under the payment basis determined 

20 under section 1848’’. 

21 (2) LIMITS SPECIFIED.—Section 1834 of the So22 cial Security Act (42 U.S.C. 1395m) is amended by 

23 adding at the end the following new subsection: 

24 ‘‘(x) LIMITATION FOR VISION SERVICES.—With respect 

25 to vision services (as defined in section 1861(kkk)) and an 


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1 individual, payment may be made under this part for only 

2 1 routine eye examination described in paragraph (1) of 

3 such section and 1 contact lens fitting service described in 

4 paragraph (2) of such section during a 2-year period.’’. 

5 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

6 (1) IN GENERAL.—Section 1848(j)(3) of the So7 cial Security Act (42 U.S.C. 1395w–4(j)(3)) is 

8 amended by inserting ‘‘(2)(II),’’ before ‘‘(3)’’. 

9 (2) BUDGET NEUTRALITY.—Section 

10 1848(c)(2)(B)(iv) of the Social Security Act (42 

11 U.S.C. 1395–w(c)(2)(B)(iv)) is amended— 

12 (A) in subclause (III), by striking ‘‘and’’ at 

13 the end; 

14 (B) in subclause (IV), by striking the period 

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

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

17 subclause: 

18 ‘‘(V) the amendment made by sec19 tion 2(d)(1) of the Medicare Vision Act 

20 of 2019 shall not be taken into account 

21 in applying clause (ii)(II) for 2022 

22 and 2023.’’. 

23 (e) COVERAGE OF CONVENTIONAL EYEGLASSES AND

24 CONTACT LENSES.—Section 1861(s)(8) of the Social Secu25 rity Act (42 U.S.C. 1395x(s)(8)) is amended by striking ‘‘, 


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1 and including one pair of conventional eyeglasses or contact 

2 lenses furnished subsequent to each cataract surgery with 

3 insertion of an intraocular lens’’ and inserting ‘‘, including 

4 one pair of conventional eyeglasses or contact lenses fur5 nished subsequent to each cataract surgery with insertion 

6 of an intraocular lens, if furnished before January 1, 2022, 

7 and including conventional eyeglasses or contact lenses, 

8 whether or not furnished subsequent to such a surgery, if 

9 furnished on or after January 1, 2022’’. 

10 (f) SPECIAL PAYMENT RULES FOR EYEGLASSES AND

11 CONTACT LENSES.— 

12 (1) LIMITATIONS.—Section 1834(h) of the Social 

13 Security Act (42 U.S.C. 1395m(h)) is amended by 

14 adding at the end the following new paragraph: 

15 ‘‘(6) PAYMENT LIMITATIONS FOR EYEGLASSES

16 AND CONTACT LENSES.— 

17 ‘‘(A) IN GENERAL.—With respect to eye18 glasses and contact lenses furnished to an indi19 vidual on or after January 1, 2022, subject to 

20 subparagraph (B), payment may be made under 

21 this part only— 

22 ‘‘(i) during a 2-year period, for either 

23 1 pair of eyeglasses (including lenses and 

24 frames) or a 2-year supply that is provided 


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1 in not more than 180-day increments of 

2 contact lenses; 

3 ‘‘(ii) with respect to amounts attrib4 utable to the frames of such a pair of eye5 glasses and amounts attributable to contact 

6 lenses furnished during a year, in an 

7 amount not greater than— 

8 ‘‘(I) for 2022, $100; and 

9 ‘‘(II) for a subsequent year, the 

10 amount specified under this subpara11 graph for the previous year, increased 

12 by the percentage change in the con13 sumer price index for all urban con14 sumers during such previous year; 

15 ‘‘(iii) for types of eyeglass lenses, and 

16 for types of contact lenses, as determined 

17 appropriate by the Secretary; 

18 ‘‘(iv) if furnished pursuant to a writ19 ten order of a physician described in section 

20 1861(kkk); and 

21 ‘‘(v) if during the 2-year period de22 scribed in clause (i), the individual did not 

23 already receive (as described in subpara24 graph (B)) one pair of conventional eye25 glasses or contact lenses subsequent to a catVerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665

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1 aract surgery with insertion of an intra2 ocular lens furnished during such period. 

3 ‘‘(B) EXCEPTION.—With respect to a 2-year 

4 period described in subparagraph (A)(i), in the 

5 case of an individual who receives cataract sur6 gery with insertion of an intraocular lens, not7 withstanding subparagraph (A), payment may 

8 be made under this part for one pair of conven9 tional eyeglasses or contact lenses furnished sub10 sequent to such cataract surgery during such pe11 riod.’’. 

12 (2) APPLICATION OF COMPETITIVE ACQUISI13 TION.— 

14 (A) IN GENERAL.—Section 1834(h)(1)(H) of 

15 the Social Security Act (42 U.S.C. 

16 1395m(h)(1)(H)) is amended— 

17 (i) in the header by inserting ‘‘, EYE18 GLASSES, AND CONTACT LENSES’’ after 

19 ‘‘ORTHOTICS’’; 

20 (ii) by inserting ‘‘and of eyeglasses and 

21 contact lenses described in paragraph 

22 (2)(D) of such section,’’ after ‘‘2009,’’ ; and 

23 (iii) in clause (i), by inserting ‘‘or 

24 such eyeglasses and contact lenses’’ after 

25 ‘‘orthotics’’. 


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1 (B) CONFORMING AMENDMENT.— 

2 (i) IN GENERAL.—Section 1847(a)(2) 

3 of the Social Security Act (42 U.S.C. 

4 1395w–3(a)(2)) is amended by adding at 

5 the end the following new subparagraph: 

6 ‘‘(D) EYEGLASSES AND CONTACT LENSES.— 

7 Eyeglasses and contact lenses for which payment 

8 would otherwise be made under section 

9 1834(h).’’. 

10 (ii) EXEMPTION OF CERTAIN ITEMS

11 FROM COMPETITIVE ACQUISITION.—Section 

12 1847(a)(7) of the Social Security Act (42 

13 U.S.C. 1395w–3(a)(7)) is amended by add14 ing at the end the following new subpara15 graph: 

16 ‘‘(C) CERTAIN EYEGLASSES AND CONTACT

17 LENSES.—Those items and services described in 

18 paragraph (2)(D) if furnished by a physician or 

19 other practitioner (as defined by the Secretary) 

20 to the physician’s or practitioner’s own patients 

21 as part of the physician’s or practitioner’s pro22 fessional service.’’. 

23 (g) EXCLUSION MODIFICATIONS.—Section 1862(a) of 

24 the Social Security Act (42 U.S.C. 1395y(a)) is amended— 

25 (1) in paragraph (1)— 


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

2 at the end; 

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

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

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

6 subparagraph: 

7 ‘‘(Q) in the case of vision services (as defined in 

8 section 1861(kkk)) that are routine eye examinations 

9 and contact lens fitting services (as described in para10 graph (1) or (2), respectively, of such section), which 

11 are furnished more frequently than once during a 2- 

12 year period;’’; and 

13 (2) in paragraph (7)— 

14 (A) by inserting ‘‘(other than such an exam15 ination that is a vision service that is covered 

16 under section 1861(s)(2)(II))’’ after ‘‘eye exami17 nations’’; and 

18 (B) by inserting ‘‘(other than such a proce19 dure that is a vision service that is covered 

20 under section 1861(s)(2)(II))’’ after ‘‘refractive 

21 state of the eyes’’. 

22 SEC. 3. IMPLEMENTATION FUNDING. 

23 The Secretary of Health and Human Services shall 

24 provide for the transfer from the Federal Supplementary 

25 Medical Insurance Trust Fund under section 1841 of the 


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1 Social Security Act (42 U.S.C. 1395t) to the Centers for 

2 Medicare & Medicaid Services Program Management Ac3 count for the period of 2020 through 2024 of such sums as 

4 may be necessary for purposes of implementing the amend5 ments made by section 2. 


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Union Calendar No. 304 

116TH CONGRESS 

2D SESSION H. R. 4665 

[Report No. 116–327, Parts I and II] 

A BILL 

To amend title XVIII of the Social Security Act to 

services under part B of the Medicare program. provide coverage for certain vision items and 

JANUARY 24, 2020 

Reported from the Committee on Energy and Commerce, 

the State of the Union, and ordered to be printed committed to the Committee of the Whole House on 


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