I 

116TH CONGRESS 

1ST SESSION H. R. 4665 

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 

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. 

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 

5 of 2019’’. 


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1 SEC. 2. PROVIDING COVERAGE FOR VISION CARE UNDER 

2 THE MEDICARE PROGRAM. 

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

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

6 after the semicolon at the end; 

7 (2) in subparagraph (HH), by striking the pe8 riod at the end and adding ‘‘; and’’; and 

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

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

12 (kkk));’’. 

13 (b) VISION SERVICES DEFINED.—Section 1861 of 

14 the Social Security Act (42 U.S.C. 1395x) is amended by 

15 adding at the end the following new subsection: 

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

17 means— 

18 ‘‘(1) routine eye examinations, including proce19 dures performed during the course of such examina20 tion to determine the refractive state of the eyes; 

21 and 

22 ‘‘(2) contact lens fitting services, 

23 furnished on or after January 1, 2022, by or under the 

24 direct supervision of an optometrist or ophthalmologist 

25 who is legally authorized to furnish such examinations, 

26 procedures, or fitting services (as applicable) under State 


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1 law (or the State regulatory mechanism provided by State 

2 law) of the State in which the examinations, procedures, 

3 or fitting services are furnished.’’. 

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

5 (1) IN GENERAL.—Section 1833(a)(1) of the 

6 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

7 amended— 

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

9 (B) by inserting before the semicolon at 

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

11 to vision services (as defined in section 

12 1861(kkk)), the amount paid shall be equal to 

13 80 percent of the lesser of the actual charge or 

14 the amount determined under the payment 

15 basis determined under section 1848’’. 

16 (2) LIMITS SPECIFIED.—Section 1834 of the 

17 Social Security Act (42 U.S.C. 1395m) is amended 

18 by adding at the end the following new subsection: 

19 ‘‘(x) LIMITATION FOR VISION SERVICES.—With re20 spect to vision services (as defined in section 1861(kkk)) 

21 and an individual, payment may be made under this part 

22 for only 1 routine eye examination described in paragraph 

23 (1) of such section and 1 contact lens fitting service de24 scribed in paragraph (2) of such section during a 2-year 

25 period.’’. 


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1 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

2 (1) IN GENERAL.—Section 1848(j)(3) of the 

3 Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 

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

5 (2) BUDGET NEUTRALITY.—Section 

6 1848(c)(2)(B)(iv) of the Social Security Act (42 

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

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

9 the end; 

10 (B) in subclause (IV), by striking the pe11 riod at the end and inserting ‘‘; and’’; and 

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

13 subclause: 

14 ‘‘(V) the amendment made by 

15 section 2(d)(1) of the Medicare Vision 

16 Act of 2019 shall not be taken into 

17 account in applying clause (ii)(II) for 

18 2022 and 2023.’’. 

19 (e) COVERAGE OF CONVENTIONAL EYEGLASSES AND

20 CONTACT LENSES.—Section 1861(s)(8) of the Social Se21 curity Act (42 U.S.C. 1395x(s)(8)) is amended by striking 

22 ‘‘, and including one pair of conventional eyeglasses or 

23 contact lenses furnished subsequent to each cataract sur24 gery with insertion of an intraocular lens’’ and inserting 

25 ‘‘, including one pair of conventional eyeglasses or contact 


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1 lenses furnished subsequent to each cataract surgery with 

2 insertion of an intraocular lens, if furnished before Janu3 ary 1, 2022, and including conventional eyeglasses or con4 tact lenses, whether or not furnished subsequent to such 

5 a surgery, if furnished on or after January 1, 2022’’. 

6 (f) SPECIAL PAYMENT RULES FOR EYEGLASSES AND

7 CONTACT LENSES.— 

8 (1) LIMITATIONS.—Section 1834(h) of the So9 cial Security Act (42 U.S.C. 1395m(h)) is amended 

10 by adding at the end the following new paragraph: 

11 ‘‘(6) PAYMENT LIMITATIONS FOR EYEGLASSES

12 AND CONTACT LENSES.—With respect to eyeglasses 

13 and contact lenses furnished to an individual on or 

14 after January 1, 2022, payment may be made under 

15 this part only— 

16 ‘‘(A) during any 2-year period, for either 1 

17 pair of eyeglasses (including lenses and frames) 

18 or a 2-year supply that is provided in not more 

19 than 180-day increments of contact lenses; 

20 ‘‘(B) with respect to amounts attributable 

21 to the frames of such a pair of eyeglasses and 

22 amounts attributable to contact lenses fur23 nished during a year, in an amount not greater 

24 than— 

25 ‘‘(i) for 2022, $100; and 


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1 ‘‘(ii) for a subsequent year, the 

2 amount specified under this subparagraph 

3 for the previous year, increased by the per4 centage change in the Consumer Price 

5 Index for All Urban Consumers during 

6 such previous year; 

7 ‘‘(C) for types of eyeglass lenses, and for 

8 types of contact lenses, as determined appro9 priate by the Secretary; and 

10 ‘‘(D) if furnished pursuant to a written 

11 order of a physician described in section 

12 1861(kkk).’’. 

13 (2) APPLICATION OF COMPETITIVE ACQUISI14 TION.— 

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

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

17 1395m(h)(1)(H)) is amended— 

18 (i) in the header by inserting ‘‘, EYE19 GLASSES, AND CONTACT LENSES’’ after 

20 ‘‘ORTHOTICS’’; 

21 (ii) by inserting ‘‘and of eyeglasses 

22 and contact lenses described in paragraph 

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

24 and 


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

2 such eyeglasses and contact lenses’’ after 

3 ‘‘orthotics’’. 

4 (B) CONFORMING AMENDMENT.— 

5 (i) IN GENERAL.—Section 1847(a)(2) 

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

7 1395w–3(a)(2)) is amended by adding at 

8 the end the following new subparagraph: 

9 ‘‘(D) EYEGLASSES AND CONTACT

10 LENSES.—Eyeglasses and contact lenses for 

11 which payment would otherwise be made under 

12 section 1834(h).’’. 

13 (ii) EXEMPTION OF CERTAIN ITEMS

14 FROM COMPETITIVE ACQUISITION.—Sec15 tion 1847(a)(7) of the Social Security Act 

16 (42 U.S.C. 1395w–3(a)(7)) is amended by 

17 adding at the end the following new sub18 paragraph: 

19 ‘‘(C) CERTAIN EYEGLASSES AND CONTACT

20 LENSES.—Those items and services described in 

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

22 other practitioner (as defined by the Secretary) 

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

24 as part of the physician’s or practitioner’s pro25 fessional service.’’. 


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1 (g) EXCLUSION MODIFICATIONS.—Section 1862(a) 

2 of the Social Security Act (42 U.S.C. 1395y(a)) is amend3 ed— 

4 (1) in paragraph (1)— 

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

6 ‘‘and’’ at the end; 

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

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

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

10 subparagraph: 

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

12 in section 1861(kkk)) that are routine eye examina13 tions and contact lens fitting services (as described 

14 in paragraph (1) or (2), respectively, of such sec15 tion), which are furnished more frequently than once 

16 during a 2-year period;’’; and 

17 (2) in paragraph (7)— 

18 (A) by inserting ‘‘(other than such an ex19 amination that is a vision service that is cov20 ered under section 1861(s)(2)(II))’’ after ‘‘eye 

21 examinations’’; and 

22 (B) by inserting ‘‘(other than such a proce23 dure that is a vision service that is covered 

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

25 state of the eyes’’. 


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1 SEC. 3. IMPLEMENTATION FUNDING. 

2 The Secretary of Health and Human Services shall 

3 provide for the transfer from the Federal Supplementary 

4 Medical Insurance Trust Fund under section 1841 of the 

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

6 Medicare & Medicaid Services Program Management Ac7 count for the period of 2020 through 2024 of such sums 

8 as may be necessary for purposes of implementing the 

9 amendments made by section 2. 

Æ 


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