II

106TH CONGRESS

1ST SESSION S. 1618

To promote primary and secondary health promotion and disease prevention

services and activities among the elderly, to amend title XVIII of the

Social Security Act to add preventive benefits, and for other purposes.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 22, 1999

Mr. GRAHAM (for himself, Mr. JEFFORDS, Mr. CHAFEE, Mr. BRYAN, Mr.

ROCKEFELLER, and Mr. KERRY) introduced the following bill; which was

read twice and referred to the Committee on Finance

A BILL

To promote primary and secondary health promotion and

disease prevention services and activities among the elderly, to amend title XVIII of the Social Security Act

to add preventive benefits, 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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Medicare Wellness Act of 1999’’.

6 (b) TABLE OF CONTENTS.—The table of contents is

7 as follows:

Sec. 1. Short title; table of contents.
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Sec. 2. Finding.

Sec. 3. Definitions.

TITLE I—HEALTHY SENIORS PROMOTION PROGRAM

Sec. 101. Healthy Seniors Promotion Program.

Sec. 102. Sense of Congress regarding the response of HCFA to preventive

health issues.

Sec. 103. Sense of Congress regarding the efforts of HCFA to study health

promotion and disease prevention for medicare beneficiaries.

Sec. 104. Sense of Congress regarding the establishment of a medicare health

promotion and disease prevention clearinghouse.

TITLE II—MEDICARE COVERAGE OF PREVENTIVE SERVICES

Sec. 201. Counseling for cessation of tobacco use.

Sec. 202. Screening for hypertension.

Sec. 203. Counseling for hormone replacement therapy.

Sec. 204. Screening for glaucoma.

Sec. 205. Screening for diminished visual acuity.

Sec. 206. Screening for hearing impairment.

Sec. 207. Screening and counseling for osteoporosis.

Sec. 208. Screening for cholesterol.

Sec. 209. Elimination of cost sharing for current preventive benefits.

Sec. 210. National falls prevention education and awareness campaign.

Sec. 211. Program integrity.

TITLE III—MEDICARE HEALTH EDUCATION AND RISK APPRAISAL

PROGRAM

Sec. 301. Medicare Health Education and Risk Appraisal Program.

TITLE IV—DISEASE SELF-MANAGEMENT DEMONSTRATION

PROJECTS

Sec. 401. Disease self-management demonstration projects.

TITLE V—STUDIES AND REPORTS ADVANCING ORIGINAL RESEARCH IN THE FIELD OF DISEASE PREVENTION AND THE

ELDERLY

Sec. 501. MedPAC biannual report.

Sec. 502. National Institute on Aging study and report.

Sec. 503. Institute of Medicine 5-year medicare prevention benefit study and

report.

Sec. 504. Fast-track consideration of prevention benefit legislation.

1 SEC. 2. FINDING.

2 Congress finds that despite significant advancements

3 in general research for health promotion and disease pre4 vention among the elderly, there has been a failure in

5 translating that research into practical intervention.
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1 SEC. 3. DEFINITIONS.

2 As used in this Act:

3 (1) COST-EFFECTIVE BENEFIT.—The term

4 ‘‘cost-effective benefit’’ means a benefit or technique

5 that has—

6 (A) been subject to peer review;

7 (B) been described in scientific journals;

8 and

9 (C) demonstrated value as measured by

10 unit costs relative to health outcomes achieved.

11 (2) COST-SAVING BENEFIT.—The term ‘‘cost12 saving benefit’’ means a benefit or technique that

13 has—

14 (A) been subject to peer review;

15 (B) been described in scientific journals;

16 and

17 (C) caused a net reduction in health care

18 costs for medicare beneficiaries.

19 (3) MEDICALLY EFFECTIVE.—The term ‘‘medi20 cally effective’’ means, with respect to a benefit or

21 technique, that the benefit or technique has been—

22 (A) subject to peer review;

23 (B) described in scientific journals; and

24 (C) determined to achieve an intended goal

25 under normal, programmatic conditions.
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1 (4) MEDICAL EFFICACY; MEDICALLY EFFICA2 CIOUS.—The terms ‘‘medical efficacy’’ and ‘‘medi3 cally efficacious’’ mean, with respect to a benefit or

4 technique, that the benefit or technique has been—

5 (A) subject to peer review;

6 (B) described in scientific journals; and

7 (C) determined to achieve an intended goal

8 under controlled conditions.

9 (5) MEDICARE BENEFICIARY.—The term

10 ‘‘medicare beneficiary’’ means any individual who is

11 entitled to benefits under part A or enrolled under

12 part B of the medicare program, including any indi13 vidual enrolled in a Medicare+Choice plan offered

14 by a Medicare+Choice organization under part C of

15 such program.

16 (6) MEDICARE PROGRAM.—The term ‘‘medicare

17 program’’ means the health care program under title

18 XVIII of the Social Security Act (42 U.S.C. 1395 et

19 seq.).

20 (7) SECRETARY.—The term ‘‘Secretary’’ means

21 the Secretary of Health and Human Services.

22 TITLE I—HEALTHY SENIORS

23 PROMOTION PROGRAM

24 SEC. 101. HEALTHY SENIORS PROMOTION PROGRAM.

25 (a) DEFINITIONS.—As used in this section:
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1 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti2 ty’’ means an entity that the Working Group deter3 mines has demonstrated expertise in research re4 garding health promotion and disease prevention

5 among the elderly.

6 (2) WORKING GROUP.—The term ‘‘Working

7 Group’’ means the Healthy Seniors Working Group

8 established under subsection (d).

9 (b) PROGRAM AUTHORIZED.—The Secretary, subject

10 to the general policies and criteria established by the

11 Working Group and in accordance with the provisions of

12 this Act, is authorized to make grants to eligible entities

13 to pay for the costs of the activities described in subsection

14 (c).

15 (c) USE OF FUNDS.—An eligible entity may use pay16 ments received under this section in any fiscal year to

17 study—

18 (1) whether using different types of providers of

19 care who are not physicians and alternative settings

20 (including community-based senior centers) for the

21 implementation of a successful health promotion and

22 disease prevention strategy, including the implica23 tions regarding the payment of such providers, is

24 medically efficacious or medically effective;
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1 (2) the most medically effective means of edu2 cating medicare beneficiaries and providers of serv3 ices regarding the importance of health promotion

4 and disease prevention among the elderly and identi5 fication of incentives that would increase the use of

6 new and existing preventive services and healthy be7 haviors by medicare beneficiaries; and

8 (3) other topics designated by the Secretary.

9 (d) HEALTHY SENIORS WORKING GROUP.—

10 (1) ESTABLISHMENT.—There is established

11 within the Department of Health and Human Serv12 ices a Healthy Seniors Working Group.

13 (2) COMPOSITION.—Subject to paragraph (3),

14 the Working Group established pursuant to sub15 section (b) shall be composed of 5 members as fol16 lows:

17 (A) The Administrator of the Health Care

18 Financing Administration.

19 (B) The Director of the Centers for Dis20 ease Control and Prevention.

21 (C) The Administrator of the Agency for

22 Health Care Policy and Research.

23 (D) The Assistant Secretary for Aging.

24 (E) The Director of the National Institute

25 on Aging.
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1 (3) ALTERNATIVE MEMBERSHIP.—

2 (A) APPOINTMENT.—Any member of the

3 Working Group described in a subparagraph of

4 paragraph (2) may appoint an individual who is

5 an officer or employee of the Federal Govern6 ment to serve as a member of the Working

7 Group instead of the member described in such

8 subparagraph.

9 (B) DEADLINE.—If a member described in

10 subparagraph (A) elects to appoint an indi11 vidual under such subparagraph, such indi12 vidual shall be appointed not later than Decem13 ber 31, 2000.

14 (4) GENERAL POLICIES AND CRITERIA.—The

15 Working Group shall establish general policies and

16 criteria with respect to the functions of the Sec17 retary under this section including—

18 (A) priorities for the approval of applica19 tions;

20 (B) procedures for developing, monitoring,

21 and evaluating research efforts conducted under

22 this section; and

23 (C) such other matters as are rec24 ommended by the Working Group and approved

25 by the Secretary.
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1 (5) CHAIRPERSON.—The Chairperson of the

2 Working Group shall be the Administrator of the

3 Agency for Health Care Policy and Research.

4 (6) QUORUM.—A majority of the members of

5 the Working Group shall constitute a quorum, but

6 a lesser number of members may hold hearings.

7 (7) MEETINGS.—The Working Group shall

8 meet at the call of the Chairperson, except that—

9 (A) it shall meet not less than 4 times each

10 year; and

11 (B) it shall meet whenever a majority of

12 the appointed members request a meeting in

13 writing.

14 (8) COMPENSATION OF MEMBERS.—Each mem15 ber of the Working Group shall be an officer or em16 ployee of the Federal Government and shall serve

17 without compensation in addition to that received for

18 their service as an officer or employee of the Federal

19 Government.

20 (e) APPLICATION.—

21 (1) IN GENERAL.—Each eligible entity which

22 desires to receive a grant under this section shall

23 submit an application to the Secretary, at such time,

24 in such manner, and accompanied by such additional
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1 information as the Secretary may reasonably re2 quire.

3 (2) CONTENTS.—Each application submitted

4 pursuant to paragraph (1) shall—

5 (A) describe the activities for which assist6 ance under this section is sought;

7 (B) describe how the research effort pro8 posed to be conducted will reflect the medical,

9 behavioral, and social aspects of care for the el10 derly, lead to the development of cost-effective

11 benefits and cost-saving benefits, and impact

12 the quality of life of medicare beneficiaries;

13 (C) provide evidence that the eligible entity

14 meets the general policies established by the

15 Working Group pursuant to subsection (d)(4);

16 (D) provide assurances that the eligible en17 tity will take such steps as may be available to

18 it to continue the activities for which the eligi19 ble entity is making application after the period

20 for which assistance is sought; and

21 (E) provide such additional assurances as

22 the Secretary determines to be essential to en23 sure compliance with the requirements of this

24 Act.
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1 (3) JOINT APPLICATION.—A consortium of eli2 gible entities may file a joint application under the

3 provisions of paragraph (1) of this subsection.

4 (f) APPROVAL OF APPLICATION.—The Secretary

5 shall approve applications in accordance with the general

6 policies established by the Working Group under sub7 section (d).

8 (g) PAYMENTS.—The Secretary shall pay to each eli9 gible entity having an application approved under sub10 section (f) the cost of the activities described in the appli11 cation.

12 (h) EVALUATION AND REPORT.—

13 (1) EVALUATION.—The Secretary shall conduct

14 an annual evaluation of grants made under this sec15 tion to determine—

16 (A) the results of the overall applied re17 search conducted under this Act;

18 (B) the extent to which research assisted

19 under this section has improved or expanded

20 the general research for health promotion and

21 disease prevention among the elderly and identi22 fied practical interventions based upon such re23 search;

24 (C) a list of specific recommendations

25 based upon research conducted under this sec-
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1 tion which show promise as practical interven2 tions for health promotion and disease preven3 tion among the elderly;

4 (D) whether or not as a result of the ap5 plied research effort certain health promotion

6 and disease prevention benefits or education ef7 forts should be added to the medicare program,

8 including discussions of quality of life, trans9 lating the applied research results into a benefit

10 under the medicare program, and whether each

11 additional benefit would be a cost-effective ben12 efit or cost-saving benefit for each proposed ad13 dition;

14 (E) the utility of, potential for, and issues

15 surrounding health risk appraisals sponsored

16 under the medicare program and targeted fol17 lowup; and

18 (F) how best to increase utilization of ex19 isting and recommended health promotion and

20 disease prevention services, including an edu21 cation and public awareness component discus22 sion of financial incentives for providers of serv23 ices and medicare beneficiaries to improve utili24 zation and other administrative means of in25 creasing utilization.
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1 (2) ANNUAL REPORT.—Not later than Decem2 ber 31, 2002, and each year thereafter through

3 2005, the Secretary shall submit a report to Con4 gress based on the annual studies made under para5 graph (1), which shall contain a detailed statement

6 of the findings and conclusions of the Working

7 Group together with its recommendations for such

8 legislation and administrative actions as it considers

9 appropriate.

10 (i) AUTHORIZATION OF APPROPRIATIONS.—There

11 are authorized to be appropriated $40,000,000 for each

12 of the fiscal years 2000, 2001, 2002, and 2003 to carry

13 out the provisions of this section.

14 SEC. 102. SENSE OF CONGRESS REGARDING THE RESPONSE

15 OF HCFA TO PREVENTIVE HEALTH ISSUES.

16 It is the sense of Congress that in administering the

17 medicare program the Secretary should ensure that the

18 Administrator of the Health Care Financing Administra19 tion encourages the inclusion of preventive measures as

20 part of all treatments described in such program.
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1 SEC. 103. SENSE OF CONGRESS REGARDING THE EFFORTS

2 OF HCFA TO STUDY HEALTH PROMOTION

3 AND DISEASE PREVENTION FOR MEDICARE

4 BENEFICIARIES.

5 It is the sense of Congress that the Secretary should

6 ensure that the Administrator of the Health Care Financ7 ing Administration expands the study of the most prom8 ising behavioral modification of risk factors associated

9 with health promotion and disease prevention for all medi10 care beneficiaries.

11 SEC. 104. SENSE OF CONGRESS REGARDING THE ESTAB12 LISHMENT OF A MEDICARE HEALTH PRO13 MOTION AND DISEASE PREVENTION CLEAR14 INGHOUSE.

15 It is the sense of Congress that the National Library

16 of Medicine should collect information regarding innova17 tive and successful health promotion and disease preven18 tion interventions from both published and unpublished

19 sources, establish a clearinghouse targeting all medicare

20 beneficiaries in a variety of settings for the consolidation

21 and coordination of all such information, and make the

22 clearinghouse available to the public and accessible

23 through the Internet.
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1 TITLE II—MEDICARE COVERAGE

2 OF PREVENTIVE SERVICES

3 SEC. 201. COUNSELING FOR CESSATION OF TOBACCO USE.

4 (a) COVERAGE.—Section 1861(s)(2) of the Social Se5 curity Act (42 U.S.C. 1395x(s)(2)) is amended—

6 (1) in subparagraph (S), by striking ‘‘and’’ at

7 the end;

8 (2) in subparagraph (T), by striking the period

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

10 (3) by adding at the end the following:

11 ‘‘(U) counseling for cessation of tobacco use (as

12 defined in subsection (uu)) for individuals who have

13 a history of tobacco use.’’.

14 (b) SERVICES DESCRIBED.—Section 1861 of such

15 Act (42 U.S.C. 1395x) is amended by adding at the end

16 the following:

17 ‘‘Counseling for Cessation of Tobacco Use

18 ‘‘(uu)(1) Except as provided in paragraph (2), the

19 term ‘counseling for cessation of tobacco use’ means diag20 nostic, therapy, and counseling services for cessation of

21 tobacco use which are furnished by or under the super22 vision of a physician or other health care professional who

23 is legally authorized to furnish such services under State

24 law (or the State regulatory mechanism provided by State

25 law) of the State in which the services are furnished, as
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1 would otherwise be covered if furnished by a physician or

2 as an incident to a physician’s professional service.

3 ‘‘(2) The term ‘counseling for cessation of tobacco

4 use’ does not include coverage for drugs or biologicals that

5 are not otherwise covered under this title.’’.

6 (c) ELIMINATION OF COST SHARING.—

7 (1) ELIMINATION OF COINSURANCE.—Section

8 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) is

9 amended—

10 (A) by striking ‘‘and (S)’’ and inserting

11 ‘‘(S)’’; and

12 (B) by striking the semicolon at the end

13 and inserting the following: ‘‘, and (T) with re14 spect to counseling for cessation of tobacco use

15 (as defined in section 1861(uu)), the amount

16 paid shall be 100 percent of the lesser of the

17 actual charge for the services or the amount de18 termined by a fee schedule established by the

19 Secretary for the purposes of this subpara20 graph;’’.

21 (2) ELIMINATION OF DEDUCTIBLE.—The first

22 sentence of section 1833(b) of such Act (42 U.S.C.

23 1395l(b)) is amended—

24 (A) by striking ‘‘and’’ before ‘‘(6)’’; and
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1 (B) by inserting before the period the fol2 lowing: ‘‘, and (7) such deductible shall not

3 apply with respect to counseling for cessation of

4 tobacco use (as defined in section 1861(uu))’’.

5 (d) EFFECTIVE DATE.—The amendments made by

6 this section shall apply to services furnished on or after

7 December 31, 2001.

8 SEC. 202. SCREENING FOR HYPERTENSION.

9 (a) COVERAGE.—Section 1861(s)(2) of the Social Se10 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec11 tion 201(a)) is amended—

12 (1) in subparagraph (T), by striking ‘‘and’’ at

13 the end;

14 (2) in subparagraph (U), by striking the period

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

16 (3) by adding at the end the following:

17 ‘‘(V) screening for hypertension (as defined in

18 subsection (vv)) not more frequently than once every

19 2 years for individuals with normotensive blood pres20 sure measurements and annually for individuals with

21 blood pressure measurements that are not

22 normotensive.’’.

23 (b) SERVICES DESCRIBED.—Section 1861 of such

24 Act (42 U.S.C. 1395x) (as amended by section 201(b))

25 is amended by adding at the end the following:
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1 ‘‘Screening for Hypertension

2 ‘‘(vv) The term ‘screening for hypertension’ means di3 agnostic services for hypertension which are furnished by

4 or under the supervision of a physician or other health

5 care professional who is legally authorized to furnish such

6 services under State law (or the State regulatory mecha7 nism provided by State law) of the State in which the serv8 ices are furnished, as would otherwise be covered if fur9 nished by a physician or as an incident to a physician’s

10 professional service.’’.

11 (c) ELIMINATION OF COST SHARING.—

12 (1) ELIMINATION OF COINSURANCE.—Section

13 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

14 amended by section 201(c)(1)) is amended—

15 (A) by striking ‘‘and (T)’’ and inserting

16 ‘‘(T)’’; and

17 (B) by striking the semicolon at the end

18 and inserting the following: ‘‘, and (U) with re19 spect to screening for hypertension (as defined

20 in section 1861(vv)), the amount paid shall be

21 100 percent of the lesser of the actual charge

22 for the services or the amount determined by a

23 fee schedule established by the Secretary for the

24 purposes of this subparagraph;’’.
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1 (2) ELIMINATION OF DEDUCTIBLE.—The first

2 sentence of section 1833(b) of such Act (42 U.S.C.

3 1395l(b)) (as amended by section 201(c)(2)) is

4 amended—

5 (A) by striking ‘‘and’’ before ‘‘(7)’’; and

6 (B) by inserting before the period the fol7 lowing: ‘‘, and (8) such deductible shall not

8 apply with respect to screening for hypertension

9 (as defined in section 1861(vv))’’.

10 (d) EFFECTIVE DATE.—The amendments made by

11 this section shall apply to services furnished on or after

12 December 31, 2001.

13 SEC. 203. COUNSELING FOR HORMONE REPLACEMENT

14 THERAPY.

15 (a) COVERAGE.—Section 1861(s)(2) of the Social Se16 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec17 tion 202(a)) is amended—

18 (1) in subparagraph (U), by striking ‘‘and’’ at

19 the end;

20 (2) in subparagraph (V), by striking the period

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

22 (3) by adding at the end the following:

23 ‘‘(W) counseling for hormone replacement ther24 apy (as defined in subsection (ww)).’’.
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1 (b) SERVICES DESCRIBED.—Section 1861 of such

2 Act (42 U.S.C. 1395x) (as amended by section 202(b))

3 is amended by adding at the end the following:

4 ‘‘Counseling for Hormone Replacement Therapy

5 ‘‘(ww)(1) Except as provided in paragraph (2), the

6 term ‘counseling for hormone replacement therapy’ means

7 diagnostic, therapy, and counseling services for hormone

8 replacement which are furnished by or under the super9 vision of a physician or other health care professional who

10 is legally authorized to furnish such services under State

11 law (or the State regulatory mechanism provided by State

12 law) of the State in which the services are furnished, as

13 would otherwise be covered if furnished by a physician or

14 as an incident to a physician’s professional service.

15 ‘‘(2) The term ‘counseling for hormone replacement

16 therapy’ does not include coverage for drugs or biologicals

17 that are not otherwise covered under this title.’’.

18 (c) ELIMINATION OF COST SHARING.—

19 (1) ELIMINATION OF COINSURANCE.—Section

20 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

21 amended by section 202(c)(1)) is amended—

22 (A) by striking ‘‘and (U)’’ and inserting

23 ‘‘(U)’’; and

24 (B) by striking the semicolon at the end

25 and inserting the following: ‘‘, and (V) with re-
20

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1 spect to counseling for hormone replacement

2 therapy (as defined in section 1861(ww)), the

3 amount paid shall be 100 percent of the lesser

4 of the actual charge for the services or the

5 amount determined by a fee schedule estab6 lished by the Secretary for the purposes of this

7 subparagraph;’’.

8 (2) ELIMINATION OF DEDUCTIBLE.—The first

9 sentence of section 1833(b) of such Act (42 U.S.C.

10 1395l(b)) (as amended by section 202(c)(2)) is

11 amended—

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

13 (B) by inserting before the period the fol14 lowing: ‘‘, and (9) such deductible shall not

15 apply with respect to counseling for hormone

16 replacement therapy (as defined in section

17 1861(ww))’’.

18 (d) EFFECTIVE DATE.—The amendments made by

19 this section shall apply to services furnished on or after

20 December 31, 2001.

21 SEC. 204. SCREENING FOR GLAUCOMA.

22 (a) COVERAGE.—Section 1861(s)(2) of the Social Se23 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec24 tion 203(a)) is amended—
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1 (1) in subparagraph (V), by striking ‘‘and’’ at

2 the end;

3 (2) in subparagraph (W), by striking the period

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

5 (3) by adding at the end the following:

6 ‘‘(X) screening for glaucoma (as defined in sub7 section (xx)) for individuals determined to be at high

8 risk for glaucoma, individuals with a family history

9 of glaucoma, and individuals with diabetes or myo10 pia.’’.

11 (b) SERVICES DESCRIBED.—Section 1861 of such

12 Act (42 U.S.C. 1395x) (as amended by section 203(b))

13 is amended by adding at the end the following:

14 ‘‘Screening for Glaucoma

15 ‘‘(xx) The term ‘screening for glaucoma’ means a di16 lated eye examination with an intraocular pressure meas17 urement, and a direct ophthalmoscopy or a slit-lamp bio18 microscopic examination for the early detection of glau19 coma which is furnished by or under the supervision of

20 an optometrist or ophthalmologist who is legally author21 ized to furnish such services under State law (or the State

22 regulatory mechanism provided by State law) of the State

23 in which the services are furnished, as would otherwise

24 be covered if furnished by a physician or as an incident

25 to a physician’s professional service.’’.
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1 (c) ELIMINATION OF COST SHARING.—

2 (1) ELIMINATION OF COINSURANCE.—Section

3 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

4 amended by section 203(c)(1)) is amended—

5 (A) by striking ‘‘and (V)’’ and inserting

6 ‘‘(V)’’; and

7 (B) by striking the semicolon at the end

8 and inserting the following: ‘‘, and (W) with re9 spect to screening for glaucoma (as defined in

10 section 1861(xx)), the amount paid shall be 100

11 percent of the lesser of the actual charge for

12 the services or amount determined by a fee

13 schedule established by the Secretary for the

14 purposes of this subparagraph;’’.

15 (2) ELIMINATION OF DEDUCTIBLE.—The first

16 sentence of section 1833(b) of such Act (42 U.S.C.

17 1395l(b)) (as amended by section 203(c)(2)) is

18 amended—

19 (A) by striking ‘‘and’’ before ‘‘(9)’’; and

20 (B) by inserting before the period the fol21 lowing: ‘‘, and (10) such deductible shall not

22 apply with respect to screening for glaucoma

23 (as defined in section 1861(xx))’’.
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1 (d) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to services furnished on or after

3 December 31, 2001.

4 SEC. 205. SCREENING FOR DIMINISHED VISUAL ACUITY.

5 (a) COVERAGE.—Section 1861(s)(2) of the Social Se6 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec7 tion 204(a)) is amended—

8 (1) in subparagraph (W), by striking ‘‘and’’ at

9 the end;

10 (2) in subparagraph (X), by striking the period

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

12 (3) by adding at the end the following:

13 ‘‘(Y) screening for diminished visual acuity (as

14 defined in subsection (yy)).’’.

15 (b) SERVICES DESCRIBED.—Section 1861 of such

16 Act (42 U.S.C. 1395x) (as amended by section 204(b))

17 is amended by adding at the end the following:

18 ‘‘Screening for Diminished Visual Acuity

19 ‘‘(yy) The term ‘screening for diminished visual acu20 ity’ means diagnostic services for screening for diminished

21 visual acuity which are furnished by or under the super22 vision of an optometrist or ophthalmologist who is legally

23 authorized to furnish such services under State law (or

24 the State regulatory mechanism provided by State law) of

25 the State in which the services are furnished, as would
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1 otherwise be covered if furnished by a physician or as an

2 incident to a physician’s professional service.’’.

3 (c) ELIMINATION OF COST SHARING.—

4 (1) ELIMINATION OF COINSURANCE.—Section

5 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

6 amended by section 204(c)(1)) is amended—

7 (A) by striking ‘‘and (W)’’ and inserting

8 ‘‘(W)’’; and

9 (B) by striking the semicolon at the end

10 and inserting the following: ‘‘, and (X) with re11 spect to screening for diminished visual acuity

12 (as defined in section 1861(yy)), the amount

13 paid shall be 100 percent of the lesser of the

14 actual charge for the services or the amount de15 termined by a fee schedule established by the

16 Secretary for the purposes of this subpara17 graph;’’.

18 (2) ELIMINATION OF DEDUCTIBLE.—The first

19 sentence of section 1833(b) of such Act (42 U.S.C.

20 1395l(b)) (as amended by section 204(c)(2)) is

21 amended—

22 (A) by striking ‘‘and’’ before ‘‘(10)’’; and

23 (B) by inserting before the period the fol24 lowing: ‘‘, and (11) such deductible shall not
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1 apply with respect to screening for diminished

2 visual acuity (as defined in section 1861(yy))’’.

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

4 this section shall apply to services furnished on or after

5 December 31, 2001.

6 SEC. 206. SCREENING FOR HEARING IMPAIRMENT.

7 (a) COVERAGE.—Section 1861(s)(2) of the Social Se8 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec9 tion 205(a)) is amended—

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

11 the end;

12 (2) in subparagraph (Y), by striking the period

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

14 (3) by adding at the end the following:

15 ‘‘(Z) screening for hearing impairment (as de16 fined in subsection (zz)).’’.

17 (b) SERVICES DESCRIBED.—Section 1861 of such

18 Act (42 U.S.C. 1395x) (as amended by section 205(b))

19 is amended by adding at the end the following:

20 ‘‘Screening for Hearing Impairment

21 ‘‘(zz) The term ‘screening for hearing impairment’

22 means diagnostic services for hearing impairment by use

23 of periodic questions, otoscopic examination and audio

24 metric testing if such questions indicate potential hearing

25 impairment, and counseling about hearing aid devices
26

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1 which are furnished by or under the supervision of a physi2 cian or other health care professional who is legally au3 thorized to furnish such services under State law (or the

4 State regulatory mechanism provided by State law) of the

5 State in which the services are furnished, as would other6 wise be covered if furnished by a physician or as an inci7 dent to a physician’s professional service.’’.

8 (c) ELIMINATION OF COST SHARING.—

9 (1) ELIMINATION OF COINSURANCE.—Section

10 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

11 amended by section 205(c)(1)) is amended—

12 (A) by striking ‘‘and (X)’’ and inserting

13 ‘‘(X)’’; and

14 (B) by striking the semicolon at the end

15 and inserting the following: ‘‘, and (Y) with re16 spect to screening for hearing impairment (as

17 defined in section 1861(zz)), the amount paid

18 shall be 100 percent of the lesser of the actual

19 charge for the services or the amount deter20 mined by a fee schedule established by the Sec21 retary for the purposes of this subparagraph;’’.

22 (2) ELIMINATION OF DEDUCTIBLE.—The first

23 sentence of section 1833(b) of such Act (42 U.S.C.

24 1395l(b)) (as amended by section 205(c)(2)) is

25 amended—
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1 (A) by striking ‘‘and’’ before ‘‘(11)’’; and

2 (B) by inserting before the period the fol3 lowing: ‘‘, and (12) such deductible shall not

4 apply with respect to screening for hearing im5 pairment (as defined in section 1861(zz))’’.

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

7 this section shall apply to services furnished on or after

8 December 31, 2001.

9 SEC. 207. SCREENING AND COUNSELING FOR

10 OSTEOPOROSIS.

11 (a) COVERAGE.—Section 1861(s)(2) of the Social Se12 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec13 tion 206(a)) is amended—

14 (1) in subparagraph (Y), by striking ‘‘and’’ at

15 the end;

16 (2) in subparagraph (Z), by striking the period

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

18 (3) by adding at the end the following:

19 ‘‘(AA) screening and counseling for osteoporosis

20 (as defined in subsection (aaa)) for—

21 ‘‘(i) women; and

22 ‘‘(ii) men with fractures.’’.

23 (b) SERVICES DESCRIBED.—Section 1861 of such

24 Act (42 U.S.C. 1395x) (as amended by section 206(b))

25 is amended by adding at the end the following:
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1 ‘‘Screening and counseling for Osteoporosis

2 ‘‘(aaa) The term ‘screening and counseling for

3 osteoporosis’ means diagnostic and counseling services for

4 osteoporosis in addition to a bone mass measurement (as

5 defined in subsection (rr)) which are furnished in accord6 ance with methods approved by the Food and Drug Ad7 ministration by or under the supervision of a physician

8 or other health care professional who is legally authorized

9 to furnish such services under State law (or the State reg10 ulatory mechanism provided by State law) of the State in

11 which the services are furnished, as would otherwise be

12 covered if furnished by a physician or as an incident to

13 a physician’s professional service.’’.

14 (c) ELIMINATION OF COST SHARING.—

15 (1) ELIMINATION OF COINSURANCE.—Section

16 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

17 amended by section 206(c)(1)) is amended—

18 (A) by striking ‘‘and (Y)’’ and inserting

19 ‘‘(Y)’’; and

20 (B) by striking the semicolon at the end

21 and inserting the following: ‘‘, and (Z) with re22 spect to screening and counseling for

23 osteoporosis (as defined in section 1861(aaa)),

24 the amount paid shall be 100 percent of the

25 lesser of the actual charge for the services or
29

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1 the amount determined by a fee schedule estab2 lished by the Secretary for the purposes of this

3 subparagraph;’’.

4 (2) ELIMINATION OF DEDUCTIBLE.—The first

5 sentence of section 1833(b) of such Act (42 U.S.C.

6 1395l(b)) (as amended by section 206(c)(2)) is

7 amended—

8 (A) by striking ‘‘and’’ before ‘‘(12)’’; and

9 (B) by inserting before the period the fol10 lowing: ‘‘, and (13) such deductible shall not

11 apply with respect to screening and counseling

12 for osteoporosis (as defined in section

13 1861(aaa))’’.

14 (d) EFFECTIVE DATE.—The amendments made by

15 this section shall apply to services furnished on or after

16 December 31, 2001.

17 SEC. 208. SCREENING FOR CHOLESTEROL.

18 (a) COVERAGE.—Section 1861(s)(2) of the Social Se19 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec20 tion 207(a)) is amended—

21 (1) in subparagraph (Z), by striking ‘‘and’’ at

22 the end;

23 (2) in subparagraph (AA), by striking the pe24 riod at the end and inserting ‘‘; and’’; and

25 (3) by adding at the end the following:
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1 ‘‘(BB) screening for cholesterol (as defined in

2 subsection (bbb)) for individuals between the ages of

3 65 and 75 that exhibit major risk factors for coro4 nary heart disease, including smoking, hypertension,

5 and diabetes.’’.

6 (b) SERVICES DESCRIBED.—Section 1861 of such

7 Act (42 U.S.C. 1395x) (as amended by section 207(b))

8 is amended by adding at the end the following:

9 ‘‘Screening for Cholesterol

10 ‘‘(bbb) The term ‘screening for cholesterol’ means di11 agnostic services for cholesterol that are furnished by or

12 under the supervision of a physician or other health care

13 professional who is legally authorized to furnish such serv14 ices under State law (or the State regulatory mechanism

15 provided by State law) of the State in which the services

16 are furnished, as would otherwise be covered if furnished

17 by a physician or as an incident to a physician’s profes18 sional service.’’.

19 (c) ELIMINATION OF COST SHARING.—

20 (1) ELIMINATION OF COINSURANCE.—Section

21 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

22 amended by section 207(c)(1)) is amended—

23 (A) by striking ‘‘and (Z)’’ and inserting

24 ‘‘(Z)’’; and
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1 (B) by striking the semicolon at the end

2 and inserting the following: ‘‘, and (AA) with

3 respect to screening for cholesterol (as defined

4 in section 1861(bbb)), the amount paid shall be

5 100 percent of the lesser of the actual charge

6 for the services or the amount determined by a

7 fee schedule established by the Secretary for the

8 purposes of this subparagraph;’’.

9 (2) ELIMINATION OF DEDUCTIBLE.—The first

10 sentence of section 1833(b) of such Act (42 U.S.C.

11 1395l(b)) (as amended by section 207(c)(2)) is

12 amended—

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

14 (B) by inserting before the period the fol15 lowing: ‘‘, and (14) such deductible shall not

16 apply with respect to screening and counseling

17 for osteoporosis (as defined in section

18 1861(bbb))’’.

19 (d) EFFECTIVE DATE.—The amendments made by

20 this section shall apply to services furnished on or after

21 December 31, 2001.

22 SEC. 209. ELIMINATION OF COST SHARING FOR CURRENT

23 PREVENTIVE BENEFITS.

24 (a) WAIVER OF COINSURANCE AND DEDUCTIBLES.—
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1 (1) IN GENERAL.—Section 1834 of the Social

2 Security Act (42 U.S.C. 1395m) is amended by add3 ing at the end the following:

4 ‘‘(m) WAIVER OF COINSURANCE AND DEDUCTIBLE

5 FOR PREVENTIVE SERVICES.—

6 ‘‘(1) COINSURANCE.—

7 ‘‘(A) IN GENERAL.—Notwithstanding any

8 other provision of this part—

9 ‘‘(i) the Secretary shall waive any co10 insurance applicable to services described

11 in subparagraph (B); and

12 ‘‘(ii) with respect to payment for such

13 services, any reference to a percent that is

14 less than 100 percent shall be deemed to

15 be a reference to 100 percent.

16 ‘‘(B) SERVICES DESCRIBED.—The services

17 described in this subparagraph are the following

18 services:

19 ‘‘(i) Screening mammography (as de20 fined in section 1861(jj)).

21 ‘‘(ii) Screening pelvic exam (as de22 fined in section 1861(nn)(2)).

23 ‘‘(iii) Hepatitis B vaccine and its ad24 ministration (under section

25 1861(s)(10)(B)).
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1 ‘‘(iv) Colorectal cancer screening test

2 (as defined in section 1861(pp)).

3 ‘‘(v) Bone mass measurement (as de4 fined in section 1861(rr)).

5 ‘‘(vi) Prostate cancer screening test

6 (as defined in section 1861(oo)).

7 ‘‘(vii) Diabetes outpatient self-man8 agement training services (as defined in

9 section 1861(qq)).

10 ‘‘(2) DEDUCTIBLE.—

11 ‘‘(A) IN GENERAL.—Notwithstanding any

12 other provision of this part, the deductible de13 scribed in section 1833(b) shall not apply with

14 respect to services described in subparagraph

15 (B).

16 ‘‘(B) SERVICES DESCRIBED.—The services

17 described in this subparagraph are the following

18 services:

19 ‘‘(i) Hepatitis B vaccine and its ad20 ministration (under section

21 1861(s)(10)(B)).

22 ‘‘(ii) Colorectal cancer screening test

23 (as defined in section 1861(pp)).

24 ‘‘(iii) Bone mass measurement (as de25 fined in section 1861(rr)).
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1 ‘‘(iv) Prostate cancer screening test

2 (as defined in section 1861(oo)).

3 ‘‘(v) Diabetes outpatient self-manage4 ment training services (as defined in sec5 tion 1861(qq)).’’.

6 (2) CONFORMING AMENDMENT.—Section

7 1833(a) of the Social Security Act (42 U.S.C.

8 1395l(a)) is amended by striking ‘‘section 1876’’

9 and inserting ‘‘sections 1834 and 1876’’ in the mat10 ter preceding paragraph (1).

11 (b) EFFECTIVE DATE.—The amendments made by

12 this section shall apply to services furnished on or after

13 December 31, 2001.

14 SEC. 210. NATIONAL FALLS PREVENTION EDUCATION AND

15 AWARENESS CAMPAIGN.

16 The Secretary, in consultation with the Director of

17 the Centers for Disease Control and Prevention, shall con18 duct a national falls prevention and awareness campaign

19 to reduce fall-related injuries among medicare bene20 ficiaries.

21 SEC. 211. PROGRAM INTEGRITY.

22 The Secretary, in consultation with the Inspector

23 General of the Department of Health and Human Serv24 ices, shall integrate the benefits described in sections 201

25 through 208 with existing program integrity measures.
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1 TITLE III—MEDICARE HEALTH

2 EDUCATION AND RISK AP3 PRAISAL PROGRAM

4 SEC. 301. MEDICARE HEALTH EDUCATION AND RISK AP5 PRAISAL PROGRAM.

6 (a) IN GENERAL.—Title XVIII of the Social Security

7 Act (42 U.S.C. 1395 et seq.) is amended by adding at

8 the end the following:

9 ‘‘MEDICARE HEALTH EDUCATION AND RISK APPRAISAL

10 PROGRAM

11 ‘‘SEC. 1897. (a) ESTABLISHMENT.—The Secretary,

12 in consultation with the Director of the Centers for Dis13 ease Control and Prevention, the Administrator of the

14 Agency for Health Care Policy and Research, and the Ad15 ministrator of the Health Care Financing Administration,

16 shall establish a health education and risk appraisal pro17 gram to inform the target individuals described in sub18 section (b) of the major behavioral risk factors described

19 in subsection (c) through the self-assessment described in

20 subsection (d) and shall conduct the periodic followup de21 scribed in subsection (e).

22 ‘‘(b) TARGET INDIVIDUALS.—The target individuals

23 described in this subsection are the following:

24 ‘‘(1) MEDICARE BENEFICIARIES.—Individuals

25 that are beneficiaries under this title.
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1 ‘‘(2) INDIVIDUALS BETWEEN THE AGES OF 50

2 AND 64.—Individuals between the ages of 50 and 64.

3 ‘‘(c) MAJOR BEHAVIORAL RISK FACTORS.—The

4 major behavioral risk factors described in this subsection

5 include—

6 ‘‘(1) the lack of proper nutrition;

7 ‘‘(2) the use of alcohol;

8 ‘‘(3) the lack of regular exercise;

9 ‘‘(4) the use of tobacco;

10 ‘‘(5) depression; and

11 ‘‘(6) other risk factors identified by the Sec12 retary.

13 ‘‘(d) SELF-ASSESSMENT.—

14 ‘‘(1) IN GENERAL.—The self-assessment de15 scribed in this subsection is a form delivered by the

16 Secretary to each target individual that—

17 ‘‘(A) includes questions regarding major

18 behavioral risk factors;

19 ‘‘(B) requests that such individual answer

20 the questions and return the form to the Sec21 retary; and

22 ‘‘(C) is then assessed using—

23 ‘‘(i) knowledge coupling computer

24 software that assesses overall health risks
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1 and then provides options for management

2 of identified risk factors;

3 ‘‘(ii) nurse hotlines; and

4 ‘‘(iii) case managers as the Secretary

5 determines appropriate.

6 ‘‘(2) INDIVIDUALS BETWEEN THE AGES OF 50

7 AND 64.—With respect to the target individuals de8 scribed in subsection (b)(2), the Secretary shall co9 ordinate the delivery of the self-assessment form

10 with the issuance of the statement described in sec11 tion 1143(c)(2).

12 ‘‘(e) PERIODIC FOLLOWUP.—

13 ‘‘(1) MEDICARE BENEFICIARIES.—Not less fre14 quently than once every 2 years, the Secretary shall

15 conduct periodic followup appraisals with respect to

16 the target individuals described in subsection (b)(1)

17 to reduce major behavioral risk factors described in

18 subsection (c)—

19 ‘‘(A) by providing such individuals with—

20 ‘‘(i) information regarding the results

21 of the self-administered risk appraisal;

22 ‘‘(ii) recommendations regarding be23 havior modifications based on such ap24 praisal; and
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1 ‘‘(iii) information regarding any need

2 for further assessment or treatment; and

3 ‘‘(B) by providing the information de4 scribed in subparagraph (A) to the provider

5 designated by such individual to receive such in6 formation.

7 ‘‘(2) INDIVIDUALS BETWEEN THE AGES OF 50

8 AND 64.—The Secretary shall conduct such periodic

9 followup appraisals with respect to the target indi10 viduals described in subsection (b)(2) as the Sec11 retary determines appropriate.’’.

12 TITLE IV—DISEASE SELF-MAN13 AGEMENT DEMONSTRATION

14 PROJECTS

15 SEC. 401. DISEASE SELF-MANAGEMENT DEMONSTRATION

16 PROJECTS.

17 (a) DEMONSTRATION PROJECTS.—

18 (1) IN GENERAL.—The Secretary, acting

19 through the Administrator of the Health Care Fi20 nancing Administration, shall conduct demonstration

21 projects for the purpose of promoting disease self22 management for conditions identified by the working

23 group established under paragraph (2) for target in24 dividuals (as defined in paragraph (3)).
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1 (2) DISEASE SELF-MANAGEMENT WORKING

2 GROUP.—

3 (A) ESTABLISHMENT.—There is estab4 lished within the Department of Health and

5 Human Services a Disease Self-Management

6 Working Group.

7 (B) COMPOSITION.—The Disease Self8 Management Working Group established under

9 subparagraph (A) shall be composed of 4 mem10 bers as follows:

11 (i) The Administrator of the Health

12 Care Financing Administration.

13 (ii) The Director of the Centers for

14 Disease Control and Prevention.

15 (iii) The Administrator of the Agency

16 for Health Care Policy and Research.

17 (iv) The Director of the Administra18 tion on Aging.

19 (C) GENERAL POLICIES AND CRITERIA.—

20 The Disease Self-Management Working Group

21 established under paragraph (1) shall establish

22 general policies and criteria with respect to the

23 functions of the Secretary under this section

24 including—
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1 (i) the identification of conditions for

2 which a demonstration project may be im3 plemented;

4 (ii) the prioritization of the conditions

5 identified under clause (i) based on poten6 tial of self-management of such condition

7 to be medically effective and for such self8 management to be a cost-effective benefit

9 or cost-saving benefit, as those terms are

10 defined in section 3 of this Act;

11 (iii) the identification of target indi12 viduals;

13 (iv) the development of procedures for

14 selecting areas in which a demonstration

15 project may be implemented; and

16 (v) such other matters as are rec17 ommended by the Disease Self-Manage18 ment Working Group and approved by the

19 Secretary.

20 (3) TARGET INDIVIDUAL DEFINED.—In this

21 section, the term ‘‘target individual’’ means an indi22 vidual that is at risk for or has a condition identified

23 by the working group described under paragraph (2)

24 and is eligible for benefits under the fee-for-service

25 program under parts A and B of title XVIII of the
41

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1 Social Security Act (42 U.S.C. 1395c et seq.; 1395j

2 et seq.) or is enrolled under the Medicare+Choice

3 program under part C of title XVIII of such Act (42

4 U.S.C. 1395w–21 et seq.).

5 (b) NUMBER, PROJECT AREAS, AND DURATION.—

6 (1) NUMBER.—Not later than 2 years after the

7 date of enactment of this Act, the Secretary shall

8 implement a series of demonstration projects.

9 (2) PROJECT AREAS.—The Secretary, acting

10 through the Administrator of the Health Care Fi11 nancing Administration, shall implement the dem12 onstration projects described in paragraph (1) in

13 urban, suburban, and rural areas.

14 (3) DURATION.—The demonstration projects

15 under this section shall be conducted for a period of

16 3 years, beginning on the date on which the Sec17 retary implements the initial demonstration project.

18 (c) REPORTS TO CONGRESS.—

19 (1) ANNUAL REPORTS.—

20 (A) IN GENERAL.—Not later than 1 year

21 after the Secretary implements the initial dem22 onstration project under this section, and bian23 nually thereafter, the Secretary shall submit to

24 Congress a report regarding the demonstration

25 projects conducted under this section.
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1 (B) CONTENTS OF REPORT.—The report

2 in subparagraph (A) shall include the following:

3 (i) A description of the demonstration

4 projects conducted under this section.

5 (ii) An evaluation of—

6 (I) whether each benefit provided

7 under the demonstration project is a

8 cost-effective benefit or a cost-saving

9 benefit;

10 (II) the level of the disease self11 management attained by target indi12 viduals under the demonstration

13 projects; and

14 (III) the satisfaction of target in15 dividuals under the demonstration

16 project.

17 (iii) Any other information regarding

18 the demonstration projects conducted

19 under this section that the Secretary deter20 mines to be appropriate.

21 (2) FINAL REPORT.—Not later than 1 year

22 after the conclusion of the demonstration projects

23 under this section, the Secretary shall submit a final

24 report to Congress on the demonstration projects

25 conducted under this section containing the rec-
43

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1 ommendations of the Secretary regarding whether to

2 conduct the demonstration projects on a permanent

3 basis, together with such recommendations for legis4 lation and administrative action as the Secretary

5 considers appropriate.

6 (d) FUNDING.—The Secretary shall provide for the

7 transfer from the Federal Hospital Insurance Trust Fund

8 under section 1817 of the Social Security Act (42 U.S.C.

9 1395i) an amount not to exceed $30,000,000 for the costs

10 of carrying out the demonstration projects under this sec11 tion, establishing the Disease Self-Management Working

12 Group under subsection (a)(2), and submitting the reports

13 to Congress under subsection (c).

14 TITLE V—STUDIES AND RE15 PORTS ADVANCING ORIGINAL

16 RESEARCH IN THE FIELD OF

17 DISEASE PREVENTION AND

18 THE ELDERLY

19 SEC. 501. MEDPAC BIANNUAL REPORT.

20 (a) IN GENERAL.—Section 1805(b) of the Social Se21 curity Act (42 U.S.C. 1395b–6(b)) is amended—

22 (1) in paragraph (1)—

23 (A) in subparagraph (C), by striking

24 ‘‘and’’ at the end;
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1 (B) in subparagraph (D), by striking the

2 period and inserting ‘‘; and’’; and

3 (C) by adding at the end the following:

4 ‘‘(E) by not later than January 1, 2001,

5 and biannually thereafter, submit the report to

6 Congress described in paragraph (7).’’; and

7 (2) by adding at the end the following:

8 ‘‘(7) EVALUATION OF ACTUARIAL EQUIVALENCE

9 OF MEDICARE AND PRIVATE SECTOR BENEFIT PACK10 AGES.—

11 ‘‘(A) EVALUATION.—The Commission

12 shall—

13 ‘‘(i) evaluate the benefit package of14 fered under the medicare program under

15 this title; and

16 ‘‘(ii) determine the degree to which

17 such benefit package is actuarially equiva18 lent to that offered by health benefit pro19 grams available in the private sector to in20 dividuals over age 65.

21 ‘‘(B) REPORT.—The Commission shall

22 submit a report to Congress that shall

23 contain—

24 ‘‘(i) a detailed statement of the find25 ings and conclusions of the Commission re-
45

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1 garding the evaluation conducted under

2 subparagraph (A);

3 ‘‘(ii) the recommendations of the

4 Commission regarding changes in the ben5 efit package offered under the medicare

6 program under this title that would keep

7 the program modern and competitive in re8 lation to health benefit programs available

9 in the private sector; and

10 ‘‘(iii) the recommendations of the

11 Commission for such legislation and ad12 ministrative actions as it considers appro13 priate.’’.

14 (b) EFFECTIVE DATE.—The amendments made by

15 this section shall take effect on the date of enactment of

16 this Act.

17 SEC. 502. NATIONAL INSTITUTE ON AGING STUDY AND RE18 PORT.

19 (a) STUDIES.—The Director of the National Institute

20 on Aging shall conduct 1 or more studies focusing on ways

21 to—

22 (1) improve quality of life for the elderly;

23 (2) develop better ways to prevent or delay the

24 onset of age-related functional decline and disease

25 and disability among the elderly; and
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1 (3) develop means of assessing the long-term

2 development of cost-effective benefits and cost-sav3 ings benefits for health promotion and disease pre4 vention among the elderly.

5 (b) REPORT.—Not later than January 1, 2005, the

6 Director of the National Institute on Aging shall submit

7 a report to the Secretary regarding each study conducted

8 under subsection (a) and containing a detailed statement

9 of research findings and conclusions that are scientifically

10 valid and are demonstrated to prevent or delay the onset

11 of chronic illness or disability among the elderly.

12 (c) TRANSMISSION TO INSTITUTE OF MEDICINE.—

13 Upon receipt of each report described in subsection (b),

14 the Secretary shall transmit such report to the Institute

15 of Medicine of the National Academy of Sciences for con16 sideration in its effort to conduct the comprehensive study

17 of current literature and best practices in the field of

18 health promotion and disease prevention among the medi19 care beneficiaries described in section 503.

20 (d) AUTHORIZATION OF APPROPRIATIONS.—

21 (1) IN GENERAL.—There are authorized to be

22 appropriated $100,000,000 for fiscal years 2000

23 through 2005 to carry out the purposes of this sec24 tion.
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1 (2) AVAILABILITY.—Any sums appropriated

2 under the authorization contained in this subsection

3 shall remain available, without fiscal year limitation,

4 until September 30, 2004.

5 SEC. 503. INSTITUTE OF MEDICINE 5-YEAR MEDICARE PRE6 VENTION BENEFIT STUDY AND REPORT.

7 (a) STUDY.—

8 (1) IN GENERAL.—The Secretary shall contract

9 with the Institute of Medicine of the National Acad10 emy of Sciences to conduct a comprehensive study of

11 current literature and best practices in the field of

12 health promotion and disease prevention among

13 medicare beneficiaries including the issues described

14 in paragraph (2) and to submit the report described

15 in subsection (b).

16 (2) ISSUES STUDIED.—The study required

17 under paragraph (1) shall include an assessment

18 of—

19 (A) whether each covered benefit is—

20 (i) medically effective; and

21 (ii) a cost-effective benefit or a cost22 saving benefit;

23 (B) utilization of covered benefits (includ24 ing any barriers to or incentives to increase uti25 lization); and
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1 (C) quality of life issues associated with

2 both health promotion and disease prevention

3 benefits covered under the medicare program

4 and those that are not covered under such pro5 gram that would affect all medicare bene6 ficiaries.

7 (b) REPORT.—

8 (1) IN GENERAL.—Not later than 5 years after

9 the date of enactment of this section, and every fifth

10 year thereafter, the Institute of Medicine of the Na11 tional Academy of Sciences shall submit to the

12 President a report that contains a detailed state13 ment of the findings and conclusions of the study

14 conducted under subsection (a) and the rec15 ommendations for legislation described in paragraph

16 (2).

17 (2) RECOMMENDATIONS FOR LEGISLATION.—

18 The Institute of Medicine of the National Academy

19 of Sciences, in consultation with the Partnership for

20 Prevention, shall develop recommendations in legis21 lative form that—

22 (A) prioritize the preventive benefits under

23 the medicare program; and
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1 (B) modify preventive benefits offered

2 under the medicare program based on the study

3 conducted under subsection (a).

4 (c) TRANSMISSION TO CONGRESS.—

5 (1) IN GENERAL.—On the day on which the re6 port described in subsection (b) is submitted to the

7 President, the President shall transmit the report

8 and recommendations in legislative form described in

9 subsection (b)(2) to Congress.

10 (2) DELIVERY.—Copies of the report and rec11 ommendations in legislative form required to be

12 transmitted to Congress under paragraph (1) shall

13 be delivered—

14 (A) to both Houses of Congress on the

15 same day;

16 (B) to the Clerk of the House of Rep17 resentatives if the House is not in session; and

18 (C) to the Secretary of the Senate if the

19 Senate is not in session.

20 SEC. 504. FAST-TRACK CONSIDERATION OF PREVENTION

21 BENEFIT LEGISLATION.

22 (a) RULES OF HOUSE OF REPRESENTATIVES AND

23 SENATE.—This section is enacted by Congress—

24 (1) as an exercise of the rulemaking power of

25 the House of Representatives and the Senate, re-
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1 spectively, and is deemed a part of the rules of each

2 House of Congress, but—

3 (A) is applicable only with respect to the

4 procedure to be followed in that House of Con5 gress in the case of an implementing bill (as de6 fined in subsection (d)); and

7 (B) supersedes other rules only to the ex8 tent that such rules are inconsistent with this

9 section; and

10 (2) with full recognition of the constitutional

11 right of either House of Congress to change the

12 rules (so far as relating to the procedure of that

13 House of Congress) at any time, in the same man14 ner and to the same extent as in the case of any

15 other rule of that House of Congress.

16 (b) INTRODUCTION AND REFERRAL.—

17 (1) INTRODUCTION.—

18 (A) IN GENERAL.—Subject to paragraph

19 (2), on the day on which the President trans20 mits the report pursuant to section 503(c) to

21 the House of Representatives and the Senate,

22 the recommendations in legislative form trans23 mitted by the President with respect to such re24 port shall be introduced as a bill (by request)

25 in the following manner:
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•S 1618 IS

1 (i) HOUSE OF REPRESENTATIVES.—In

2 the House of Representatives, by the Ma3 jority Leader, for himself and the Minority

4 Leader, or by Members of the House of

5 Representatives designated by the Majority

6 Leader and Minority Leader.

7 (ii) SENATE.—In the Senate, by the

8 Majority Leader, for himself and the Mi9 nority Leader, or by Members of the Sen10 ate designated by the Majority Leader and

11 Minority Leader.

12 (B) SPECIAL RULE.—If either House of

13 Congress is not in session on the day on which

14 such recommendations in legislative form are

15 transmitted, the recommendations in legislative

16 form shall be introduced as a bill in that House

17 of Congress, as provided in subparagraph (A),

18 on the first day thereafter on which that House

19 of Congress is in session.

20 (2) REFERRAL.—Such bills shall be referred by

21 the presiding officers of the respective Houses to the

22 appropriate committee, or, in the case of a bill con23 taining provisions within the jurisdiction of 2 or

24 more committees, jointly to such committees for con-
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•S 1618 IS

1 sideration of those provisions within their respective

2 jurisdictions.

3 (c) CONSIDERATION.—After the recommendations in

4 legislative form have been introduced as a bill and referred

5 under subsection (b), such implementing bill shall be con6 sidered in the same manner as an implementing bill is con7 sidered under subsections (d), (e), (f), and (g) of section

8 151 of the Trade Act of 1974 (19 U.S.C. 2191).

9 (d) IMPLEMENTING BILL DEFINED.—In this section,

10 the term ‘‘implementing bill’’ means only the recommenda11 tions in legislative form of the Institute of Medicine of the

12 National Academy of Sciences described in section

13 503(b)(2), transmitted by the President to the House of

14 Representatives and the Senate under subsection 503(c),

15 and introduced and referred as provided in subsection (b)

16 as a bill of either House of Congress.

17 (e) COUNTING OF DAYS.—For purposes of this sec18 tion, any period of days referred to in section 151 of the

19 Trade Act of 1974 shall be computed by excluding—

20 (1) the days on which either House of Congress

21 is not in session because of an adjournment of more

22 than 3 days to a day certain or an adjournment of

23 Congress sine die; and
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1 (2) any Saturday and Sunday, not excluded

2 under paragraph (1), when either House is not in

3 session.

Æ