II

106TH CONGRESS

2D SESSION S. 2232

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

MARCH 9, 2000

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

L. CHAFEE, Mr. KERRY, Mr. ROCKEFELLER, Mr. MOYNIHAN, Mrs. MURRAY, Mr. LUGAR, and Ms. SNOWE) 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 2000’’.

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

7 as follows:
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Sec. 1. Short title; table of contents.

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. Medical nutrition therapy services for beneficiaries with diabetes, a

cardiovascular disease, or a renal disease.

Sec. 210. Elimination of cost-sharing for current preventive benefits.

Sec. 211. National falls prevention education and awareness campaign.

Sec. 212. 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 pre-
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1 vention among the elderly, there has been a failure in

2 translating that research into practical intervention.

3 SEC. 3. DEFINITIONS.

4 As used in this Act:

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

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

7 that has—

8 (A) been subject to peer review;

9 (B) been described in scientific journals;

10 and

11 (C) demonstrated value as measured by

12 unit costs relative to health outcomes achieved.

13 (2) COST-SAVING BENEFIT.—The term ‘‘cost14 saving benefit’’ means a benefit or technique that

15 has—

16 (A) been subject to peer review;

17 (B) been described in scientific journals;

18 and

19 (C) caused a net reduction in health care

20 costs for medicare beneficiaries.

21 (3) MEDICALLY EFFECTIVE.—The term ‘‘medi22 cally effective’’ means, with respect to a benefit or

23 technique, that the benefit or technique has been—

24 (A) subject to peer review;

25 (B) described in scientific journals; and
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1 (C) determined to achieve an intended goal

2 under normal programmatic conditions.

3 (4) MEDICAL EFFICACY; MEDICALLY EFFICA4 CIOUS.—The terms ‘‘medical efficacy’’ and ‘‘medi5 cally efficacious’’ mean, with respect to a benefit or

6 technique, that the benefit or technique has been—

7 (A) subject to peer review;

8 (B) described in scientific journals; and

9 (C) determined to achieve an intended goal

10 under controlled conditions.

11 (5) MEDICARE BENEFICIARY.—The term

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

13 entitled to benefits under part A or enrolled under

14 part B of the medicare program, including any indi15 vidual enrolled in a Medicare+Choice plan offered

16 by a Medicare+Choice organization under part C of

17 such program.

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

19 program’’ means the health benefits program under

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

21 1395 et seq.).

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

23 the Secretary of Health and Human Services.
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1 TITLE I—HEALTHY SENIORS

2 PROMOTION PROGRAM

3 SEC. 101. HEALTHY SENIORS PROMOTION PROGRAM.

4 (a) DEFINITIONS.—As used in this section:

5 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti6 ty’’ means an entity that the Working Group (as de7 fined in paragraph (2)) determines has dem8 onstrated expertise in research regarding health pro9 motion and disease prevention among the elderly.

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

11 Group’’ means the Healthy Seniors Working Group

12 established under subsection (d).

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

14 to the general policies and criteria established by the

15 Working Group and in accordance with the provisions of

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

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

18 (c).

19 (c) USE OF FUNDS.—An eligible entity may use pay20 ments received under this section in any fiscal year to

21 study—

22 (1) whether using different types of providers of

23 care who are not physicians and alternative settings

24 (including community-based senior centers) for the

25 implementation of a successful health promotion and
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1 disease prevention strategy, including the implica2 tions regarding the payment of such providers, is

3 medically efficacious or medically effective;

4 (2) the most medically effective means of edu5 cating medicare beneficiaries and providers of serv6 ices regarding the importance of health promotion

7 and disease prevention among the elderly and identi8 fication of incentives that would increase the use of

9 new and existing preventive services and healthy be10 haviors by medicare beneficiaries; and

11 (3) other topics designated by the Secretary.

12 (d) HEALTHY SENIORS WORKING GROUP.—

13 (1) ESTABLISHMENT.—There is established

14 within the Department of Health and Human Serv15 ices a Healthy Seniors Working Group.

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

17 the Working Group established pursuant to sub18 section (b) shall be composed of 5 members as fol19 lows:

20 (A) The Administrator of the Health Care

21 Financing Administration.

22 (B) The Director of the Centers for Dis23 ease Control and Prevention.

24 (C) The Administrator of the Agency for

25 Health Care Policy and Research.
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1 (D) The Assistant Secretary for Aging.

2 (E) The Director of the National Institute

3 on Aging.

4 (3) ALTERNATIVE MEMBERSHIP.—

5 (A) APPOINTMENT.—Any member of the

6 Working Group described in a subparagraph of

7 paragraph (2) may appoint an individual who is

8 an officer or employee of the Federal Govern9 ment to serve as a member of the Working

10 Group instead of the member described in such

11 subparagraph.

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

13 subparagraph (A) elects to appoint an indi14 vidual under such subparagraph, such indi15 vidual shall be appointed not later than Decem16 ber 31, 2001.

17 (4) GENERAL POLICIES AND CRITERIA.—The

18 Working Group shall establish general policies and

19 criteria with respect to the functions of the Sec20 retary under this section including—

21 (A) priorities for the approval of applica22 tions submitted under subsection (e);

23 (B) procedures for developing, monitoring,

24 and evaluating research efforts conducted under

25 this section; and
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1 (C) such other matters as are rec2 ommended by the Working Group and approved

3 by the Secretary.

4 (5) CHAIRPERSON.—The Chairperson of the

5 Working Group shall be the Administrator of the

6 Agency for Health Care Policy and Research.

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

8 the Working Group shall constitute a quorum, but

9 a lesser number of members may hold hearings.

10 (7) MEETINGS.—The Working Group shall

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

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

13 year; and

14 (B) it shall meet whenever a majority of

15 the appointed members request a meeting in

16 writing.

17 (8) COMPENSATION OF MEMBERS.—Each mem18 ber of the Working Group shall be an officer or em19 ployee of the Federal Government and shall serve

20 without compensation in addition to that received for

21 their service as an officer or employee of the Federal

22 Government.

23 (e) APPLICATION.—

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

25 desires to receive a grant under this section shall
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1 submit an application to the Secretary, at such time,

2 in such manner, and accompanied by such additional

3 information as the Secretary may reasonably re4 quire.

5 (2) CONTENTS.—Each application submitted

6 pursuant to paragraph (1) shall—

7 (A) describe the activities for which assist8 ance under this section is sought;

9 (B) describe how the research effort pro10 posed to be conducted will reflect the medical,

11 behavioral, and social aspects of care for the el12 derly, lead to the development of cost-effective

13 benefits and cost-saving benefits, and impact

14 the quality of life of medicare beneficiaries;

15 (C) provide evidence that the eligible entity

16 meets the general policies and criteria estab17 lished by the Working Group pursuant to sub18 section (d)(4);

19 (D) provide assurances that the eligible en20 tity will take such steps as may be available to

21 it to continue the activities for which the eligi22 ble entity is making application after the period

23 for which assistance is sought; and

24 (E) provide such additional assurances as

25 the Secretary determines to be essential to en-
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1 sure compliance with the requirements of this

2 Act.

3 (3) JOINT APPLICATION.—A consortium of eli4 gible entities may file a joint application under the

5 provisions of paragraph (1) of this subsection.

6 (f) APPROVAL OF APPLICATION.—The Secretary

7 shall approve applications in accordance with the general

8 policies and criteria established by the Working Group

9 under subsection (d)(4).

10 (g) PAYMENTS.—The Secretary shall pay to each eli11 gible entity having an application approved under sub12 section (f) the cost of the activities described in the appli13 cation.

14 (h) EVALUATION AND REPORT.—

15 (1) EVALUATION.—The Secretary shall conduct

16 an annual evaluation of grants made under this sec17 tion to determine—

18 (A) the results of the overall applied re19 search conducted under this Act;

20 (B) the extent to which research assisted

21 under this section has improved or expanded

22 the general research for health promotion and

23 disease prevention among the elderly and identi24 fied practical interventions based upon such re25 search;
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1 (C) a list of specific recommendations

2 based upon research conducted under this sec3 tion which show promise as practical interven4 tions for health promotion and disease preven5 tion among the elderly;

6 (D) whether or not as a result of the ap7 plied research effort certain health promotion

8 and disease prevention benefits or education ef9 forts should be added to the medicare program,

10 including discussions of quality of life, trans11 lating the applied research results into a benefit

12 under the medicare program, and whether each

13 additional benefit would be a cost-effective ben14 efit or a cost-saving benefit for each proposed

15 addition;

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

17 surrounding health risk appraisals sponsored

18 under the medicare program and targeted fol19 lowup; and

20 (F) how best to increase utilization of ex21 isting and recommended health promotion and

22 disease prevention services, including an edu23 cation and public awareness component discus24 sion of financial incentives for providers of serv25 ices and medicare beneficiaries to improve utili-
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1 zation and other administrative means of in2 creasing utilization.

3 (2) ANNUAL REPORT.—Not later than Decem4 ber 31, 2002, and each year thereafter through

5 2005, the Secretary shall submit a report to Con6 gress based on the annual studies made under para7 graph (1), which shall contain a detailed statement

8 of the findings and conclusions of the Working

9 Group together with its recommendations for such

10 legislation and administrative actions as it considers

11 appropriate.

12 (i) AUTHORIZATION OF APPROPRIATIONS.—There

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

14 of the fiscal years 2001, 2002, 2003, and 2004 to carry

15 out the provisions of this section.

16 SEC. 102. SENSE OF CONGRESS REGARDING THE RESPONSE

17 OF HCFA TO PREVENTIVE HEALTH ISSUES.

18 It is the sense of Congress that in administering the

19 medicare program the Secretary should ensure that the

20 Administrator of the Health Care Financing Administra21 tion encourages the inclusion of preventive measures as

22 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 inserting ‘‘and’’ at

9 the end; and

10 (3) by adding at the end the following new sub11 paragraph:

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

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

14 a history of tobacco use;’’.

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

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

17 the following new subsection:

18 ‘‘Counseling for Cessation of Tobacco Use

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

20 term ‘counseling for cessation of tobacco use’ means diag21 nostic, therapy, and counseling services for cessation of

22 tobacco use which are furnished—

23 ‘‘(A) by or under the supervision of a physician;

24 or
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1 ‘‘(B) by any other health care professional who

2 is legally authorized to furnish such services under

3 State law (or the State regulatory mechanism pro4 vided by State law) of the State in which the serv5 ices are furnished, as would otherwise be covered if

6 furnished by a physician or as an incident to a phy7 sician’s professional service.

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

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

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

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)) is

14 amended—

15 (A) by striking ‘‘and’’ before ‘‘(S)’’; and

16 (B) by inserting before the semicolon at

17 the end the following: ‘‘, and (T) with respect

18 to counseling for cessation of tobacco use (as

19 defined in section 1861(uu)), the amount paid

20 shall be 100 percent of the lesser of the actual

21 charge for the services or the amount deter22 mined by a fee schedule established by the Sec23 retary for the 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)) is amended—

4 (A) by striking ‘‘and’’ before ‘‘(6)’’; and

5 (B) by inserting before the period the fol6 lowing: ‘‘, and (7) such deductible shall not

7 apply with respect to counseling for cessation of

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

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

10 this section shall apply to services furnished on or after

11 December 31, 2001.

12 SEC. 202. SCREENING FOR HYPERTENSION.

13 (a) COVERAGE.—Section 1861(s)(2) of the Social Se14 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec15 tion 201(a)) is amended—

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

17 the end;

18 (2) in subparagraph (U), by inserting ‘‘and’’ at

19 the end; and

20 (3) by adding at the end the following new sub21 paragraph:

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

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

24 2 years for individuals with normotensive blood pres25 sure measurements and annually for individuals with
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1 blood pressure measurements that are not

2 normotensive;’’.

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

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

5 is amended by adding at the end the following new sub6 section:

7 ‘‘Screening for Hypertension

8 ‘‘(vv) The term ‘screening for hypertension’ means di9 agnostic services for hypertension which are furnished—

10 ‘‘(1) by or under the supervision of a physician;

11 or

12 ‘‘(2) by any other health care professional who

13 is legally authorized to furnish such services under

14 State law (or the State regulatory mechanism pro15 vided by State law) of the State in which the serv16 ices are furnished, as would otherwise be covered if

17 furnished by a physician or as an incident to a phy18 sician’s professional 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 201(c)(1)) is amended—

23 (A) by striking ‘‘and’’ before ‘‘(T)’’; and

24 (B) by inserting before the semicolon at

25 the end the following: ‘‘, and (U) with respect
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1 to screening for hypertension (as defined in sec2 tion 1861(vv)), the amount paid shall be 100

3 percent of the lesser of the actual charge for

4 the services or the amount determined by a fee

5 schedule established by the Secretary for the

6 purposes of this subparagraph;’’.

7 (2) ELIMINATION OF DEDUCTIBLE.—The first

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

9 1395l(b)) (as amended by section 201(c)(2)) is

10 amended—

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

12 (B) by inserting before the period the fol13 lowing: ‘‘, and (8) such deductible shall not

14 apply with respect to screening for hypertension

15 (as defined in section 1861(vv))’’.

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

17 this section shall apply to services furnished on or after

18 December 31, 2001.

19 SEC. 203. COUNSELING FOR HORMONE REPLACEMENT

20 THERAPY.

21 (a) COVERAGE.—Section 1861(s)(2) of the Social Se22 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec23 tion 202(a)) is amended—

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

25 the end;
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1 (2) in subparagraph (V), by inserting ‘‘and’’ at

2 the end; and

3 (3) by adding at the end the following new sub4 paragraph:

5 ‘‘(W) counseling for hormone replacement ther6 apy (as defined in subsection (ww));’’.

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

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

9 is amended by adding at the end the following new sub10 section:

11 ‘‘Counseling for Hormone Replacement Therapy

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

13 term ‘counseling for hormone replacement therapy’ means

14 diagnostic, therapy, and counseling services for hormone

15 replacement which are furnished—

16 ‘‘(A) by or under the supervision of a physician;

17 or

18 ‘‘(B) by any other health care professional who

19 is legally authorized to furnish such services under

20 State law (or the State regulatory mechanism pro21 vided by State law) of the State in which the serv22 ices are furnished, as would otherwise be covered if

23 furnished by a physician or as an incident to a phy24 sician’s professional service.
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1 ‘‘(2) The term ‘counseling for hormone replacement

2 therapy’ does not include coverage for drugs or biologicals

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

4 (c) ELIMINATION OF COST-SHARING.—

5 (1) ELIMINATION OF COINSURANCE.—Section

6 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

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

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

9 (B) by inserting before the semicolon at

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

11 to counseling for hormone replacement therapy

12 (as defined in section 1861(ww)), 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 202(c)(2)) is

21 amended—

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

23 (B) by inserting before the period the fol24 lowing: ‘‘, and (9) such deductible shall not

25 apply with respect to counseling for hormone
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1 replacement therapy (as defined in section

2 1861(ww))’’.

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. 204. SCREENING FOR GLAUCOMA.

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 203(a)) is amended—

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

11 the end;

12 (2) in subparagraph (W), by inserting ‘‘and’’ at

13 the end; and

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

16 ‘‘(X) screening for glaucoma (as defined in sub17 section (xx)) for individuals determined to be at high

18 risk for glaucoma, individuals with a family history

19 of glaucoma, and individuals with diabetes or myo20 pia;’’.

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

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

23 is amended by adding at the end the following new sub24 section:
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1 ‘‘Screening for Glaucoma

2 ‘‘(xx) The term ‘screening for glaucoma’ means a di3 lated eye examination with an intraocular pressure meas4 urement, and a direct ophthalmoscopy or a slit-lamp bio5 microscopic examination for the early detection of glau6 coma which is furnished by or under the supervision of

7 an optometrist or ophthalmologist who is legally author8 ized to furnish such services under State law (or the State

9 regulatory mechanism provided by State law) of the State

10 in which the services are furnished, as would otherwise

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

12 to a physician’s professional service.’’.

13 (c) ELIMINATION OF COST-SHARING.—

14 (1) ELIMINATION OF COINSURANCE.—Section

15 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

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

17 (A) by striking ‘‘and’’ before ‘‘(V)’’; and

18 (B) by inserting before the semicolon at

19 the end the following: ‘‘, and (W) with respect

20 to screening for glaucoma (as defined in section

21 1861(xx)), the amount paid shall be 100 per22 cent of the lesser of the actual charge for the

23 services or amount determined by a fee schedule

24 established by the Secretary for the purposes of

25 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 203(c)(2)) is

4 amended—

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

6 (B) by inserting before the period the fol7 lowing: ‘‘, and (10) such deductible shall not

8 apply with respect to screening for glaucoma

9 (as defined in section 1861(xx))’’.

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. 205. SCREENING FOR DIMINISHED VISUAL ACUITY.

14 (a) COVERAGE.—Section 1861(s)(2) of the Social Se15 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec16 tion 204(a)) is amended—

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

18 the end;

19 (2) in subparagraph (X), by inserting ‘‘and’’ at

20 the end; and

21 (3) by adding at the end the following new sub22 paragraph:

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

24 defined in subsection (yy));’’.
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1 (b) SERVICES DESCRIBED.—Section 1861 of such

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

3 is amended by adding at the end the following new sub4 section:

5 ‘‘Screening for Diminished Visual Acuity

6 ‘‘(yy) The term ‘screening for diminished visual acu7 ity’ means diagnostic services for screening for diminished

8 visual acuity which are furnished by or under the super9 vision of an optometrist or ophthalmologist who is legally

10 authorized to furnish such services under State law (or

11 the State regulatory mechanism provided by State law) of

12 the State in which the services are furnished, as would

13 otherwise be covered if furnished by a physician or as an

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

15 (c) ELIMINATION OF COST-SHARING.—

16 (1) ELIMINATION OF COINSURANCE.—Section

17 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

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

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

20 (B) by inserting before the semicolon at

21 the end the following: ‘‘, and (X) with respect

22 to screening for diminished visual acuity (as de23 fined in section 1861(yy)), the amount paid

24 shall be 100 percent of the lesser of the actual

25 charge for the services or the amount deter-
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1 mined by a fee schedule established by the Sec2 retary for the purposes of this subparagraph;’’.

3 (2) ELIMINATION OF DEDUCTIBLE.—The first

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

5 1395l(b)) (as amended by section 204(c)(2)) is

6 amended—

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

8 (B) by inserting before the period the fol9 lowing: ‘‘, and (11) such deductible shall not

10 apply with respect to screening for diminished

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

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

13 this section shall apply to services furnished on or after

14 December 31, 2001.

15 SEC. 206. SCREENING FOR HEARING IMPAIRMENT.

16 (a) COVERAGE.—Section 1861(s)(2) of the Social Se17 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec18 tion 205(a)) is amended—

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

20 the end;

21 (2) in subparagraph (Y), by inserting ‘‘and’’ at

22 the end; and

23 (3) by adding at the end the following new sub24 paragraph:
26

•S 2232 IS

1 ‘‘(Z) screening for hearing impairment (as de2 fined in subsection (zz));’’.

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

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

5 is amended by adding at the end the following new sub6 section:

7 ‘‘Screening for Hearing Impairment

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

9 means diagnostic services for hearing impairment by use

10 of periodic questions, otoscopic examination and audio

11 metric testing if such questions indicate potential hearing

12 impairment, and counseling about hearing aid devices

13 which are furnished—

14 ‘‘(1) by or under the supervision of a physician;

15 or

16 ‘‘(2) by any other health care professional who

17 is legally authorized to furnish such services under

18 State law (or the State regulatory mechanism pro19 vided by State law) of the State in which the serv20 ices are furnished, as would otherwise be covered if

21 furnished by a physician or as an incident to a phy22 sician’s professional service.’’.

23 (c) ELIMINATION OF COST-SHARING.—
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1 (1) ELIMINATION OF COINSURANCE.—Section

2 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

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

4 (A) by striking ‘‘and’’ before ‘‘(X)’’; and

5 (B) by inserting before the semicolon at

6 the end the following: ‘‘, and (Y) with respect

7 to screening for hearing impairment (as defined

8 in section 1861(zz)), the amount paid shall be

9 100 percent of the lesser of the actual charge

10 for the services or the amount determined by a

11 fee schedule established by the Secretary for the

12 purposes of this subparagraph;’’.

13 (2) ELIMINATION OF DEDUCTIBLE.—The first

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

15 1395l(b)) (as amended by section 205(c)(2)) is

16 amended—

17 (A) by striking ‘‘and’’ before ‘‘(11)’’; and

18 (B) by inserting before the period the fol19 lowing: ‘‘, and (12) such deductible shall not

20 apply with respect to screening for hearing im21 pairment (as defined in section 1861(zz))’’.

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

23 this section shall apply to services furnished on or after

24 December 31, 2001.
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1 SEC. 207. SCREENING AND COUNSELING FOR

2 OSTEOPOROSIS.

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec5 tion 206(a)) is amended—

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

7 the end;

8 (2) in subparagraph (Z), by inserting ‘‘and’’ at

9 the end; and

10 (3) by adding at the end the following new sub11 paragraph:

12 ‘‘(AA) screening and counseling for osteoporosis

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

14 ‘‘(i) women; and

15 ‘‘(ii) men with fractures;’’.

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

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

18 is amended by adding at the end the following new sub19 section:

20 ‘‘Screening and Counseling for Osteoporosis

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

22 osteoporosis’ means diagnostic and counseling services for

23 osteoporosis in addition to a bone mass measurement (as

24 defined in subsection (rr)) which are furnished in accord25 ance with methods approved by the Food and Drug

26 Administration—
29

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1 ‘‘(1) by or under the supervision of a physician;

2 or

3 ‘‘(2) by any other health care professional who

4 is legally authorized to furnish such services under

5 State law (or the State regulatory mechanism pro6 vided by State law) of the State in which the serv7 ices are furnished, as would otherwise be covered if

8 furnished by a physician or as an incident to a phy9 sician’s professional service.’’.

10 (c) ELIMINATION OF COST-SHARING.—

11 (1) ELIMINATION OF COINSURANCE.—Section

12 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

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

14 (A) by striking ‘‘and’’ before ‘‘(Y)’’; and

15 (B) by inserting before the semicolon at

16 the end and inserting the following: ‘‘, and (Z)

17 with respect to screening and counseling for

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

19 the amount paid shall be 100 percent of the

20 lesser of the actual charge for the services or

21 the amount determined by a fee schedule estab22 lished by the Secretary for the purposes of this

23 subparagraph;’’.

24 (2) ELIMINATION OF DEDUCTIBLE.—The first

25 sentence of section 1833(b) of such Act (42 U.S.C.
30

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1 1395l(b)) (as amended by section 206(c)(2)) is

2 amended—

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

4 (B) by inserting before the period the fol5 lowing: ‘‘, and (13) such deductible shall not

6 apply with respect to screening and counseling

7 for osteoporosis (as defined in section

8 1861(aaa))’’.

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

10 this section shall apply to services furnished on or after

11 December 31, 2001.

12 SEC. 208. SCREENING FOR CHOLESTEROL.

13 (a) COVERAGE.—Section 1861(s)(2) of the Social Se14 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec15 tion 207(a)) is amended—

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

17 the end;

18 (2) in subparagraph (AA), by inserting ‘‘and’’

19 at the end; and

20 (3) by adding at the end the following new sub21 paragraph:

22 ‘‘(BB) screening for cholesterol (as defined in

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

24 65 and 75 that exhibit major risk factors for coro-
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1 nary heart disease, including smoking, hypertension,

2 and diabetes;’’.

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

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

5 is amended by adding at the end the following new sub6 section:

7 ‘‘Screening for Cholesterol

8 ‘‘(bbb) The term ‘screening for cholesterol’ means di9 agnostic services for cholesterol that are furnished—

10 ‘‘(1) by or under the supervision of a physician;

11 or

12 ‘‘(2) by any other health care professional who

13 is legally authorized to furnish such services under

14 State law (or the State regulatory mechanism pro15 vided by State law) of the State in which the serv16 ices are furnished, as would otherwise be covered if

17 furnished by a physician or as an incident to a phy18 sician’s professional 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’’ before ‘‘(Z)’’; and

24 (B) by inserting before the semicolon at

25 the end the following: ‘‘, and (AA) with respect
32

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1 to screening for cholesterol (as defined in sec2 tion 1861(bbb)), the amount paid shall be 100

3 percent of the lesser of the actual charge for

4 the services or the amount determined by a fee

5 schedule established by the Secretary for the

6 purposes of this subparagraph;’’.

7 (2) ELIMINATION OF DEDUCTIBLE.—The first

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

9 1395l(b)) (as amended by section 207(c)(2)) is

10 amended—

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

12 (B) by inserting before the period the fol13 lowing: ‘‘, and (14) such deductible shall not

14 apply with respect to screening and counseling

15 for osteoporosis (as defined in section

16 1861(bbb))’’.

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

18 this section shall apply to services furnished on or after

19 December 31, 2001.

20 SEC. 209. MEDICAL NUTRITION THERAPY SERVICES FOR

21 BENEFICIARIES WITH DIABETES, A CARDIO22 VASCULAR DISEASE, OR A RENAL DISEASE.

23 (a) COVERAGE.—Section 1861(s)(2) of the Social Se24 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec25 tion 208(a)) is amended—
33

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1 (1) in subparagraph (AA) by striking ‘‘and’’ at

2 the end;

3 (2) in subparagraph (BB) by inserting ‘‘and’’

4 at the end; and

5 (3) by adding at the end the following new sub6 paragraph:

7 ‘‘(CC) medical nutrition therapy services (as de8 fined in subsection (ccc)(1)) in the case of a bene9 ficiary with diabetes, a cardiovascular disease (in10 cluding congestive heart failure, arteriosclerosis,

11 hyperlipidemia, hypertension, and hypercholester12 olemia), or a renal disease;’’.

13 (b) SERVICES DESCRIBED.—Section 1861 of the So14 cial Security Act (42 U.S.C. 1395x) (as amended by sec15 tion 208(b)) is amended by adding at the end the following

16 new subsection:

17 ‘‘Medical Nutrition Therapy Services; Registered

18 Dietitian or Nutrition Professional

19 ‘‘(ccc)(1) The term ‘medical nutrition therapy serv20 ices’ means nutritional diagnostic, therapy, and counseling

21 services for the purpose of disease management which are

22 furnished by a registered dietitian or nutrition profes23 sional (as defined in paragraph (2)) pursuant to a referral

24 by a physician.
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1 ‘‘(2) Subject to paragraph (3), the term ‘registered

2 dietitian or nutrition professional’ means an individual

3 who—

4 ‘‘(A) holds a baccalaureate or higher degree

5 granted by a regionally accredited college or univer6 sity in the United States (or an equivalent foreign

7 degree) with completion of the academic require8 ments of a program in nutrition or dietetics, as ac9 credited by an appropriate national accreditation or10 ganization recognized by the Secretary for this pur11 pose;

12 ‘‘(B) has completed at least 900 hours of super13 vised dietetics practice under the supervision of a

14 registered dietitian or nutrition professional; and

15 ‘‘(C)(i) is licensed or certified as a dietitian or

16 nutrition professional by the State in which the serv17 ices are performed; or

18 ‘‘(ii) in the case of an individual in a State that

19 does not provide for such licensure or certification,

20 meets such other criteria as the Secretary estab21 lishes.

22 ‘‘(3) Subparagraphs (A) and (B) of paragraph (2)

23 shall not apply in the case of an individual who, as of the

24 date of enactment of this subsection, is licensed or cer25 tified as a dietitian or nutrition professional by the State
35

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1 in which medical nutrition therapy services are per2 formed.’’.

3 (c) ELIMINATION OF COINSURANCE.—Section

4 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as

5 amended by section 208(c)(1)) is amended—

6 (1) by striking ‘‘and’’ before ‘‘(AA)’’; and

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

8 the following: ‘‘, and (BB) with respect to medical

9 nutrition therapy services (as defined in section

10 1861(ccc)), the amount paid shall be 85 percent of

11 the lesser of the actual charge for the services or the

12 amount determined under the fee schedule estab13 lished under section 1848(b) for the same services if

14 furnished by a physician’’.

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

16 this section apply to services furnished on or after Decem17 ber 31, 2001.

18 SEC. 210. ELIMINATION OF COST-SHARING FOR CURRENT

19 PREVENTIVE BENEFITS.

20 (a) WAIVER OF COINSURANCE AND DEDUCTIBLES.—

21 (1) IN GENERAL.—Section 1834 of the Social

22 Security Act (42 U.S.C. 1395m) is amended by add23 ing at the end the following new subsection:

24 ‘‘(m) WAIVER OF COINSURANCE AND DEDUCTIBLE

25 FOR PREVENTIVE SERVICES.—
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1 ‘‘(1) COINSURANCE.—

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

3 other provision of this part—

4 ‘‘(i) the Secretary shall waive any co5 insurance applicable to services described

6 in subparagraph (B); and

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

8 services, any reference to a percent that is

9 less than 100 percent shall be deemed to

10 be a reference to 100 percent.

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

12 described in this subparagraph are the following

13 services:

14 ‘‘(i) Screening mammography (as de15 fined in section 1861(jj)).

16 ‘‘(ii) Screening pelvic exam (as de17 fined in section 1861(nn)(2)).

18 ‘‘(iii) Hepatitis B vaccine and its ad19 ministration (under section

20 1861(s)(10)(B)).

21 ‘‘(iv) Colorectal cancer screening test

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

23 ‘‘(v) Bone mass measurement (as de24 fined in section 1861(rr)).
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1 ‘‘(vi) Prostate cancer screening test

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

3 ‘‘(vii) Diabetes outpatient self-man4 agement training services (as defined in

5 section 1861(qq)).

6 ‘‘(2) DEDUCTIBLE.—

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

8 other provision of this part, the deductible de9 scribed in section 1833(b) shall not apply with

10 respect to services described in subparagraph

11 (B).

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

13 described in this subparagraph are the following

14 services:

15 ‘‘(i) Hepatitis B vaccine and its ad16 ministration (under section

17 1861(s)(10)(B)).

18 ‘‘(ii) Colorectal cancer screening test

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

20 ‘‘(iii) Bone mass measurement (as de21 fined in section 1861(rr)).

22 ‘‘(iv) Prostate cancer screening test

23 (as defined in section 1861(oo)).
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1 ‘‘(v) Diabetes outpatient self-manage2 ment training services (as defined in sec3 tion 1861(qq)).’’.

4 (2) CONFORMING AMENDMENT.—Section

5 1833(a) of the Social Security Act (42 U.S.C.

6 1395l(a)) is amended by striking ‘‘section 1876’’

7 and inserting ‘‘sections 1834 and 1876’’ in the mat8 ter preceding paragraph (1).

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

10 this section shall apply to services furnished on or after

11 December 31, 2001.

12 SEC. 211. NATIONAL FALLS PREVENTION EDUCATION AND

13 AWARENESS CAMPAIGN.

14 The Secretary, in consultation with the Director of

15 the Centers for Disease Control and Prevention, shall con16 duct a national falls prevention and awareness campaign

17 to reduce fall-related injuries among medicare bene18 ficiaries.

19 SEC. 212. PROGRAM INTEGRITY.

20 The Secretary, in consultation with the Inspector

21 General of the Department of Health and Human Serv22 ices, shall integrate the benefits described in sections 201

23 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 Title XVIII of the Social Security Act (42 U.S.C.

7 1395 et seq.) is amended by adding at the end the fol8 lowing new section:

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
41

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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
42

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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
45

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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-
47

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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 new

4 subparagraph:

5 ‘‘(E) by not later than January 1, 2002,

6 and biannually thereafter, submit the report to

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

8 (2) by adding at the end the following new

9 paragraph:

10 ‘‘(7) EVALUATION OF ACTUARIAL EQUIVALENCE

11 OF MEDICARE AND PRIVATE SECTOR BENEFIT PACK12 AGES.—

13 ‘‘(A) EVALUATION.—The Commission

14 shall—

15 ‘‘(i) evaluate the benefit package of16 fered under the medicare program under

17 this title; and

18 ‘‘(ii) determine the degree to which

19 such benefit package is actuarially equiva20 lent to that offered by health benefit pro21 grams available in the private sector to in22 dividuals over age 65.

23 ‘‘(B) REPORT.—The Commission shall

24 submit a report to Congress that shall

25 contain—
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1 ‘‘(i) a detailed statement of the find2 ings and conclusions of the Commission re3 garding the evaluation conducted under

4 subparagraph (A);

5 ‘‘(ii) the recommendations of the

6 Commission regarding changes in the ben7 efit package offered under the medicare

8 program under this title that would keep

9 the program modern and competitive in re10 lation to health benefit programs available

11 in the private sector; and

12 ‘‘(iii) the recommendations of the

13 Commission for such legislation and ad14 ministrative actions as it considers appro15 priate.’’.

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

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

18 this Act.

19 SEC. 502. NATIONAL INSTITUTE ON AGING STUDY AND RE20 PORT.

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

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

23 to—

24 (1) improve quality of life for the elderly;
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1 (2) develop better ways to prevent or delay the

2 onset of age-related functional decline and disease

3 and disability among the elderly; and

4 (3) develop means of assessing the long-term

5 development of cost-effective benefits and cost-sav6 ings benefits for health promotion and disease pre7 vention among the elderly.

8 (b) REPORT.—Not later than January 1, 2006, the

9 Director of the National Institute on Aging shall submit

10 a report to the Secretary regarding each study conducted

11 under subsection (a) and containing a detailed statement

12 of research findings and conclusions that are scientifically

13 valid and are demonstrated to prevent or delay the onset

14 of chronic illness or disability among the elderly.

15 (c) TRANSMISSION TO INSTITUTE OF MEDICINE.—

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

17 the Secretary shall transmit such report to the Institute

18 of Medicine of the National Academy of Sciences for con19 sideration in its effort to conduct the comprehensive study

20 of current literature and best practices in the field of

21 health promotion and disease prevention among the medi22 care beneficiaries described in section 503.

23 (d) AUTHORIZATION OF APPROPRIATIONS.—

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

25 appropriated $100,000,000 for fiscal years 2001
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1 through 2006 to carry out the purposes of this sec2 tion.

3 (2) AVAILABILITY.—Any sums appropriated

4 under the authorization contained in this subsection

5 shall remain available, without fiscal year limitation,

6 until September 30, 2005.

7 SEC. 503. INSTITUTE OF MEDICINE 5-YEAR MEDICARE PRE8 VENTION BENEFIT STUDY AND REPORT.

9 (a) STUDY.—

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

11 with the Institute of Medicine of the National Acad12 emy of Sciences to conduct a comprehensive study of

13 current literature and best practices in the field of

14 health promotion and disease prevention among

15 medicare beneficiaries including the issues described

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

17 in subsection (b).

18 (2) ISSUES STUDIED.—The study required

19 under paragraph (1) shall include an assessment

20 of—

21 (A) whether each covered benefit is—

22 (i) medically effective; and

23 (ii) a cost-effective benefit or a cost24 saving benefit;
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1 (B) utilization of covered benefits (includ2 ing any barriers to or incentives to increase uti3 lization); and

4 (C) quality of life issues associated with

5 both health promotion and disease prevention

6 benefits covered under the medicare program

7 and those that are not covered under such pro8 gram that would affect all medicare bene9 ficiaries.

10 (b) REPORT.—

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

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

13 year thereafter, the Institute of Medicine of the Na14 tional Academy of Sciences shall submit to the

15 President a report that contains a detailed state16 ment of the findings and conclusions of the study

17 conducted under subsection (a) and the rec18 ommendations for legislation described in paragraph

19 (2).

20 (2) RECOMMENDATIONS FOR LEGISLATION.—

21 The Institute of Medicine of the National Academy

22 of Sciences, in consultation with the Partnership for

23 Prevention, shall develop recommendations in legis24 lative form that—
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1 (A) prioritize the preventive benefits under

2 the medicare program; and

3 (B) modify preventive benefits offered

4 under the medicare program based on the study

5 conducted under subsection (a).

6 (c) TRANSMISSION TO CONGRESS.—

7 (1) IN GENERAL.—On the day on which the re8 port described in subsection (b) is submitted to the

9 President, the President shall transmit the report

10 and recommendations in legislative form described in

11 subsection (b)(2) to Congress.

12 (2) DELIVERY.—Copies of the report and rec13 ommendations in legislative form required to be

14 transmitted to Congress under paragraph (1) shall

15 be delivered—

16 (A) to both Houses of Congress on the

17 same day;

18 (B) to the Clerk of the House of Rep19 resentatives if the House is not in session; and

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

21 Senate is not in session.

22 SEC. 504. FAST-TRACK CONSIDERATION OF PREVENTION

23 BENEFIT LEGISLATION.

24 (a) RULES OF HOUSE OF REPRESENTATIVES AND

25 SENATE.—This section is enacted by Congress—
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1 (1) as an exercise of the rulemaking power of

2 the House of Representatives and the Senate, re3 spectively, and is deemed a part of the rules of each

4 House of Congress, but—

5 (A) is applicable only with respect to the

6 procedure to be followed in that House of Con7 gress in the case of an implementing bill (as de8 fined in subsection (d)); and

9 (B) supersedes other rules only to the ex10 tent that such rules are inconsistent with this

11 section; and

12 (2) with full recognition of the constitutional

13 right of either House of Congress to change the

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

15 House of Congress) at any time, in the same man16 ner and to the same extent as in the case of any

17 other rule of that House of Congress.

18 (b) INTRODUCTION AND REFERRAL.—

19 (1) INTRODUCTION.—

20 (A) IN GENERAL.—Subject to paragraph

21 (2), on the day on which the President trans22 mits the report pursuant to section 503(c) to

23 the House of Representatives and the Senate,

24 the recommendations in legislative form trans25 mitted by the President with respect to such re-
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1 port shall be introduced as a bill (by request)

2 in the following manner:

3 (i) HOUSE OF REPRESENTATIVES.—In

4 the House of Representatives, by the Ma5 jority Leader, for himself and the Minority

6 Leader, or by Members of the House of

7 Representatives designated by the Majority

8 Leader and Minority Leader.

9 (ii) SENATE.—In the Senate, by the

10 Majority Leader, for himself and the Mi11 nority Leader, or by Members of the Sen12 ate designated by the Majority Leader and

13 Minority Leader.

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

15 Congress is not in session on the day on which

16 such recommendations in legislative form are

17 transmitted, the recommendations in legislative

18 form shall be introduced as a bill in that House

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

20 on the first day thereafter on which that House

21 of Congress is in session.

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

23 the presiding officers of the respective Houses to the

24 appropriate committee, or, in the case of a bill con25 taining provisions within the jurisdiction of 2 or
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1 more committees, jointly to such committees for con2 sideration of those provisions within their respective

3 jurisdictions.

4 (c) CONSIDERATION.—After the recommendations in

5 legislative form have been introduced as a bill and referred

6 under subsection (b), such implementing bill shall be con7 sidered in the same manner as an implementing bill is con8 sidered under subsections (d), (e), (f), and (g) of section

9 151 of the Trade Act of 1974 (19 U.S.C. 2191).

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

11 the term ‘‘implementing bill’’ means only the recommenda12 tions in legislative form of the Institute of Medicine of the

13 National Academy of Sciences described in section

14 503(b)(2), transmitted by the President to the House of

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

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

17 as a bill of either House of Congress.

18 (e) COUNTING OF DAYS.—For purposes of this sec19 tion, any period of days referred to in section 151 of the

20 Trade Act of 1974 shall be computed by excluding—

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

22 is not in session because of an adjournment of more

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

24 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