I

107TH CONGRESS

1ST SESSION H. R. 2058

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 health benefits, and for other

purposes.

IN THE HOUSE OF REPRESENTATIVES

JUNE 5, 2001

Mr. LEVIN (for himself, Mr. FOLEY, Mr. STARK, Mr. LEACH, Mr. ABERCROMBIE, Mr. BALDACCI, Mr. CARDIN, Mr. COYNE, Mr. CROWLEY, Ms.

DEGETTE, Mr. HINCHEY, Mr. HOEFFEL, Mr. HORN, Mr. KILDEE, Ms.

LEE, Mr. MCNULTY, Mr. PASTOR, Ms. ROYBAL-ALLARD, Mr. SANDERS,

Mr. SERRANO, Mr. SIMMONS, Mrs. THURMAN, and Mr. WAXMAN) introduced the following bill; which was referred to the Committee on Energy

and Commerce, and in addition to the Committees on Ways and Means

and Rules, for a period to be subsequently determined by the Speaker,

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To 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 health 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,
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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

3 ‘‘Medicare Wellness Act of 2001’’.

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

5 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Definitions.

TITLE I—HEALTHY SENIORS PROMOTION PROGRAM

Sec. 101. Definitions.

Sec. 102. Working Group on Disease Self-Management and Health Promotion.

Sec. 103. Healthy seniors promotion grants.

Sec. 104. Disease self-management demonstration projects.

TITLE II—MEDICARE COVERAGE OF PREVENTIVE HEALTH

BENEFITS

Sec. 201. Therapy and counseling for cessation of tobacco use.

Sec. 202. Counseling for post-menopausal women.

Sec. 203. Screening for diminished visual acuity.

Sec. 204. Screening for hearing impairment.

Sec. 205. Screening for cholesterol.

Sec. 206. Screening for hypertension.

Sec. 207. Expansion of eligibility for bone mass measurement.

Sec. 208. Coverage of medical nutrition therapy services for beneficiaries with

cardiovascular diseases.

Sec. 209. Elimination of deductibles and coinsurance for existing preventive

health benefits.

Sec. 210. Program integrity.

Sec. 211. Promotion of preventive health benefits.

TITLE III—NATIONAL FALLS PREVENTION EDUCATION AND

AWARENESS CAMPAIGN

Sec. 301. National falls prevention education and awareness campaign.

TITLE IV—CLINICAL DEPRESSION SCREENING DEMONSTRATION

PROJECTS

Sec. 401. Clinical depression screening demonstration projects.

TITLE V—MEDICARE HEALTH EDUCATION AND RISK APPRAISAL

PROGRAM

Sec. 501. Medicare health education and risk appraisal program.

TITLE VI—STUDIES, EVALUATIONS, AND REPORTS IN THE FIELD

OF DISEASE PREVENTION AND THE ELDERLY

Sec. 601. MedPAC evaluation and report on medicare benefit package in relation to private sector benefit packages.
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Sec. 602. National Institute on Aging study and report on ways to improve the

quality of life of elderly.

Sec. 603. Institute of Medicine medicare prevention benefit study and report.

Sec. 604. Fast-track consideration of prevention benefit legislation.

1 SEC. 2. DEFINITIONS.

2 In this Act:

3 (1) MEDICARE BENEFICIARY.—The term

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

5 entitled to benefits under part A or enrolled under

6 part B of the medicare program, including any indi7 vidual enrolled in a Medicare+Choice plan offered

8 by a Medicare+Choice organization under part C of

9 such program.

10 (2) MEDICARE PROGRAM.—The term ‘‘medicare

11 program’’ means the health benefits program under

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

13 1395 et seq.).

14 (3) SECRETARY.—The term ‘‘Secretary’’ means

15 the Secretary of Health and Human Services.

16 TITLE I—HEALTHY SENIORS

17 PROMOTION PROGRAM

18 SEC. 101. DEFINITIONS.

19 In this title:

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

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

22 that has—

23 (A) been subject to peer review;
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1 (B) been described in scientific journals;

2 and

3 (C) demonstrated value as measured by

4 unit costs relative to health outcomes achieved.

5 (2) COST-SAVING BENEFIT.—The term ‘‘cost6 saving benefit’’ means a benefit or technique that

7 has—

8 (A) been subject to peer review;

9 (B) been described in scientific journals;

10 and

11 (C) caused a net reduction in health care

12 costs for medicare beneficiaries.

13 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti14 ty’’ means an entity that the Working Group (as de15 fined in paragraph (6)) determines has dem16 onstrated expertise regarding health promotion and

17 disease prevention among medicare beneficiaries.

18 (4) MEDICALLY EFFECTIVE.—The term ‘‘medi19 cally effective’’ means, with respect to a benefit or

20 technique, that the benefit or technique has been—

21 (A) subject to peer review;

22 (B) described in scientific journals; and

23 (C) determined to achieve an intended goal

24 under normal programmatic conditions.
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1 (5) MEDICALLY EFFICACIOUS.—The term

2 ‘‘medically efficacious’’ means, with respect to a ben3 efit or technique, that the benefit or technique has

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

10 Group’’ means the Working Group on Disease Self11 Management and Health Promotion established

12 under section 102.

13 SEC. 102. WORKING GROUP ON DISEASE SELF-MANAGE14 MENT AND HEALTH PROMOTION.

15 (a) ESTABLISHMENT.—There is established within

16 the Department of Health and Human Services a Working

17 Group on Disease Self-Management and Health Pro18 motion.

19 (b) COMPOSITION.—

20 (1) IN GENERAL.—Subject to paragraph (2),

21 the Working Group shall be composed of 5 members

22 as follows:

23 (A) The Administrator of the Health Care

24 Financing Administration.
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1 (B) The Director of the Centers for Dis2 ease Control and Prevention.

3 (C) The Director of the Agency for

4 Healthcare Research and Quality.

5 (D) The Assistant Secretary for Aging.

6 (E) The Director of the National Institutes

7 of Health.

8 (2) ALTERNATIVE MEMBERSHIP.—Any member

9 of the Working Group described in a subparagraph

10 of paragraph (1) may appoint an individual who is

11 an officer or employee of the Federal Government to

12 serve as a member of the Working Group instead of

13 the member described in such subparagraph.

14 (c) DUTIES.—The duties of the Working Group are

15 as follows:

16 (1) HEALTHY SENIORS PROMOTION GRANTS.—

17 The Working Group shall establish general policies

18 and criteria with respect to the functions of the Sec19 retary under section 103, including—

20 (A) priorities for the approval of applica21 tions submitted under subsection (c) of such

22 section;

23 (B) procedures for monitoring and evalu24 ating research efforts conducted under such

25 section; and
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1 (C) such other matters relating to the

2 grant program established under such section

3 as are recommended by the Working Group and

4 approved by the Secretary.

5 (2) DISEASE SELF-MANAGEMENT DEMONSTRA6 TION PROJECTS.—The Working Group shall estab7 lish general policies and criteria with respect to the

8 functions of the Secretary under section 104,

9 including—

10 (A) the identification of medical conditions

11 for which a demonstration project under such

12 section may be implemented;

13 (B) the prioritization of the conditions

14 identified under subparagraph (A) based on the

15 potential for the self-management of such con16 dition to be medically effective and for such

17 self-management to be a cost-effective benefit

18 or cost-saving benefit;

19 (C) the identification of target individuals

20 (as defined in section 104(a)(2));

21 (D) the development of procedures for se22 lecting areas in which such a demonstration

23 project may be implemented; and

24 (E) such other matters relating to such

25 demonstration projects as are recommended by
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1 the Working Group and approved by the Sec2 retary.

3 (d) CHAIRPERSON.—The Secretary shall designate 1

4 of the members of the Working Group to be the chair5 person of the Group.

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

7 Working Group shall constitute a quorum, but, subject to

8 subsection (f), a lesser number of members may hold

9 meetings.

10 (f) MEETINGS.—The Working Group shall meet at

11 the call of the chairperson, except that—

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

13 year; and

14 (2) it shall meet upon the written request of a

15 majority of the members.

16 (g) COMPENSATION OF MEMBERS.—Each member of

17 the Working Group shall serve without compensation in

18 addition to that received for their service as an officer or

19 employee of the Federal Government.

20 (h) AUTHORIZATION OF APPROPRIATIONS.—There

21 are authorized to be appropriated such sums as may be

22 necessary for the purpose of carrying out this section.

23 SEC. 103. HEALTHY SENIORS PROMOTION GRANTS.

24 (a) PROGRAM AUTHORIZED.—The Secretary, using

25 the general policies and criteria established by the Work-
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1 ing Group under section 102(c)(1) and in accordance with

2 the provisions of this section, is authorized to make grants

3 to eligible entities (as defined in section 101(3)) to pay

4 for the costs of the activities described in subsection (b).

5 (b) USE OF FUNDS.—An eligible entity may use pay6 ments received under this section in any fiscal year to con7 duct a program to—

8 (1) study whether using different types of pro9 viders of care and alternative settings (including

10 community-based senior centers) for the implemen11 tation of a successful health promotion and disease

12 prevention strategy, including the implications re13 garding the payment of such providers, is medically

14 efficacious or medically effective;

15 (2) determine the most effective means of edu16 cating medicare beneficiaries, either directly or

17 through providers of care, regarding the importance

18 of health promotion and disease prevention among

19 such beneficiaries;

20 (3) identify incentives that would increase the

21 use of new and existing preventive health benefits

22 and healthy behaviors by medicare beneficiaries;

23 (4) promote—
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1 (A) the use of preventive health benefits by

2 medicare beneficiaries, including such services

3 that are covered under the medicare program;

4 (B) the proper use by medicare bene5 ficiaries of prescription and over-the-counter

6 drugs in order to reduce the number of hospital

7 stays and physician visits that are a result of

8 improper use of such drugs; and

9 (C) the utilization by medicare bene10 ficiaries of the steps (including exercise, mainte11 nance of a proper diet, and the utilization of ac12 cident prevention techniques) that research has

13 shown to promote and safeguard individual

14 health; and

15 (5) address other topics designated by the Sec16 retary.

17 (c) APPLICATION.—

18 (1) IN GENERAL.—Each eligible entity that de19 sires to receive a grant under this section shall sub20 mit an application to the Secretary, at such time, in

21 such manner, and accompanied by such additional

22 information as the Secretary may reasonably re23 quire.

24 (2) CONTENTS.—Each application submitted

25 under paragraph (1) shall—
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1 (A) describe the activities for which assist2 ance under this section is sought;

3 (B) describe how such activities will—

4 (i) reflect the medical, behavioral, and

5 social aspects of care for medicare bene6 ficiaries;

7 (ii) lead to the development of cost-ef8 fective benefits and cost-saving benefits;

9 and

10 (iii) impact the quality of life of medi11 care beneficiaries;

12 (C) provide assurances that such activities

13 will focus on broad medicare populations rather

14 than unique local medicare populations;

15 (D) provide evidence that the eligible entity

16 meets the general policies and criteria estab17 lished by the Working Group under section

18 102(c)(1);

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

21 the entity in order to continue the activities for

22 which the entity is making application after the

23 period for which assistance is sought; and

24 (F) 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 title.

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

5 provisions of paragraph (1).

6 (d) 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 section 102(c)(1).

10 (e) PAYMENTS.—Subject to amounts appropriated

11 under subsection (g), the Secretary shall pay to each eligi12 ble entity having an application approved under subsection

13 (d) the cost of the activities described in the application.

14 (f) 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 activities conducted

19 under the programs for which grants were

20 made under this section;

21 (B) the extent to which research assisted

22 under this section has improved or expanded

23 the general research for health promotion and

24 disease prevention among medicare beneficiaries
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1 and identified practical interventions based

2 upon such research;

3 (C) a list of specific recommendations

4 based upon the activities conducted under the

5 programs for which grants were made under

6 this section which show promise as practical

7 interventions for health promotion and disease

8 prevention among medicare beneficiaries;

9 (D) whether or not, as a result of the ac10 tivities conducted under the programs for which

11 grants were made under this section, certain

12 health promotion and disease prevention bene13 fits or education efforts should be added to the

14 medicare program, including discussions of

15 quality of life, translating the applied research

16 results into a benefit under the medicare pro17 gram, and whether each additional benefit

18 would be a cost-effective benefit or a cost-saving

19 benefit for each proposed addition; and

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

22 disease prevention services, such as an edu23 cation and public awareness campaign, pro24 viding financial incentives for providers of care
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1 and medicare beneficiaries, or utilizing other

2 administrative means.

3 (2) ANNUAL REPORT.—Not later than Decem4 ber 31, 2003, and annually thereafter through 2005,

5 the Secretary, in consultation with the Working

6 Group, shall submit a report to Congress on the

7 evaluation conducted under paragraph (1), together

8 with such recommendations for such legislation and

9 administrative actions as the Secretary considers ap10 propriate.

11 (g) AUTHORIZATION OF APPROPRIATIONS.—There

12 are authorized to be appropriated for the purpose of car13 rying out this section $50,000,000 for each of fiscal years

14 2002, 2003, 2004, and 2005.

15 SEC. 104. DISEASE SELF-MANAGEMENT DEMONSTRATION

16 PROJECTS.

17 (a) DEMONSTRATION PROJECTS.—

18 (1) IN GENERAL.—The Secretary shall conduct

19 demonstration projects for the purpose of promoting

20 disease self-management for conditions identified by

21 the Working Group under section 102(c)(2) for tar22 get individuals (as defined in paragraph (2)).

23 (2) TARGET INDIVIDUAL DEFINED.—In this

24 section, the term ‘‘target individual’’ means an indi25 vidual who—
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1 (A) is at risk for, or has, 1 or more of the

2 conditions identified by the Working Group

3 under section 102(c)(2); and

4 (B) is enrolled under the original medicare

5 fee-for-service program under parts A and B of

6 title XVIII of the Social Security Act (42

7 U.S.C. 1395c et seq.; 1395j et seq.) or is en8 rolled under the Medicare+Choice program

9 under part C of title XVIII of such Act (42

10 U.S.C. 1395w–21 et seq.).

11 (b) NUMBER; PROJECT AREAS; DURATION.—

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

13 date of enactment of this Act, the Secretary shall

14 implement a series of demonstration projects to

15 carry out the purpose described in subsection (a)(1).

16 (2) PROJECT AREAS.—The Secretary shall im17 plement the demonstration projects described in

18 paragraph (1) in urban, suburban, and rural areas.

19 (3) DURATION.—The demonstration projects

20 under this section shall be conducted during the 3-

21 year period beginning on the date on which the ini22 tial demonstration project is implemented.

23 (c) REPORT TO CONGRESS.—

24 (1) IN GENERAL.—Not later than 18 months

25 after the conclusion of the demonstration projects
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1 under this section, the Secretary shall submit a re2 port to Congress on such projects.

3 (2) CONTENTS OF REPORT.—The report re4 quired under paragraph (1) shall include the fol5 lowing:

6 (A) A description of the demonstration

7 projects.

8 (B) An evaluation of—

9 (i) whether each benefit provided

10 under the demonstration projects is a cost11 effective benefit or a cost-saving benefit;

12 (ii) the level of the disease self-man13 agement attained by target individuals

14 under the demonstration projects; and

15 (iii) the satisfaction of target individ16 uals under the demonstration projects.

17 (C) Recommendations of the Secretary re18 garding whether to conduct the demonstration

19 projects on a permanent basis.

20 (D) Such recommendations for legislation

21 and administrative action as the Secretary de22 termines to be appropriate.

23 (E) Any other information regarding the

24 demonstration projects that the Secretary de25 termines to be appropriate.
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1 (d) FUNDING.—The Secretary shall provide for the

2 transfer from the Federal Hospital Insurance Trust Fund

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

4 1395i) an amount not to exceed $30,000,000 for the costs

5 of carrying out this section.

6 TITLE II—MEDICARE COVERAGE

7 OF PREVENTIVE HEALTH

8 BENEFITS

9 SEC. 201. THERAPY AND COUNSELING FOR CESSATION OF

10 TOBACCO USE.

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

13 105(a) of the Medicare, Medicaid, and SCHIP Benefits

14 Improvement and Protection Act of 2000 (114 Stat.

15 2763A–471), as enacted into law by section 1(a)(6) of

16 Public Law 106–554, is amended—

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

18 the end;

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

20 the end; and

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

23 ‘‘(W) supplemental preventive health services

24 (as defined in subsection (ww));’’.
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1 (b) SERVICES DESCRIBED.—Section 1861 of the So2 cial Security Act (42 U.S.C. 1395x), as amended by sec3 tion 105(b) of the Medicare, Medicaid, and SCHIP Bene4 fits Improvement and Protection Act of 2000 (114 Stat.

5 2763A–471), as enacted into law by section 1(a)(6) of

6 Public Law 106–554, is amended by adding at the end

7 the following new subsection:

8 ‘‘Supplemental Preventive Health Services

9 ‘‘(ww) The term ‘supplemental preventive health serv10 ices’ means the following:

11 ‘‘(1)(A) Therapy and counseling for cessation of

12 tobacco use for individuals who use tobacco products

13 or who are being treated for tobacco use that is

14 furnished—

15 ‘‘(i) by or under the supervision of a physi16 cian; or

17 ‘‘(ii) by any other health care professional

18 who—

19 ‘‘(I) is legally authorized to furnish

20 such services under State law (or the State

21 regulatory mechanism provided by State

22 law) of the State in which the services are

23 furnished; and
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1 ‘‘(II) is authorized to receive payment

2 for other services under this title or is des3 ignated by the Secretary for this purpose.

4 ‘‘(B) Subject to subparagraph (C), such term is

5 limited to—

6 ‘‘(i) therapy and counseling services rec7 ommended in ‘Treating Tobacco Use and De8 pendence: A Clinical Practice Guideline’, pub9 lished by the Public Health Service in June

10 2000, or any subsequent modification of such

11 Guideline; and

12 ‘‘(ii) such other therapy and counseling

13 services that the Secretary recognizes to be ef14 fective.

15 ‘‘(C) Such term shall not include coverage for

16 drugs or biologicals that are not otherwise covered

17 under this title.’’.

18 (c) PAYMENT AND ELIMINATION OF COST-SHARING

19 FOR ALL SUPPLEMENTAL PREVENTIVE HEALTH SERV20 ICES.—

21 (1) PAYMENT AND ELIMINATION OF COINSUR22 ANCE.—Section 1833(a)(1) of the Social Security

23 Act (42 U.S.C. 1395l(a)(1)), as amended by section

24 223(c) of the Medicare, Medicaid, and SCHIP Bene25 fits Improvement and Protection Act of 2000 (114
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1 Stat. 2763A–489), as enacted into law by section

2 1(a)(6) of Public Law 106–554, is amended—

3 (A) in subparagraph (N), by inserting

4 ‘‘other than supplemental preventive health

5 services (as defined in section 1861(ww))’’ after

6 ‘‘(as defined in section 1848(j)(3))’’

7 (B) by striking ‘‘and’’ before ‘‘(U)’’; and

8 (C) by inserting before the semicolon at

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

10 to supplemental preventive health services (as

11 defined in section 1861(ww)), the amount paid

12 shall be 100 percent of the lesser of the actual

13 charge for the services or the amount deter14 mined under the payment basis determined

15 under section 1848 by the Secretary for the

16 particular supplemental preventive health serv17 ice involved’’.

18 (2) PAYMENT UNDER PHYSICIAN FEE SCHED19 ULE.—Section 1848(j)(3) (42 U.S.C. 1395w–

20 4(j)(3)) is amended by inserting ‘‘(2)(W),’’ after

21 ‘‘(2)(S),’’.

22 (3) ELIMINATION OF COINSURANCE IN OUT23 PATIENT HOSPITAL SETTINGS.—The third sentence

24 of section 1866(a)(2)(A) of the Social Security Act

25 (42 U.S.C. 1395cc(a)(2)(A)) is amended by insert-
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1 ing after ‘‘1861(s)(10)(A)’’ the following: ‘‘, with re2 spect to supplemental preventive health services (as

3 defined in section 1861(ww)),’’.

4 (4) ELIMINATION OF DEDUCTIBLE.—The first

5 sentence of section 1833(b) of the Social Security

6 Act (42 U.S.C. 1395l(b)) is amended—

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

8 (B) by inserting before the period the fol9 lowing: ‘‘, and (7) such deductible shall not

10 apply with respect to supplemental preventive

11 health services (as defined in section

12 1861(ww))’’.

13 (d) APPLICATION OF LIMITS ON BILLING.—Section

14 1842(b)(18)(C) of the Social Security Act (42 U.S.C.

15 1395u(b)(18)(C)), as amended by section 105(d) of the

16 Medicare, Medicaid, and SCHIP Benefits Improvement

17 and Protection Act of 2000 (114 Stat. 2763A–472), as

18 enacted into law by section 1(a)(6) of Public Law 106–

19 554, is amended by adding at the end the following new

20 clause:

21 ‘‘(vii) Any health care professional designated

22 under section 1861(ww)(1)(A)(ii)(II) to perform

23 therapy and counseling for cessation of tobacco

24 use.’’.
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1 (e) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to services furnished on or after

3 the day that is 1 year after the date of enactment of this

4 Act.

5 SEC. 202. COUNSELING FOR POST-MENOPAUSAL WOMEN.

6 (a) COVERAGE.—Section 1861(ww) of the Social Se7 curity Act (42 U.S.C. 1395x(s)(2)), as added by section

8 201(b), is amended by adding at the end the following new

9 paragraph:

10 ‘‘(2)(A) Counseling for post-menopausal

11 women.

12 ‘‘(B) For purposes of subparagraph (A), the

13 term ‘counseling for post-menopausal women’ means

14 counseling provided to a post-menopausal woman

15 regarding—

16 ‘‘(i) the symptoms, risk factors, and condi17 tions associated with menopause;

18 ‘‘(ii) appropriate treatment options for

19 post-menopausal women, including hormone re20 placement therapy; and

21 ‘‘(iii) other interventions that can be imple22 mented to prevent or delay the onset of health

23 risks associated with menopause.
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1 ‘‘(C) Such term does not include coverage for

2 drugs or biologicals that are not otherwise covered

3 under this title.’’.

4 (b) EFFECTIVE DATE.—The amendment made by

5 this section shall apply to services furnished on or after

6 the day that is 1 year after the date of enactment of this

7 Act.

8 SEC. 203. SCREENING FOR DIMINISHED VISUAL ACUITY.

9 (a) COVERAGE.—Section 1861(ww) of the Social Se10 curity Act (42 U.S.C. 1395x(s)(2)), as amended by section

11 202(a), is amended by adding at the end the following new

12 paragraph:

13 ‘‘(3)(A) Screening for diminished visual acuity.

14 ‘‘(B) For purposes of subparagraph (A), the

15 term ‘screening for diminished visual acuity’ means

16 a screening for diminished visual acuity that is fur17 nished by or under the supervision of an optometrist

18 or ophthalmologist who is legally authorized to fur19 nish such services under State law (or the State reg20 ulatory mechanism provided by State law) of the

21 State in which the services are furnished.’’.

22 (b) EFFECTIVE DATE.—The amendment made by

23 this section shall apply to services furnished on or after

24 the day that is 1 year after the date of enactment of this

25 Act.
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1 SEC. 204. SCREENING FOR HEARING IMPAIRMENT.

2 (a) COVERAGE.—Section 1861(ww) of the Social Se3 curity Act (42 U.S.C. 1395x(s)(2)), as amended by section

4 203(a), is amended by adding at the end the following new

5 paragraph:

6 ‘‘(4)(A) Screening for hearing impairment.

7 ‘‘(B) For purposes of subparagraph (A), the

8 term ‘screening for hearing impairment’ means the

9 following services:

10 ‘‘(i) A screening for hearing impairment

11 using periodic questions that is furnished by—

12 ‘‘(I) a physician, including an

13 otolaryngologist;

14 ‘‘(II) a qualified audiologist (as de15 fined in subsection (ll)(3)(B)); or

16 ‘‘(III) any other health care profes17 sional who is legally authorized to furnish

18 such screening under State law (or the

19 State regulatory mechanism provided by

20 State law) of the State in which the

21 screening is furnished.

22 ‘‘(ii) If the answers to such questions indi23 cate potential hearing impairment, an otoscopic

24 examination and an audiometric screening test

25 that are furnished by an otolaryngologist or a

26 qualified audiologist (as so defined).
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1 ‘‘(iii) If the results of such examination or

2 test indicate a need for assistive listening de3 vices (whether or not such examination or test

4 was based on a screening or was diagnostic),

5 counseling about such devices that is furnished

6 by an otolaryngologist or a qualified audiologist

7 (as so defined).’’.

8 (b) EFFECTIVE DATE.—The amendment made by

9 this section shall apply to services furnished on or after

10 the day that is 1 year after the date of enactment of this

11 Act.

12 SEC. 205. SCREENING FOR CHOLESTEROL.

13 (a) COVERAGE.—Section 1861(ww) of the Social Se14 curity Act (42 U.S.C. 1395x(s)(2)), as amended by section

15 204(a), is amended by adding at the end the following new

16 paragraph:

17 ‘‘(5)(A) Screening for cholesterol if the indi18 vidual involved has not had such a screening during

19 the preceding 5 years.

20 ‘‘(B) Notwithstanding subparagraph (A), pay21 ment may be made under this part for a screening

22 for cholesterol with respect to an individual even if

23 the individual has had such a screening during the

24 preceding 5 years if the individual exhibits major

25 risk factors for coronary heart disease or a stroke,
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1 including, but not limited to, smoking, hypertension,

2 and diabetes.’’.

3 (b) CONFORMING AMENDMENT.—Section 1862(a)(1)

4 of the Social Security Act (42 U.S.C. 1395y(a)(1)) is

5 amended—

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

7 the end;

8 (2) in subparagraph (I), by striking the semi9 colon at the end and inserting ‘‘, and’’; and

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

12 ‘‘(J) in the case of a screening for choles13 terol, which is performed more frequently than

14 is covered under section 1861(ww)(5);’’.

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

16 this section shall apply to services furnished on or after

17 the day that is 1 year after the date of enactment of this

18 Act.

19 SEC. 206. SCREENING FOR HYPERTENSION.

20 (a) COVERAGE.—Section 1861(ww) of the Social Se21 curity Act (42 U.S.C. 1395x(s)(2)), as amended by section

22 205(a), is amended by adding at the end the following new

23 paragraph:
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1 ‘‘(6)(A) Screening for hypertension if the indi2 vidual involved has not had such a screening during

3 the preceding 2 years.

4 ‘‘(B) Notwithstanding subparagraph (A), pay5 ment may be made under this part for a screening

6 for hypertension with respect to an individual even

7 if the individual has had such a screening during the

8 preceding 2 years if the individual has a history of,

9 or is at risk for, hypertension.’’.

10 (b) CONFORMING AMENDMENT.—Section 1862(a)(1)

11 of the Social Security Act (42 U.S.C. 1395y(a)(1)), as

12 amended by section 205(b), is amended—

13 (1) in subparagraph (I), by striking ‘‘and’’ at

14 the end;

15 (2) in subparagraph (J), by striking the semi16 colon at the end and inserting ‘‘, and’’; and

17 (3) by adding at the end the following new sub18 paragraph:

19 ‘‘(K) in the case of a screening for hyper20 tension, which is performed more frequently

21 than is covered under section 1861(ww)(6);’’.

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

23 this section shall apply to services furnished on or after

24 the day that is 1 year after the date of enactment of this

25 Act.
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1 SEC. 207. EXPANSION OF ELIGIBILITY FOR BONE MASS

2 MEASUREMENT.

3 (a) EXPANSION.—Section 1861(rr)(2) of the Social

4 Security Act (42 U.S.C. 1395x(rr)(2)) is amended to read

5 as follows:

6 ‘‘(2) For purposes of this subsection, the term ‘quali7 fied individual’ means an individual who is (in accordance

8 with regulations prescribed by the Secretary)—

9 ‘‘(A) an estrogen-deficient woman (including

10 those receiving hormone replacement therapy);

11 ‘‘(B) an individual with low trauma or fragility

12 fractures (including vertebral abnormalities and hip,

13 rib, wrist, pelvic, or proximal humeral fractures);

14 ‘‘(C) an individual receiving long-term medica15 tions that have associations to bone loss or

16 osteoporosis (including glucocorticoid therapy and

17 androgen deprivation therapy);

18 ‘‘(D) an individual with a long-term medical

19 condition that has association to osteoporosis (in20 cluding primary hyperparathyroidism);

21 ‘‘(E) a man with risk factors for osteoporosis

22 such as hypogonadism; and

23 ‘‘(F) an individual being monitored to assess

24 the response to, or efficacy of, an approved

25 osteoporosis therapy.’’.
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1 (b) REFERENCE TO ELIMINATION OF COINSURANCE

2 AND WAIVER OF APPLICATION OF DEDUCTIBLE.—For

3 the elimination of the coinsurance for bone mass measure4 ment and for the waiver of the application of the part B

5 deductible for such measurement, see section 209.

6 (c) EFFECTIVE DATE.—The amendment made by

7 subsection (a) shall apply to services furnished on or after

8 the day that is 1 year after the date of enactment of this

9 Act.

10 SEC. 208. COVERAGE OF MEDICAL NUTRITION THERAPY

11 SERVICES FOR BENEFICIARIES WITH CAR12 DIOVASCULAR DISEASES.

13 (a) IN GENERAL.—Section 1861(s)(2)(V) of the So14 cial Security Act (42 U.S.C. 1395x(s)(2)(V)), as added by

15 subsection (a) of section 105 of the Medicare, Medicaid,

16 and SCHIP Benefits Improvement and Protection Act of

17 2000 (114 Stat. 2763A–471), as enacted into law by sec18 tion 1(a)(6) of Public Law 106–554, is amended to read

19 as follows:

20 ‘‘(V) medical nutrition therapy services (as de21 fined in subsection (vv)(1)) in the case of a

22 beneficiary—

23 ‘‘(i) with a cardiovascular disease (includ24 ing congestive heart failure, arteriosclerosis,

25 hyperlipidemia, hypertension, and
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1 hypercholesterolemia), diabetes, or a renal dis2 ease (or a combination of such conditions)

3 who—

4 ‘‘(I) has not received diabetes out5 patient self-management training services

6 within a time period determined by the

7 Secretary;

8 ‘‘(II) is not receiving maintenance di9 alysis for which payment is made under

10 section 1881; and

11 ‘‘(III) meets such other criteria deter12 mined by the Secretary after consideration

13 of protocols established by dietitian or nu14 trition professional organizations; or

15 ‘‘(ii) with a combination of such conditions

16 who—

17 ‘‘(I) is not described in clause (i) be18 cause of the application of subclause (I) or

19 (II) of such clause;

20 ‘‘(II) receives such medical nutrition

21 therapy services in a coordinated manner

22 (as determined appropriate by the Sec23 retary) with any services described in such

24 subclauses that the beneficiary is receiving;

25 and
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1 ‘‘(III) meets such other criteria deter2 mined by the Secretary after consideration

3 of protocols established by dietitian or nu4 trition professional organizations;’’.

5 (b) ELIMINATION OF COINSURANCE.—Section

6 1833(a)(1)(T) of the Social Security Act (42 U.S.C.

7 1395l(a)(1)(T)), as added by section 105(c)(2) of the

8 Medicare, Medicaid, and SCHIP Benefits Improvement

9 and Protection Act of 2000 (114 Stat. 2763A–472), as

10 enacted into law by section 1(a)(6) of Public Law 106–

11 554, is amended by striking ‘‘80 percent’’ and inserting

12 ‘‘100 percent’’.

13 (c) REFERENCE TO WAIVER OF APPLICATION OF DE14 DUCTIBLE.—For the waiver of the application of the part

15 B deductible for medical nutrition therapy services, see

16 section 209.

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

18 this section shall take effect as if included in the enact19 ment of section 105 of the Medicare, Medicaid, and

20 SCHIP Benefits Improvement and Protection Act of 2000

21 (114 Stat. 2763A–471), as enacted into law by section

22 1(a)(6) of Public Law 106–554.
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1 SEC. 209. ELIMINATION OF DEDUCTIBLES AND COINSUR2 ANCE FOR EXISTING PREVENTIVE HEALTH

3 BENEFITS.

4 (a) IN GENERAL.—Section 1833 of the Social Secu5 rity Act (42 U.S.C. 1395l) is amended by inserting after

6 subsection (o) the following new subsection:

7 ‘‘(p) DEDUCTIBLES AND COINSURANCE WAIVED FOR

8 PREVENTIVE HEALTH ITEMS AND SERVICES.—The Sec9 retary may not require the payment of any deductible or

10 coinsurance under subsection (a) or (b), respectively, of

11 any individual enrolled for coverage under this part for

12 any of the following preventive health items and services:

13 ‘‘(1) Blood-testing strips, lancets, and blood

14 glucose monitors for individuals with diabetes de15 scribed in section 1861(n).

16 ‘‘(2) Diabetes outpatient self-management

17 training services (as defined in section 1861(qq)(1)).

18 ‘‘(3) Pneumococcal, influenza, and hepatitis B

19 vaccines and administration described in section

20 1861(s)(10).

21 ‘‘(4) Screening mammography (as defined in

22 section 1861(jj)).

23 ‘‘(5) Screening pap smear and screening pelvic

24 exam (as defined in paragraphs (1) and (2) of sec25 tion 1861(nn), respectively).
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1 ‘‘(6) Bone mass measurement (as defined in

2 section 1861(rr)(1)).

3 ‘‘(7) Prostate cancer screening test (as defined

4 in section 1861(oo)(1)).

5 ‘‘(8) Colorectal cancer screening test (as de6 fined in section 1861(pp)(1)).

7 ‘‘(9) Screening for glaucoma (as defined in sec8 tion 1861(uu)).

9 ‘‘(10) Medical nutrition therapy services (as de10 fined in section 1861(vv)(1)).’’.

11 (b) WAIVER OF COINSURANCE.—

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

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

14 amended to read as follows: ‘‘(B) with respect to

15 preventive health items and services described in

16 subsection (p), the amounts paid shall be 100 per17 cent of the fee schedule or other basis of payment

18 under this title for the particular item or service,’’.

19 (2) ELIMINATION OF COINSURANCE IN OUT20 PATIENT HOSPITAL SETTINGS.—The third sentence

21 of section 1866(a)(2)(A) of the Social Security Act

22 (42 U.S.C. 1395cc(a)(2)(A)), as amended by section

23 201(c)(3), is amended by inserting after ‘‘section

24 1861(ww)’’ the following: ‘‘and preventive health

25 items and services described in section 1833(p)’’.
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1 (c) WAIVER OF APPLICATION OF DEDUCTIBLE.—

2 Section 1833(b)(1) of the Social Security Act (42 U.S.C.

3 1395l(b)(1)) is amended to read as follows: ‘‘(1) such de4 ductible shall not apply with respect to preventive health

5 items and services described in subsection (p),’’.

6 (d) ADDING ‘‘LANCET’’ TO DEFINITION OF DME.—

7 Section 1861(n) of the Social Security Act (42 U.S.C.

8 1395x(n)) is amended by striking ‘‘blood-testing strips

9 and blood glucose monitors’’ and inserting ‘‘blood-testing

10 strips, lancets, and blood glucose monitors’’.

11 (e) CONFORMING AMENDMENTS.—

12 (1) ELIMINATION OF COINSURANCE FOR CLIN13 ICAL DIAGNOSTIC LABORATORY TESTS.—Paragraphs

14 (1)(D)(i) and (2)(D)(i) of section 1833(a) of the So15 cial Security Act (42 U.S.C. 1395l(a)), as amended

16 by section 201(b)(1) of the Medicare, Medicaid, and

17 SCHIP Benefits Improvement and Protection Act of

18 2000 (114 Stat. 2763A–481), as enacted into law by

19 section 1(a)(6) of Public Law 106–554, are each

20 amended by inserting ‘‘or which are described in

21 subsection (p)’’ after ‘‘assignment-related basis’’.

22 (2) ELIMINATION OF COINSURANCE FOR CER23 TAIN DME.—Section 1834(a)(1)(A) of the Social Se24 curity Act (42 U.S.C. 1395m(a)(1)(A)) is amended

25 by inserting ‘‘(or 100 percent, in the case of such an
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1 item described in section 1833(p))’’ after ‘‘80 per2 cent’’.

3 (3) ELIMINATION OF DEDUCTIBLES AND COIN4 SURANCE FOR COLORECTAL CANCER SCREENING

5 TESTS.—Section 1834(d) of the Social Security Act

6 (42 U.S.C. 1395m(d)) is amended—

7 (A) in paragraph (2)(C)—

8 (i) by striking ‘‘(C) FACILITY PAY9 MENT LIMIT.—’’ and all that follows

10 through ‘‘Notwithstanding subsections’’

11 and inserting the following:

12 ‘‘(C) FACILITY PAYMENT LIMIT.—Notwith13 standing subsections’’;

14 (ii) by striking ‘‘(I) in accordance’’

15 and inserting the following:

16 ‘‘(i) in accordance’’;

17 (iii) by striking ‘‘(II) are performed’’

18 and all that follows through ‘‘payment

19 under’’ and inserting the following:

20 ‘‘(ii) are performed in an ambulatory

21 surgical center or hospital outpatient de22 partment,

23 payment under’’; and

24 (iv) by striking clause (ii); and

25 (B) in paragraph (3)(C)—
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1 (i) by striking ‘‘(C) FACILITY PAY2 MENT LIMIT.—’’ and all that follows

3 through ‘‘Notwithstanding subsections’’

4 and inserting the following:

5 ‘‘(C) FACILITY PAYMENT LIMIT.—Notwith6 standing subsections’’; and

7 (ii) by striking clause (ii).

8 (f) EFFECTIVE DATE.—The amendments made by

9 this section shall apply to services furnished on or after

10 the day that is 1 year after the date of enactment of this

11 Act.

12 SEC. 210. PROGRAM INTEGRITY.

13 The Secretary, in consultation with the Inspector

14 General of the Department of Health and Human Serv15 ices, shall integrate supplemental preventive health serv16 ices (as defined in section 1861(ww) of the Social Security

17 Act (as added by the preceding provisions of this title))

18 with existing program integrity measures.

19 SEC. 211. PROMOTION OF PREVENTIVE HEALTH BENEFITS.

20 In order to promote the use by medicare beneficiaries

21 of preventive health benefits, including preventive health

22 services (as defined in section 1861(ww) of the Social Se23 curity Act (as added by the preceding provisions of this

24 title)) and preventive health items and services described
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1 in section 1833(p) of such Act (as added by section 209),

2 the Secretary shall do the following:

3 (1) MEDICARE HANDBOOK AND OTHER ANNUAL

4 NOTICES.—Include in any medicare handbook and

5 any other annual notice provided to medicare bene6 ficiaries a detailed description of—

7 (A) the preventive health benefits that are

8 covered under the medicare program; and

9 (B) the importance of using such benefits.

10 (2) FISCAL INTERMEDIARIES AND CARRIERS.—

11 Require that fiscal intermediaries with a contract

12 under section 1816 of the Social Security Act (42

13 U.S.C. 1395h) and carriers with a contract under

14 section 1842 of such Act (42 U.S.C. 1395u) include

15 preventive health benefits messages on Medicare

16 Summary Notice Statements and Explanations of

17 Medicare Benefits distributed by such entities.

18 (3) MEDICARE PART B STATEMENT.—Regularly

19 include preventive health benefits messages on the

20 medicare part B statement.

21 (4) MEDICARE+CHOICE PLANS.—Require that

22 Medicare+Choice organizations offering a

23 Medicare+Choice plan disclose under section

24 1852(c)(1)(B) of the Social Security Act (42 U.S.C.

25 1395w–22(c)(1)(B)) information regarding the pre-
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1 ventive health benefits that are covered under the

2 plan.

3 (5) OTHER ACTIVITIES.—Conduct activities in

4 addition to those described in paragraphs (1)

5 through (4) that the Secretary determines to be use6 ful in disseminating information to medicare bene7 ficiaries regarding—

8 (A) the preventive health benefits that are

9 covered under the medicare program;

10 (B) the importance of using such benefits;

11 and

12 (C) general health promotion.

13 TITLE III—NATIONAL FALLS

14 PREVENTION EDUCATION

15 AND AWARENESS CAMPAIGN

16 SEC. 301. NATIONAL FALLS PREVENTION EDUCATION AND

17 AWARENESS CAMPAIGN.

18 (a) IN GENERAL.—The Director of the Centers for

19 Disease Control and Prevention, in consultation with the

20 Administrator of the Health Care Financing Administra21 tion, shall conduct a national falls prevention and aware22 ness campaign to reduce fall-related injuries among medi23 care beneficiaries.

24 (b) REPORT TO CONGRESS.—
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1 (1) IN GENERAL.—The Director of the Centers

2 for Disease Control and Prevention, in consultation

3 with the Administrator of the Health Care Financ4 ing Administration, shall submit to Congress a re5 port on the campaign conducted under this section.

6 (2) DEADLINE FOR REPORT.—The report re7 quired under paragraph (1) shall be submitted not

8 later than the earlier of—

9 (A) 6 months after the campaign is com10 pleted; or

11 (B) 3 years after the campaign is imple12 mented.

13 (3) CONTENTS OF REPORT.—The report re14 quired under paragraph (1) shall include the fol15 lowing:

16 (A) A description of the campaign.

17 (B) An evaluation of—

18 (i) whether the campaign has effec19 tively reached its target population; and

20 (ii) the cost-effectiveness of the cam21 paign.

22 (C) An assessment of whether the cam23 paign has been effective, as measured by

24 whether—
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1 (i) the target population has adopted

2 the interventions suggested in the cam3 paign, and if not, the reasons why such

4 interventions have not been adopted; and

5 (ii) the fall rates among the target

6 population have decreased since the cam7 paign was implemented, and if not, the

8 reasons why such fall rates have not de9 creased.

10 (D) Any other information regarding the

11 campaign that the Director of the Centers for

12 Disease Control and Prevention determines to

13 be appropriate.

14 (c) AUTHORIZATION OF APPROPRIATIONS.—There

15 are authorized to be appropriated such sums as may be

16 necessary for the purpose of carrying out this section.

17 TITLE IV—CLINICAL DEPRES18 SION SCREENING DEM19 ONSTRATION PROJECTS

20 SEC. 401. CLINICAL DEPRESSION SCREENING DEMONSTRA21 TION PROJECTS.

22 (a) DEFINITIONS.—In this section:

23 (1) DEMONSTRATION PROJECT.—The term

24 ‘‘demonstration project’’ means a demonstration

25 project established under subsection (b)(1).
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1 (2) ELIGIBLE BENEFICIARY.—The term ‘‘eligi2 ble beneficiary’’ means an individual enrolled for

3 benefits under part B who is not enrolled in any of

4 the following:

5 (A) A Medicare+Choice plan under part C

6 of title XVIII of the Social Security Act (42

7 U.S.C. 1395w–21 et seq.).

8 (B) A plan offered by an eligible organiza9 tion under section 1876 of such Act (42 U.S.C.

10 1395mm).

11 (C) A program of all-inclusive care for the

12 elderly (PACE) under section 1894 of such Act

13 (42 U.S.C. 1395eee).

14 (D) A social health maintenance organiza15 tion (SHMO) demonstration project established

16 under section 4018(b) of the Omnibus Budget

17 Reconciliation Act of 1987 (Public Law 100–

18 203).

19 (E) A health care prepayment plan under

20 section 1833(a)(1)(A) of the Social Security Act

21 (42 U.S.C. 1395l(a)(1)(A)).

22 (3) PART B.—The term ‘‘part B’’ means part

23 B of the original medicare fee-for-service program

24 under title XVIII of the Social Security Act (42

25 U.S.C. 1395j et seq.).
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1 (4) QUALIFIED HEALTH PROFESSIONAL.—The

2 term ‘‘qualified health professional’’ means an indi3 vidual that—

4 (A) is—

5 (i) a physician (as defined in section

6 1861(r)(1) of the Social Security Act (42

7 U.S.C. 1395x(r)(1)));

8 (ii) a nurse practitioner (as defined in

9 section 1861(aa)(5) of such Act (42 U.S.C.

10 1395x(aa)(5))); or

11 (iii) a mental health care professional

12 (including a clinical social worker, as de13 fined in section 1861(hh) of such Act (42

14 U.S.C. 1395x(hh))) that is licensed to per15 form mental health services by the State in

16 which a screening for clinical depression is

17 furnished under a demonstration project;

18 and

19 (B) has an agreement in effect with the

20 Secretary under which the professional agrees

21 to accept the amount determined by the Sec22 retary under subsection (b)(4) as full payment

23 for such screening and to accept an assignment

24 described in section 1842(b)(3)(B)(ii) of the So25 cial Security Act (42 U.S.C.
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1 1395u(b)(3)(B)(ii)) with respect to payment for

2 each screening furnished by the professional to

3 an eligible beneficiary participating in a dem4 onstration project.

5 (5) SCREENING FOR CLINICAL DEPRESSION.—

6 (A) IN GENERAL.—The term ‘‘screening

7 for clinical depression’’ means a consultation

8 during which—

9 (i) a self-administered written screen10 ing test (or an alternative format for such

11 test pursuant to subsection (b)(3)(B)) is

12 made available to an eligible beneficiary;

13 and

14 (ii) a qualified health professional—

15 (I) interprets the results of such

16 test;

17 (II) discusses the beneficiary’s

18 responses to the questions on the test

19 with the beneficiary;

20 (III) assesses the beneficiary’s

21 risk of clinical depression; and

22 (IV) if the qualified health pro23 fessional determines that the bene24 ficiary is at high risk for clinical de25 pression, refers the eligible beneficiary
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1 for a full diagnostic evaluation and

2 such additional treatment as may be

3 required.

4 (B) CONSTRUCTION.—Nothing in subpara5 graph (A)(ii)(IV) shall be construed as prohib6 iting a qualified health professional performing

7 the screening for clinical depression with re8 spect to an individual from directly providing

9 the diagnostic evaluation and additional treat10 ment described in such subparagraph to such

11 individual if legally authorized under State law

12 to do so.

13 (6) SELF-ADMINISTERED WRITTEN SCREENING

14 TEST.—The term ‘‘self-administered written screen15 ing test’’ means an instrument on which an eligible

16 beneficiary writes answers to questions designed to

17 enable a qualified health professional to establish the

18 level of risk of such eligible beneficiary for clinical

19 depression.

20 (b) DEMONSTRATION PROJECTS.—

21 (1) IN GENERAL.—The Secretary shall establish

22 and conduct demonstration projects for the purpose

23 of evaluating the efficacy of providing screenings for

24 clinical depression as a benefit under part B to eligi25 ble beneficiaries through qualified health profes-
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1 sionals in accordance with the requirements of this

2 section.

3 (2) NUMBER, PROJECT AREAS, DURATION.—

4 (A) NUMBER.—The Secretary shall estab5 lish no fewer than 6 and no more than 10 dem6 onstration projects.

7 (B) PROJECT AREAS.—

8 (i) IN GENERAL.—The Secretary shall

9 conduct demonstration projects in geo10 graphic areas that include urban, subur11 ban, and rural areas.

12 (ii) SELECTION.—The Secretary shall

13 select the geographic areas described in

14 clause (i) in a manner that—

15 (I) ensures geographic diversity

16 and a mix of screening sites (includ17 ing physicians’ offices, hospital out18 patient departments, community men19 tal health centers, and skilled nursing

20 facilities); and

21 (II) gives preference to areas

22 with a high concentration of eligible

23 beneficiaries.

24 (C) DURATION.—The demonstration

25 projects under this section shall be conducted
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1 during the 3-year period beginning on the date

2 on which the initial demonstration project is

3 implemented.

4 (3) IDENTIFICATION AND DISTRIBUTION OF

5 SELF-ADMINISTERED TESTS.—

6 (A) IN GENERAL.—The Secretary, in con7 sultation with professionals experienced in con8 ducting large-scale depression screening

9 projects, shall—

10 (i) establish or identify a self-adminis11 tered written screening test to be used in

12 conducting the demonstration projects; and

13 (ii) not later than the date that is 3

14 months before the date on which a dem15 onstration project is implemented in a geo16 graphic area, distribute such test to each

17 qualified health professional that provides

18 services in such area in which the Sec19 retary conducts a demonstration project,

20 together with guidelines for making the

21 test available to eligible beneficiaries.

22 (B) ALTERNATIVE FORMATS FOR TEST.—

23 The Secretary shall also establish and distribute

24 alternative formats for the self-administered

25 written screening test under subparagraph (A)
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1 which shall be available for use when cir2 cumstances do not permit an individual to com3 plete the self-administered written screening

4 test.

5 (4) PAYMENT FOR SCREENINGS FOR CLINICAL

6 DEPRESSION.—

7 (A) IN GENERAL.—Subject to subpara8 graph (C), the Secretary shall provide for pay9 ment of the reasonable charges for each screen10 ing for clinical depression furnished to an eligi11 ble beneficiary by a qualified health professional

12 from the amounts transferred under subsection

13 (d).

14 (B) WAIVER OF COINSURANCE AND

15 DEDUCTIBLES.—The Secretary may not require

16 the payment of any deductible or coinsurance

17 by any eligible beneficiary for a screening for

18 clinical depression furnished under a dem19 onstration project.

20 (C) FREQUENCY LIMITATION.—No pay21 ment may be made under this section for a

22 screening for clinical depression if such a

23 screening is performed with respect to an eligi24 ble beneficiary within the year after a previous

25 screening of such beneficiary.
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1 (5) WAIVER AUTHORITY.—The Secretary may

2 waive such requirements under title XVIII of the So3 cial Security Act (42 U.S.C. 1395 et seq.) as the

4 Secretary determines necessary to carry out the

5 demonstration projects under this section.

6 (c) REPORTS TO CONGRESS.—

7 (1) INTERIM REPORT.—

8 (A) IN GENERAL.—Not later than 2 years

9 after the Secretary implements the initial dem10 onstration project, the Secretary shall submit to

11 Congress a report regarding the demonstration

12 projects conducted under this section.

13 (B) CONTENTS OF REPORT.—The report

14 submitted under subparagraph (A) shall

15 contain—

16 (i) a description of the demonstration

17 projects conducted under this section;

18 (ii) an evaluation of—

19 (I) whether screening for clinical

20 depression is a cost-effective benefit or

21 a cost-saving benefit; and

22 (II) the level of satisfaction of el23 igible beneficiaries to whom such a

24 screening is furnished under the dem25 onstration project; and
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1 (iii) any other information regarding

2 the demonstration projects that the Sec3 retary determines to be appropriate.

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

5 after the conclusion of the demonstration projects,

6 the Secretary shall submit a final report to Congress

7 on the demonstration projects containing the rec8 ommendations of the Secretary regarding whether to

9 conduct the demonstration projects on a permanent

10 basis, together with such recommendations for legis11 lation and administrative action as the Secretary

12 considers appropriate.

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

14 transfer from the Federal Hospital Insurance Trust Fund

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

16 1395i) an amount not to exceed $30,000,000 for the costs

17 of carrying out the demonstration projects under this sec18 tion.
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1 TITLE V—MEDICARE HEALTH

2 EDUCATION AND RISK AP3 PRAISAL PROGRAM

4 SEC. 501. 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.—Not later than

12 18 months after the date of the conclusion of the dem13 onstration projects conducted under subsection (b)(1), the

14 Secretary shall implement the demonstration project that

15 the Secretary identifies as being the most effective project

16 under subsection (c)(2)(C) on a nationwide and perma17 nent basis.

18 ‘‘(b) DEMONSTRATION PROJECTS.—

19 ‘‘(1) ESTABLISHMENT.—Not later than 1 year

20 after the date of enactment of this Act, the Sec21 retary, in consultation with the Health Care Financ22 ing Administration, the Centers for Disease Control

23 and Prevention, and the Agency for Healthcare Re24 search and Quality, shall conduct a demonstration

25 project for the purpose of developing a comprehen-
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1 sive and systematic model for delivering health pro2 motion and disease prevention services that—

3 ‘‘(A) through self-assessment identifies—

4 ‘‘(i) behavioral risk factors, such as

5 tobacco use, physical inactivity, alcohol

6 use, and depression, among target individ7 uals;

8 ‘‘(ii) needed medicare clinical preven9 tive and screening health benefits among

10 target individuals; and

11 ‘‘(iii) functional and self-management

12 information the Secretary determines to be

13 appropriate;

14 ‘‘(B) provides ongoing followup to reduce

15 risk factors and promote the appropriate use of

16 preventive and screening health benefits;

17 ‘‘(C) improves clinical outcomes, satisfac18 tion, quality of life, and appropriate use by tar19 get individuals of items and services covered

20 under the medicare program; and

21 ‘‘(D) provides target individuals with infor22 mation regarding the adoption of healthy behav23 iors.

24 ‘‘(2) SELF-ASSESSMENT AND PROVISION OF IN25 FORMATION.—The Secretary shall conduct the dem-
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1 onstration projects established under paragraph (1)

2 in the following manner:

3 ‘‘(A) SELF-ASSESSMENT.—

4 ‘‘(i) IN GENERAL.—The Secretary

5 shall test different—

6 ‘‘(I) methods of making self-as7 sessments available to each target in8 dividual;

9 ‘‘(II) methods of encouraging

10 each target individual to participate in

11 the self-assessment; and

12 ‘‘(III) methods for processing re13 sponses to the self-assessment.

14 ‘‘(ii) CONTENTS.—A self-assessment

15 made available under clause (i) shall

16 include—

17 ‘‘(I) questions regarding behav18 ioral risk factors;

19 ‘‘(II) questions regarding needed

20 preventive screening health services;

21 ‘‘(III) questions regarding the

22 target individual’s preferences for re23 ceiving follow-up information; and

24 ‘‘(IV) other information that the

25 Secretary determines appropriate.
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1 ‘‘(B) PROVISION OF INFORMATION.—After

2 each target individual completes the self-assess3 ment, the Secretary shall ensure that the target

4 individual is provided with such information as

5 the Secretary determines appropriate, which

6 may include—

7 ‘‘(i) information regarding the results

8 of the self-assessment;

9 ‘‘(ii) recommendations regarding any

10 appropriate behavior modification based on

11 the self-assessment;

12 ‘‘(iii) information regarding how to

13 access behavior modification assistance

14 that promotes healthy behavior, including

15 information on nurse hotlines, counseling

16 services, provider services, and case-man17 agement services;

18 ‘‘(iv) information, feedback, support,

19 and recommendations regarding any need

20 for clinical preventive and screening health

21 services or treatment; and

22 ‘‘(v) referrals to available community

23 resources in order to assist the target indi24 vidual in reducing health risks.

25 ‘‘(3) PROJECT AREAS AND DURATION.—
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1 ‘‘(A) PROJECT AREAS.—The Secretary

2 shall implement the demonstration projects in

3 geographic areas that include urban, suburban,

4 and rural areas.

5 ‘‘(B) DURATION.—The Secretary shall

6 conduct the demonstration projects during the

7 3-year period beginning on the date on which

8 the first demonstration project is implemented.

9 ‘‘(c) REPORT TO CONGRESS.—

10 ‘‘(1) IN GENERAL.—Not later than 1 year after

11 the date on which the demonstration projects con12 clude, the Secretary shall submit to Congress a re13 port on such projects.

14 ‘‘(2) CONTENTS OF REPORT.—The report sub15 mitted under paragraph (1) shall—

16 ‘‘(A) describe the demonstration projects

17 conducted under this section;

18 ‘‘(B) identify the demonstration project

19 that is the most effective; and

20 ‘‘(C) contain such other information re21 garding the demonstration projects as the Sec22 retary determines appropriate.

23 ‘‘(3) MEASUREMENT OF EFFECTIVENESS.—For

24 purposes of paragraph (2)(B), in identifying the
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1 demonstration project that is the most effective, the

2 Secretary shall consider—

3 ‘‘(A) how successful the project was at—

4 ‘‘(i) reaching target individuals and

5 engaging them in an assessment of the risk

6 factors of such individuals;

7 ‘‘(ii) educating target individuals on

8 healthy behaviors and getting such individ9 uals to modify their behaviors in order to

10 diminish the risk of chronic disease; and

11 ‘‘(iii) ensuring that target individuals

12 were provided with necessary information;

13 ‘‘(B) the cost-effectiveness of the dem14 onstration project; and

15 ‘‘(C) the degree of beneficiary satisfaction

16 under the demonstration projects.

17 ‘‘(d) WAIVER AUTHORITY.—The Secretary may

18 waive such requirements under this title as the Secretary

19 determines necessary to carry out the demonstration

20 projects under this section.

21 ‘‘(e) FUNDING.—There are authorized to be appro22 priated $25,000,000 for carrying out the demonstration

23 project under this section.

24 ‘‘(f) DEFINITIONS.—In this section:
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1 ‘‘(1) TARGET INDIVIDUAL.—The term ‘target

2 individual’ means each individual that is—

3 ‘‘(A) entitled to benefits under part A or

4 enrolled under part B, including an individual

5 enrolled under the Medicare+Choice program

6 under part C; or

7 ‘‘(B) between the ages of 50 and 64 who

8 is not a beneficiary under this title.

9 ‘‘(2) MAJOR BEHAVIORAL RISK FACTOR.—The

10 term ‘major behavioral risk factor’ includes—

11 ‘‘(A) the lack of proper nutrition;

12 ‘‘(B) the use of alcohol;

13 ‘‘(C) the lack of regular exercise;

14 ‘‘(D) the use of tobacco;

15 ‘‘(E) depression; and

16 ‘‘(F) any other risk factor identified by the

17 Secretary.’’.
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1 TITLE VI—STUDIES, EVALUA2 TIONS, AND REPORTS IN THE

3 FIELD OF DISEASE PREVEN4 TION AND THE ELDERLY

5 SEC. 601. MEDPAC EVALUATION AND REPORT ON MEDI6 CARE BENEFIT PACKAGE IN RELATION TO

7 PRIVATE SECTOR BENEFIT PACKAGES.

8 (a) IN GENERAL.—Section 1805(b) of the Social Se9 curity Act (42 U.S.C. 1395b–6(b)), as amended by section

10 544(b) of the Medicare, Medicaid, and SCHIP Benefits

11 Improvement and Protection Act of 2000 (114 Stat.

12 2763A–551), as enacted into law by section 1(a)(6) of

13 Public Law 106–554, is amended—

14 (1) in paragraph (1)—

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

16 ‘‘and’’ at the end;

17 (B) in subparagraph (D), by striking the

18 period and inserting ‘‘; and’’; and

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

20 subparagraph:

21 ‘‘(E) on the date that is 3 years after the

22 date of enactment of the Medicare Wellness Act

23 of 2001, and each successive 3-year anniversary

24 thereafter, submit the report described in para25 graph (8)(C) to Congress.’’; and
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1 (2) by adding at the end the following new

2 paragraph:

3 ‘‘(8) EVALUATION OF MEDICARE BENEFIT

4 PACKAGE IN RELATION TO PRIVATE SECTOR BEN5 EFIT PACKAGES.—

6 ‘‘(A) EVALUATION.—The Commission shall

7 evaluate—

8 ‘‘(i) the benefit package offered under

9 the medicare program under this title; and

10 ‘‘(ii) the degree to which such benefit

11 package compares to the benefit packages

12 offered by health benefit programs avail13 able in the private sector to individuals

14 over age 55.

15 ‘‘(B) ISSUES.—In conducting the evalua16 tion under subparagraph (A)(ii), the Commis17 sion shall address the following issues:

18 ‘‘(i) Whether the benefit packages

19 available under the programs are—

20 ‘‘(I) similar;

21 ‘‘(II) appropriate for the enroll22 ees of the programs (based on what

23 experts recommend for such enroll24 ees);

25 ‘‘(III) actuarially equivalent; and
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1 ‘‘(IV) comprehensive.

2 ‘‘(ii) The financial liabilities of enroll3 ees of the programs and whether such li4 abilities are appropriate.

5 ‘‘(iii) The ability of enrollees of the

6 programs to take advantage of benefits

7 under the programs.

8 ‘‘(C) REPORT.—The Commission shall

9 submit a report to Congress that shall

10 contain—

11 ‘‘(i) a detailed statement of the find12 ings and conclusions of the Commission re13 garding the evaluation conducted under

14 subparagraph (A);

15 ‘‘(ii) the recommendations of the

16 Commission regarding changes in the ben17 efit package offered under the medicare

18 program under this title that would keep

19 the program modern and competitive in re20 lation to health benefit packages offered by

21 health benefit programs available in the

22 private sector to individuals over age 55;

23 and

24 ‘‘(iii) the recommendations of the

25 Commission for such legislation and ad-
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1 ministrative actions as it considers appro2 priate.’’.

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

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

5 this Act.

6 SEC. 602. NATIONAL INSTITUTE ON AGING STUDY AND RE7 PORT ON WAYS TO IMPROVE THE QUALITY

8 OF LIFE OF ELDERLY.

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

10 on Aging, in consultation with the Working Group on Dis11 ease Self-Management and Health Promotion (established

12 in section 102) and the United States Preventive Services

13 Task Force, shall conduct 1 or more studies focusing on

14 ways to—

15 (1) improve quality of life for the elderly; and

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

17 onset of age-related functional decline and disease

18 and disability among the elderly.

19 (b) REPORTS.—

20 (1) REPORT FOR EACH STUDY.—The Director

21 of the National Institute on Aging, in consultation

22 with the Working Group on Disease Self-Manage23 ment and Health Promotion and the United States

24 Preventive Services Task Force, shall submit a re25 port to the Secretary regarding each study con-
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1 ducted under subsection (a), together with a detailed

2 statement of research findings and conclusions that

3 are scientifically valid and are demonstrated to pre4 vent or delay the onset of chronic illness or disability

5 among the elderly.

6 (2) TIMING FOR SUBMITTING REPORTS.—Each

7 report regarding a study that is required to be sub8 mitted pursuant to paragraph (1) shall be submitted

9 by not later than the earlier of—

10 (A) the date that is 18 months after the

11 completion of the study involved; or

12 (B) January 1, 2008.

13 (c) TRANSMISSION TO INSTITUTE OF MEDICINE.—

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

15 the Secretary shall transmit such report to the Institute

16 of Medicine of the National Academy of Sciences for con17 sideration in its effort to conduct the comprehensive study

18 of current literature and best practices in the field of

19 health promotion and disease prevention among the medi20 care beneficiaries described in section 603.

21 (d) AUTHORIZATION OF APPROPRIATIONS.—

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

23 appropriated for the purpose of carrying out this

24 section such sums as may be necessary for the pe25 riod of fiscal years 2002 through 2008.
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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, 2008.

5 SEC. 603. INSTITUTE OF MEDICINE MEDICARE PREVEN6 TION 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—

11 (A) conduct a comprehensive study of cur12 rent literature and best practices in the field of

13 health promotion and disease prevention among

14 medicare beneficiaries, including the issues de15 scribed in paragraph (2); and

16 (B) submit the report described in sub17 section (b).

18 (2) ISSUES STUDIED.—The study required

19 under paragraph (1) shall include an assessment

20 of—

21 (A) whether each health promotion and

22 disease prevention benefit covered under the

23 medicare program is—

24 (i) medically effective (as defined in

25 section 101(4)); and
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1 (ii) a cost-effective benefit (as defined

2 in section 101(2)) or a cost-saving benefit

3 (as defined in section 101(3));

4 (B) utilization by medicare beneficiaries of

5 such benefits (including any barriers to or in6 centives to increase utilization);

7 (C) quality of life issues associated with

8 such benefits; and

9 (D) health promotion and disease preven10 tion benefits that are not covered under the

11 medicare program that would affect all medi12 care beneficiaries.

13 (b) REPORTS.—

14 (1) THREE-YEAR REPORT.—On the date that is

15 3 years after the date of enactment of this Act, and

16 each successive 3-year anniversary thereafter, the

17 Institute of Medicine of the National Academy of

18 Sciences shall submit to the President a report that

19 contains—

20 (A) a detailed statement of the findings

21 and conclusions of the study conducted under

22 subsection (a); and

23 (B) the recommendations for legislation

24 described in paragraph (3).
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1 (2) INTERIM REPORT BASED ON NEW GUIDE2 LINES.—If the United States Preventive Services

3 Task Force or the Task Force on Community Pre4 ventive Services establishes new guidelines regarding

5 preventive health benefits for medicare beneficiaries

6 more than 1 year prior to the date that a report de7 scribed in paragraph (1) is due to be submitted to

8 the President, then not later than 6 months after

9 the date such new guidelines are established, the In10 stitute of Medicine of the National Academy of

11 Sciences shall submit to the President a report that

12 contains a detailed description of such new guide13 lines. Such report may also contain recommenda14 tions for legislation described in paragraph (3).

15 (3) RECOMMENDATIONS FOR LEGISLATION.—

16 The Institute of Medicine of the National Academy

17 of Sciences, in consultation with the United States

18 Preventive Services Task Force and the Task Force

19 on Community Preventive Services, shall develop

20 recommendations in legislative form that—

21 (A) prioritize the preventive health benefits

22 under the medicare program; and

23 (B) modify such benefits, including adding

24 new benefits under such program, based on the

25 study conducted under subsection (a).
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1 (c) TRANSMISSION TO CONGRESS.—

2 (1) IN GENERAL.—On the day on which the re3 port described in paragraph (1) of subsection (b) (or

4 paragraph (2) of such subsection if the report con5 tains recommendations in legislative form described

6 in subsection (b)(3)) is submitted to the President,

7 the President shall transmit the report and rec8 ommendations to Congress.

9 (2) DELIVERY.—Copies of the report and rec10 ommendations in legislative form required to be

11 transmitted to Congress under paragraph (1) shall

12 be delivered—

13 (A) to both Houses of Congress on the

14 same day;

15 (B) to the Clerk of the House of Rep16 resentatives if the House is not in session; and

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

18 Senate is not in session.

19 SEC. 604. FAST-TRACK CONSIDERATION OF PREVENTION

20 BENEFIT LEGISLATION.

21 (a) RULES OF HOUSE OF REPRESENTATIVES AND

22 SENATE.—This section is enacted by Congress—

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

24 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 603(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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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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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

13 603(b)(3), transmitted by the President to the House of

14 Representatives and the Senate under subsection 603(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