II 

108TH CONGRESS 

2D SESSION S. 2535 

To amend title XVIII of the Social Security Act to modernize the medicare 

program by ensuring that appropriate preventive services are covered 

under such program. 

IN THE SENATE OF THE UNITED STATES 

JUNE 17, 2004 

Mr. GRAHAM of Florida (for himself and Mr. DURBIN) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to modernize 

the medicare program by ensuring that appropriate preventive services are covered under such program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Preventive 

5 Services Coverage Act of 2004’’. 

6 SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE SERVICES 

7 DETERMINED APPROPRIATE BY THE SEC8 RETARY. 

9 (a) COVERAGE.— 
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•S 2535 IS 

1 (1) DESCRIPTION OF PROGRAM.—Section 1831 

2 of the Social Security Act (42 U.S.C. 1395j) is 

3 amended by inserting ‘‘(including appropriate pre4 ventive benefits)’’ after ‘‘medical insurance bene5 fits’’. 

6 (2) MEDICAL AND OTHER HEALTH SERVICES.— 

7 Section 1861(s)(2) of the Social Security Act (42 

8 U.S.C. 1395x(s)(2)), as amended by section 642(a) 

9 of the Medicare Prescription Drug, Improvement, 

10 and Modernization Act of 2003 (Public Law 108– 

11 173; 117 Stat. 2322), is amended— 

12 (A) in subparagraph (Y), by striking 

13 ‘‘and’’ after the semicolon at the end; 

14 (B) in subparagraph (Z), by adding ‘‘and’’ 

15 after the semicolon at the end; and 

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

17 subparagraph: 

18 ‘‘(AA) additional preventive services (as defined 

19 in subsection (bbb)(1));’’. 

20 (b) SERVICES DESCRIBED.—Section 1861 of the So21 cial Security Act (42 U.S.C. 1395x), as amended by sec22 tion 706(b) of the Medicare Prescription Drug, Improve23 ment, and Modernization Act of 2003 (Public Law 108– 

24 173; 117 Stat. 2339), is amended by adding at the end 

25 the following new subsection: 
3 

•S 2535 IS 

1 ‘‘Additional Preventive Services 

2 ‘‘(bbb)(1) The term ‘additional preventive services’ 

3 means items and services, including mental health serv4 ices, not otherwise covered under this title that the Sec5 retary determines to be reasonable and necessary for the 

6 prevention or early detection of an illness or disability. 

7 ‘‘(2) In making determinations under paragraph (1), 

8 the Secretary shall— 

9 ‘‘(A) take into account evidence-based rec10 ommendations by the United States Preventive Serv11 ices Task Force and other appropriate organizations; 

12 and 

13 ‘‘(B) use the process for making national cov14 erage determinations (as defined in section 

15 1869(f)(1)(B)) under this title.’’. 

16 (c) PAYMENT AND ELIMINATION OF COST-SHAR17 ING.— 

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

19 Social Security Act (42 U.S.C. 1395l(a)(1)), as 

20 amended by section 302(b)(2) of the Medicare Pre21 scription Drug, Improvement, and Modernization 

22 Act of 2003 (Public Law 108–173; 117 Stat. 2229), 

23 is amended— 

24 (A) by striking ‘‘and’’ before ‘‘(V)’’; and 
4 

•S 2535 IS 

1 (B) by inserting before the semicolon at 

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

3 to additional preventive services (as defined in 

4 section 1861(bbb)(1)), the amount paid shall be 

5 100 percent of the lesser of the actual charge 

6 for the services or the amount determined 

7 under a fee schedule established by the Sec8 retary for purposes of this subparagraph’’. 

9 (2) ELIMINATION OF COINSURANCE IN OUT10 PATIENT HOSPITAL SETTINGS.— 

11 (A) EXCLUSION FROM OPD FEE SCHED12 ULE.—Section 1833(t)(1)(B)(iv) of the Social 

13 Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)), as 

14 amended by section 614 of the Medicare Pre15 scription Drug, Improvement, and Moderniza16 tion Act of 2003 (Public Law 108–173; 117 

17 Stat. 2306), is amended by striking ‘‘and diag18 nostic mammography’’ and inserting ‘‘, diag19 nostic mammography, or additional preventive 

20 services (as defined in section 1861(bbb)(1))’’. 

21 (B) CONFORMING AMENDMENTS.—Section 

22 1833(a)(2) of the Social Security Act (42 

23 U.S.C. 1395l(a)(2)) is amended— 

24 (i) in subparagraph (F), by striking 

25 ‘‘and’’ after the semicolon at the end; 
5 

•S 2535 IS 

1 (ii) in subparagraph (G)(ii), by strik2 ing the comma at the end and inserting ‘‘; 

3 and’’; and 

4 (iii) by inserting after subparagraph 

5 (G)(ii) the following new subparagraph: 

6 ‘‘(H) with respect to additional preventive 

7 services (as defined in section 1861(bbb)(1)) 

8 furnished by an outpatient department of a hos9 pital, the amount determined under paragraph 

10 (1)(W),’’. 

11 (3) WAIVER OF APPLICATION OF DEDUCT12 IBLE.—The first sentence of section 1833(b) of the 

13 Social Security Act (42 U.S.C. 1395l(b)) is amend14 ed— 

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

16 (B) by inserting before the period the fol17 lowing: ‘‘, and (7) such deductible shall not 

18 apply with respect to additional preventive serv19 ices (as defined in section 1861(bbb)(1))’’. 

20 (d) INCLUSION AS PART OF INITIAL PREVENTIVE

21 PHYSICAL EXAMINATION.—Section 1861(ww)(2) of the 

22 Social Security Act (42 U.S.C. 1395x(ww)(2)), as added 

23 by section 611(b) of the Medicare Prescription Drug, Im24 provement, and Modernization Act of 2003 (Public Law 
6 

•S 2535 IS 

1 108–173; 117 Stat. 2303), is amended by adding at the 

2 end the following new subparagraph: 

3 ‘‘(L) Additional preventive services (as defined 

4 in subsection (bbb)(1)).’’. 

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

6 this section shall apply to services furnished on or after 

7 the date of enactment of this Act. 

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