I 

108TH CONGRESS 

2D SESSION H. R. 4898

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 HOUSE OF REPRESENTATIVES 

JULY 22, 2004

Mr. BROWN of Ohio (for himself, Mr. DINGELL, Mr. WAXMAN, Mr. RANGEL, 

Mr. STARK, Mr. STRICKLAND, Mr. ENGEL, and Mr. PALLONE) introduced the following bill; which was referred to the Committee on Energy 

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

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

A BILL

To amend title XVIII of the Social Security Act to 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’’. 
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1 SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE SERVICES 

2 DETERMINED APPROPRIATE BY THE SEC3 RETARY. 

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

6 642(a) of the Medicare Prescription Drug, Improvement, 

7 and Modernization Act of 2003 (Public Law 108–173; 117 

8 Stat. 2322), is amended—

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

10 after the semicolon at the end; 

11 (2) in subparagraph (Z), by adding ‘‘and’’ after 

12 the semicolon at the end; and 

13 (3) by adding at the end the following new sub14 paragraph: 

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

16 in subsection (bbb)(1));’’. 

17 (b) SERVICES DESCRIBED.—Section 1861 of the So18 cial Security Act (42 U.S.C. 1395x), as amended by sec19 tion 706(b) of the Medicare Prescription Drug, Improve20 ment, and Modernization Act of 2003 (Public Law 108–

21 173; 117 Stat. 2339), is amended by adding at the end 

22 the following new subsection: 

23 ‘‘(bbb) ADDITIONAL PREVENTIVE SERVICES.—(1) 

24 The term ‘additional preventive services’ means items and 

25 services, including mental health services, not otherwise 

26 covered under this title that the Secretary determines to 
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1 be reasonable and necessary for the prevention or early 

2 detection of an illness or disability. 

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

4 the Secretary shall—

5 ‘‘(A) take into account evidence-based rec6 ommendations by the United States Preventive Serv7 ices Task Force and other appropriate organizations; 

8 and 

9 ‘‘(B) use the process for making national cov10 erage determinations (as defined in section 

11 1869(f)(1)(B)) under this title.’’. 

12 (c) PAYMENT AND ELIMINATION OF COST-SHAR13 ING.—

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

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

16 amended by section 302(b)(2) of the Medicare Pre17 scription Drug, Improvement, and Modernization 

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

19 is amended—

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

21 (B) by inserting before the semicolon at 

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

23 to additional preventive services (as defined in 

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

25 100 percent of the lesser of the actual charge 
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1 for the services or the amount determined 

2 under a fee schedule established by the Sec3 retary for purposes of this subparagraph’’. 

4 (2) ELIMINATION OF COINSURANCE IN OUT5 PATIENT HOSPITAL SETTINGS.—

6 (A) EXCLUSION FROM OPD FEE SCHED7 ULE.—Section 1833(t)(1)(B)(iv) of the Social 

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

9 amended by section 614 of the Medicare Pre10 scription Drug, Improvement, and Moderniza11 tion Act of 2003 (Public Law 108–173; 117 

12 Stat. 2306), is amended by striking ‘‘and diag13 nostic mammography’’ and inserting ‘‘, diag14 nostic mammography, or additional preventive 

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

16 (B) CONFORMING AMENDMENTS.—Section 

17 1833(a)(2) of the Social Security Act (42 

18 U.S.C. 1395l(a)(2)) is amended—

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

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

21 (ii) in subparagraph (G)(ii), by strik22 ing the comma at the end and inserting ‘‘; 

23 and’’; and 

24 (iii) by inserting after subparagraph 

25 (G)(ii) the following new subparagraph: 
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1 ‘‘(H) with respect to additional preventive 

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

3 furnished by an outpatient department of a hos4 pital, the amount determined under paragraph 

5 (1)(W),’’. 

6 (3) WAIVER OF APPLICATION OF DEDUCT7 IBLE.—The first sentence of section 1833(b) of the 

8 Social Security Act (42 U.S.C. 1395l(b)) is amend9 ed—

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

11 (B) by inserting before the period the fol12 lowing: ‘‘, and (7) such deductible shall not 

13 apply with respect to additional preventive serv14 ices (as defined in section 1861(bbb)(1))’’. 

15 (d) INCLUSION AS PART OF INITIAL PREVENTIVE

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

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

18 by section 611(b) of the Medicare Prescription Drug, Im19 provement, and Modernization Act of 2003 (Public Law 

20 108–173; 117 Stat. 2303), is amended by adding at the 

21 end the following new subparagraph: 

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

23 in subsection (bbb)(1)).’’. 
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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 date of enactment of this Act.

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