I
107TH CONGRESS
1ST SESSION
H. R. 828
To amend title XVIII of the Social Security Act to expand coverage of
preventive services under the Medicare Program and to provide coverage
of outpatient prescription drugs under that program.
IN THE HOUSE OF REPRESENTATIVES
MARCH 1, 2001
Mr. GRUCCI 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 subseqently determined by the Speaker,
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to expand
coverage of preventive services under the Medicare Pro-
gram and to provide coverage of outpatient prescription
drugs under that program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Senior’s Health Care Choice Act of 2001’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—MEDICARE COVERAGE OF PREVENTIVE SERVICES
Sec. 101. Counseling for cessation of tobacco use.
Sec. 102. Screening for hypertension.
Sec. 103. Counseling for hormone replacement therapy.
Sec. 104. Screening for diminished visual acuity.
Sec. 105. Screening for hearing impairment.
Sec. 106. Screening and counseling for osteoporosis.
Sec. 107. Screening for cholesterol.
Sec. 108. Expansion of coverage of medical nutrition therapy services.
Sec. 109. Expansion of coverage of glaucoma screening.
Sec. 110. Routine annual physical checkups.
Sec. 111. Routine annual dental examinations and cleaning.
Sec. 112. Routine annual eye examinations.
TITLE II—MEDICARE PRESCRIPTION DRUG AND SUPPLEMENTAL
BENEFIT PROGRAM
Sec. 201. Establishment of program.
‘‘TITLE XXII—MEDICARE PRESCRIPTION DRUG BENEFIT
PROGRAM
‘‘Sec. 2201. Establishment of prescription drug and supplemental benefit
program.
‘‘Sec. 2202. Enrollment under program.
‘‘Sec. 2203. Election of a medicare prescription plus plan.
‘‘Sec. 2204. Beneficiary information.
‘‘Sec. 2205. Outpatient prescription drug and other supplemental benefits.
‘‘Sec. 2206. Beneficiary protections.
‘‘Sec. 2207. Requirements for entities offering medicare prescription plus
plans.
‘‘Sec. 2208. Submission of medicare prescription plus plans.
‘‘Sec. 2209. Approval of medicare prescription plus plans.
‘‘Sec. 2210. Payments to medicare prescription plus plans for benefits.
‘‘Sec. 2211. Computation and collection of beneficiary share of premium.
‘‘Sec. 2212. Additional prescription drug subsidies through reinsurance.
‘‘Sec. 2213. Plan fees for administrative costs.
‘‘Sec. 2214. Medicare prescription drug account.
‘‘Sec. 2215. Secondary payer provisions.
‘‘Sec. 2216. Definitions; 
treatment 
of 
references 
to 
provisions 
in
medicare+choice program.
Sec. 202. Amendments to Federal Supplementary Medical Insurance Trust
Fund.
Sec. 203. Prescription drug coverage under the Medicare+Choice program.
Sec. 205. Medigap provisions.
TITLE I—MEDICARE COVERAGE
OF PREVENTIVE SERVICES
SEC. 101. COUNSELING FOR CESSATION OF TOBACCO USE.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)), as amended by 102(a)
and 105(a) of the Medicare, Medicaid, and SCHIP Bene-
fits Improvement and Protection Act of 2000 (as enacted
into law by section 1(a)(6) of Public Law 106–554), is
amended—
(1) in subparagraph (U), by striking ‘‘and’’ at
the end;
(2) in subparagraph (V), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(W) counseling for cessation of tobacco use (as
defined in subsection (vv)) for individuals who have
a history of tobacco use;’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x), as amended by section 102(b) of
the Medicare, Medicaid, and SCHIP Benefits Improve-
ment and Protection Act of 2000 (as enacted into law by
section 1(a)(6) of Public Law 106–554), is amended by
adding at the end the following new subsection:
‘‘Counseling for Cessation of Tobacco Use
‘‘(vv)(1) Except as provided in paragraph (2), the
term ‘counseling for cessation of tobacco use’ means diag-
nostic, therapy, and counseling services for cessation of
tobacco use which are furnished—
‘‘(A) by or under the supervision of a physician;
or
‘‘(B) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.
‘‘(2) The term ‘counseling for cessation of tobacco
use’ does not include coverage for drugs or biologicals that
are not otherwise covered under this title.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)), as
amended by section 105(c) and 223(c) of the Medi-
care, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000 (as enacted into law by
section 1(a)(6) of Public Law 106–554), is
amended—
(A) by striking ‘‘and’’ before ‘‘(U)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (V) with respect
to counseling for cessation of tobacco use (as
defined in section 1861(vv)), the amount paid
shall be 100 percent of the lesser of the actual
charge for the services or the amount deter-
mined by a fee schedule established by the Sec-
retary for the purposes of this subparagraph’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) is amended—
(A) by striking ‘‘and’’ before ‘‘(6)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (7) such deductible shall not
apply with respect to counseling for cessation of
tobacco use (as defined in section 1861(vv))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 102. SCREENING FOR HYPERTENSION.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 101(a)) is amended—
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 101(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(V)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (W) with respect
to screening for hypertension (as defined in sec-
tion 1861(ww)), the amount paid shall be 100
percent of the lesser of the actual charge for
the services or the amount determined by a fee
schedule established by the Secretary for the
purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 101(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(7)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (8) such deductible shall not
apply with respect to screening for hypertension
(as defined in section 1861(ww))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 103. COUNSELING FOR HORMONE REPLACEMENT
THERAPY.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 102(a)) is amended—
(1) in subparagraph (W), by striking ‘‘and’’ at
the end;
(2) in subparagraph (X), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(Y) counseling for hormone replacement ther-
apy (as defined in subsection (xx));’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 102(b))
is amended by adding at the end the following new sub-
section:
‘‘Counseling for Hormone Replacement Therapy
‘‘(xx)(1) Except as provided in paragraph (2), the
term ‘counseling for hormone replacement therapy’ means
diagnostic, therapy, and counseling services for hormone
replacement which are furnished—
‘‘(A) by or under the supervision of a physician;
or
‘‘(B) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.
‘‘(2) The term ‘counseling for hormone replacement
therapy’ does not include coverage for drugs or biologicals
that are not otherwise covered under this title.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 102(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(W)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (X) with respect
to counseling for hormone replacement therapy
(as defined in section 1861(xx)), the amount
paid shall be 100 percent of the lesser of the
actual charge for the services or the amount de-
termined by a fee schedule established by the
Secretary for the purposes of this subpara-
graph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 102(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(8)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (9) such deductible shall not
apply with respect to counseling for hormone
replacement therapy (as defined in section
1861(xx))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 104. SCREENING FOR DIMINISHED VISUAL ACUITY.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 103(a)) is amended—
(1) in subparagraph (X), by striking ‘‘and’’ at
the end;
(2) in subparagraph (Y), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(Z) screening for diminished visual acuity (as
defined in subsection (yy));’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 103(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening for Diminished Visual Acuity
‘‘(yy) The term ‘screening for diminished visual acu-
ity’ means diagnostic services for screening for diminished
visual acuity which are furnished by or under the super-
vision of an optometrist or ophthalmologist who is legally
authorized to furnish such services under State law (or
the State regulatory mechanism provided by State law) of
the State in which the services are furnished, as would
otherwise be covered if furnished by a physician or as an
incident to a physician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 103(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(X)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (Y) with respect
to screening for diminished visual acuity (as de-
fined in section 1861(yy)), the amount paid
shall be 100 percent of the lesser of the actual
charge for the services or the amount deter-
mined by a fee schedule established by the Sec-
retary for the purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 103(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(9)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (10) such deductible shall not
apply with respect to screening for diminished
visual acuity (as defined in section 1861(yy))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 105. SCREENING FOR HEARING IMPAIRMENT.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 104(a)) is amended—
(1) in subparagraph (Y), by striking ‘‘and’’ at
the end;
(2) in subparagraph (Z), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(AA) screening for hearing impairment (as de-
fined in subsection (zz));’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 104(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening for Hearing Impairment
‘‘(zz) The term ‘screening for hearing impairment’
means diagnostic services for hearing impairment by use
of periodic questions, otoscopic examination and audio
metric testing if such questions indicate potential hearing
impairment, and counseling about hearing aid devices
which are furnished—
‘‘(1) by or under the supervision of a physician;
or
‘‘(2) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 104(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(Y)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (Z) with respect
to screening for hearing impairment (as defined
in section 1861(zz)), the amount paid shall be
100 percent of the lesser of the actual charge
for the services or the amount determined by a
fee schedule established by the Secretary for the
purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 104(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(10)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (11) such deductible shall not
apply with respect to screening for hearing im-
pairment (as defined in section 1861(zz))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 
106. 
SCREENING 
AND 
COUNSELING 
FOR
OSTEOPOROSIS.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 105(a)) is amended—
(1) in subparagraph (Z), by striking ‘‘and’’ at
the end;
(2) in subparagraph (AA), by inserting ‘‘and’’
at the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(BB) 
screening 
and 
counseling 
for
osteoporosis (as defined in subsection (aaa)) for—
‘‘(i) women; and
‘‘(ii) men with fractures;’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 105(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening and Counseling for Osteoporosis
‘‘(aaa) The term ‘screening and counseling for
osteoporosis’ means diagnostic and counseling services for
osteoporosis in addition to a bone mass measurement (as
defined in subsection (rr)) which are furnished in accord-
ance with methods approved by the Food and Drug
Administration—
‘‘(1) by or under the supervision of a physician;
or
‘‘(2) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 105(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(Z)’’; and
(B) by inserting before the semicolon at
the end and inserting the following: ‘‘, and
(AA) with respect to screening and counseling
for 
osteoporosis 
(as 
defined 
in 
section
1861(aaa)), the amount paid shall be 100 per-
cent of the lesser of the actual charge for the
services or the amount determined by a fee
schedule established by the Secretary for the
purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 105(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(11)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (12) such deductible shall not
apply with respect to screening and counseling
for 
osteoporosis 
(as 
defined 
in 
section
1861(aaa))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 107. SCREENING FOR CHOLESTEROL.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 106(a)) is amended—
(1) in subparagraph (AA), by striking ‘‘and’’ at
the end;
(2) in subparagraph (BB), by inserting ‘‘and’’
at the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(CC) screening for cholesterol (as defined in
subsection (bbb)) for individuals between the ages of
65 and 75 that exhibit major risk factors for coro-
nary heart disease, including smoking, hypertension,
and diabetes;’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 106(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening for Cholesterol
‘‘(bbb) The term ‘screening for cholesterol’ means di-
agnostic services for cholesterol that are furnished—
‘‘(1) by or under the supervision of a physician;
or
‘‘(2) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 106(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(AA)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (BB) with respect
to screening for cholesterol (as defined in sec-
tion 1861(bbb)), the amount paid shall be 100
percent of the lesser of the actual charge for
the services or the amount determined by a fee
schedule established by the Secretary for the
purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 106(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(12)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (13) such deductible shall not
apply with respect to screening and counseling
for 
osteoporosis 
(as 
defined 
in 
section
1861(bbb))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 108. EXPANSION OF COVERAGE OF MEDICAL NUTRI-
TION THERAPY SERVICES.
(a) EXPANSION OF MEDICAL NUTRITION THERAPY
SERVICES TO BENEFICIARIES WITH A CARDIOVASCULAR
DISEASE.—Section 1861(s)(2)(V) of the Social Security
Act, as added by section 105(a) of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of
2000 (as enacted into law by section 1(a)(6) of Public Law
106–554), is amended by inserting ‘‘, a cardiovascular dis-
ease (including congestive heart failure, arteriosclerosis,
hyperlipidemia, hypertension, and hypercholesterolemia),’’
after ‘‘diabetes’’.
(b) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 107(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(BB)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (CC) with respect
to medical nutrition therapy services (as defined
in section 1861(vv)(1)), the amount paid shall
be 85 percent of the lesser of the actual charge
for the services or the amount determined
under the fee schedule established under section
1848(b) for the same services if furnished by a
physician’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 107(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(13)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (14) such deductible shall not
apply with respect to nutrition therapy services
(as defined in section 1861(vv)(1))’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply to services furnished on or after Janu-
ary 1, 2002.
SEC. 
109. 
EXPANSION 
OF 
COVERAGE 
OF 
GLAUCOMA
SCREENING.
(a) EXPANSION
OF
GLAUCOMA
SCREENING
TO
COVER
INDIVIDUALS
WITH
MYOPIA.—Section
1861(s)(2)(U) of the Social Security Act, as added by sec-
tion 101(a) of the Medicare, Medicaid, and SCHIP Bene-
fits Improvement and Protection Act of 2000 (as enacted
into law by section 1(a)(6) of Public Law 106–554), is
amended by inserting ‘‘or myopia’’ after ‘‘diabetes’’.
(b) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 108(b)(1) is amended—
(A) by striking ‘‘and’’ before ‘‘(BB)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (CC) with respect
to screening for glaucoma (as defined in section
1861(uu)), the amount paid shall be 100 per-
cent of the lesser of the actual charge for the
services or amount determined by a fee schedule
established by the Secretary for the purposes of
this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 108(b)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(14)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (15) such deductible shall not
apply with respect to screening for glaucoma
(as defined in section 1861(uu))’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply to services furnished on or after Janu-
ary 1, 2002.
SEC. 110. ROUTINE ANNUAL PHYSICAL CHECKUPS.
(a) IN GENERAL.—Section 1862 of the Social Secu-
rity Act (42 U.S.C. 1395y) is amended—
(1) in subsection (a)(7), by inserting ‘‘subject
to subsection (h),’’ after ‘‘(7)’’; and
(2) by inserting after subsection (g) the fol-
lowing new subsection:
‘‘(h)(1) The exclusion under subsection (a)(7) shall
not include coverage of a routine annual physical checkup,
including coverage of related laboratory tests.’’.
(b) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 109(b)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(CC)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (DD) with respect
to routine annual physical checkups described
in section 1862(h)(1), the amount paid shall be
100 percent of the lesser of the actual charge
for the services or amount determined by a fee
schedule established by the Secretary for the
purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 109(b)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(15)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (16) such deductible shall not
apply with respect to routine annual physical
checkups described in section 1862(h)(1)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply to services furnished on or after Janu-
ary 1, 2002.
SEC. 111. ROUTINE ANNUAL DENTAL EXAMINATIONS AND
CLEANING.
(a) IN GENERAL.—Section 1862 of the Social Secu-
rity Act (42 U.S.C. 1395y), as amended by section 110(a),
is amended—
(1) in subsection (a)(2), by inserting ‘‘subject
to subsection (h),’’ after ‘‘(7)’’; and
(2) by adding at the end of subsection (h) the
following new paragraph:
‘‘(2) The exclusion subsection (a)(12) shall not in-
clude coverage of a routine annual dental examination and
cleaning, including coverage of oral gum disease screen-
ing.’’.
(b) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 110(b)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(DD)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (EE) with respect
to routine annual dental examination and clean-
ing described in section 1862(h)(2), the amount
paid shall be 100 percent of the lesser of the
actual charge for the services or amount deter-
mined by a fee schedule established by the Sec-
retary for the purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 110(b)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(16)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (17) such deductible shall not
apply with respect to routine annual dental ex-
amination and cleaning described in section
1862(h)(2)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply to services furnished on or after Janu-
ary 1, 2002.
SEC. 112. ROUTINE ANNUAL EYE EXAMINATIONS.
(a) IN GENERAL.—Section 1862(h) of the Social Se-
curity Act (42 U.S.C. 1395y(h)), as inserted by section
111(a), is amended by adding at the end the following new
paragraph:
‘‘(3) The exclusion under subsection (a)(7) shall not
include coverage of a routine annual eye examination, in-
cluding a refraction, and of coverage per year of 1 pair
of glasses (or coverage of contract or other correctible
lenses, up to the financial equivalence of a pair of glass-
es).’’.
(b) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 111(b)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(EE)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (FF) with respect
to routine annual eye examinations and cov-
erage of eyeglasses (or other lense equivalents)
described in section 1862(h)(3), the amount
paid shall be 100 percent of the lesser of the
actual charge for the services or amount deter-
mined by a fee schedule established by the Sec-
retary for the purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 111(b)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(17)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (18) such deductible shall not
apply with respect to routine annual eye exami-
nations and coverage of eyeglasses and other
lenses described in section 1862(h)(3)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply to services furnished on or after Janu-
ary 1, 2002.
TITLE II—MEDICARE PRESCRIP-
TION 
DRUG 
AND 
SUPPLE-
MENTAL BENEFIT PROGRAM
SEC. 201. ESTABLISHMENT OF PROGRAM.
(a) IN GENERAL.—The Social Security Act is amend-
ed by adding at the end the following new title:
‘‘TITLE XXII—MEDICARE PRESCRIPTION DRUG
BENEFIT PROGRAM
‘‘ESTABLISHMENT OF PRESCRIPTION DRUG AND
SUPPLEMENTAL BENEFIT PROGRAM
‘‘SEC. 2201. (a) PROVISION OF BENEFIT.—The Sec-
retary shall establish a Prescription Drug and Supple-
mental Benefit Program under which an eligible bene-
ficiary may voluntarily enroll and receive access to covered
outpatient prescription drugs and other benefits through
enrollment in a Medicare Prescription Plus plan offered
by a private entity or a Medicare+Choice plan offered by
a Medicare+Choice organization.
‘‘(b) PROGRAM TO BEGIN IN 2003.—The Secretary
shall establish the program under this part in a manner
so that benefits are first provided for months beginning
with January 2003.
‘‘(c) VOLUNTARY NATURE OF PROGRAM.—Nothing
in this part shall be construed as requiring an eligible ben-
eficiary to enroll in the program under this part.
‘‘(d) FINANCING.—The costs of providing benefits
under this part shall be payable from the Medicare Pre-
scription Drug Account.
‘‘(e) NO EFFECT ON TITLE XVIII BENEFITS.—The
program under this part shall have no effect on the entitle-
ment to benefits under title XVIII.
‘‘ENROLLMENT UNDER PROGRAM
‘‘SEC. 2202. (a) ESTABLISHMENT OF PROCESS.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a process through which an eligible beneficiary
(including an eligible beneficiary enrolled in a
Medicare+Choice 
plan 
offered 
by 
a
Medicare+Choice organization) may make an elec-
tion to enroll under the program under this part.
Except as otherwise provided in this section, such
process shall be similar to the process for enrollment
in part B under section 1837.
‘‘(2) REQUIREMENT OF ENROLLMENT.—An eli-
gible beneficiary must enroll under this part in order
to be eligible to receive benefits under this part.
‘‘(b) ENROLLMENT PERIOD.—
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2) or (3), an eligible beneficiary may not en-
roll in the program under this part during any pe-
riod after the beneficiary’s initial enrollment period.
‘‘(2) OPEN ENROLLMENT PERIOD FOR BENE-
FICIARIES CURRENTLY COVERED.—In the case of an
individual who is entitled to part A of title XVIII
and enrolled under part B of such title as of Novem-
ber 1, 2002, there shall be an open enrollment pe-
riod of 6 months beginning on that date.
‘‘(3) SPECIAL ENROLLMENT PERIOD FOR BENE-
FICIARIES THAT LOSE OTHER DRUG COVERAGE.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (D), in the case of an applicable eligible
beneficiary, the Secretary shall establish proce-
dures for permitting such beneficiary to enroll
under the program under this part.
‘‘(B) 
APPLICABLE
ELIGIBLE
BENE-
FICIARY.—For purposes of this paragraph, the
term ‘applicable eligible beneficiary’ means an
eligible beneficiary who—
‘‘(i) had applicable drug coverage; and
‘‘(ii) involuntarily lost such coverage.
‘‘(C) APPLICABLE
DRUG
COVERAGE
DE-
FINED.—For purposes of subparagraph (B),
the term ‘applicable drug coverage’ means any
of the following prescription drug coverage:
‘‘(i) MEDICAID
PRESCRIPTION
DRUG
COVERAGE.—Prescription drug coverage
under a medicaid plan under title XIX, in-
cluding through the Program of All-inclu-
sive Care for the Elderly (PACE) under
section 1934, through a social health main-
tenance organization (referred to in section
4104(c) of the Balanced Budget Act of
1997), or through a Medicare+Choice
project that demonstrates the application
of capitation payment rates for frail elderly
medicare beneficiaries through the use of a
interdisciplinary team and through the
provision of primary care services to such
beneficiaries by means of such a team at
the nursing facility involved.
‘‘(ii) PRESCRIPTION DRUG COVERAGE
UNDER GROUP HEALTH PLAN.—Any out-
patient prescription drug coverage under a
group health plan, including a health bene-
fits plan under the Federal Employees
Health Benefit Plan under chapter 89 of
title 5, United States Code, and a qualified
retiree prescription drug plan (as defined
in section 2212(e)(1)).
‘‘(iii) PRESCRIPTION DRUG COVERAGE
UNDER
CERTAIN
MEDIGAP
POLICIES.—
Coverage under a medicare supplemental
policy under section 1882 that provides
benefits for prescription drugs (whether or
not such coverage conforms to the stand-
ards for packages of benefits under section
1882(p)(1)), but only if the policy was in
effect on January 1, 2003.
‘‘(iv) STATE
PHARMACEUTICAL
AS-
SISTANCE
PROGRAM.—Coverage of pre-
scription drugs under a State pharma-
ceutical assistance program.
‘‘(v) VETERANS’ COVERAGE OF PRE-
SCRIPTION DRUGS.—Coverage of prescrip-
tion drugs for veterans under chapter 17
of title 38, United States Code.
‘‘(D) REQUIREMENTS.—The procedures
established under subparagraph (A) shall re-
quire that an applicable eligible beneficiary—
‘‘(i) seek to enroll under the program
not later than 63 days after the date that
the beneficiary lost applicable drug cov-
erage; and
‘‘(ii) submit evidence of the date that
the beneficiary lost such coverage along
with the application for enrollment in the
program under this part.
‘‘(4) STUDY AND REPORT ON PERMITTING PART
B ONLY INDIVIDUALS TO ENROLL IN PROGRAM.—
‘‘(A) STUDY.—The Secretary shall conduct
a study on the need for rules relating to permit-
ting individuals who are enrolled under part B
of title XVIII but are not entitled to benefits
under part A to buy into the program under
this part.
‘‘(B) REPORT.—Not later than January 1,
2002, the Secretary shall submit a report to
Congress on the study conducted under sub-
paragraph (A), together with any recommenda-
tions for legislation that the Secretary deter-
mines to be appropriate as a result of such
study.
‘‘(c) PERIOD OF COVERAGE.—
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2) and subject to paragraph (3), an eligible
beneficiary’s coverage under the program under this
part shall be effective for the period provided in sec-
tion 1838, as if that section applied to the program
under this part.
‘‘(2) ENROLLMENT DURING OPEN AND SPECIAL
ENROLLMENT.—Subject to paragraph (3), an eligi-
ble beneficiary who enrolls under the program under
this part pursuant to paragraph (2) or (3) of sub-
section (b) shall be entitled to the benefits under
this part beginning on the first day of the month fol-
lowing the month in which such enrollment occurs.
‘‘(3) LIMITATION.—Coverage under this part
shall not begin prior to January 1, 2003.
‘‘(d) PROGRAM COVERAGE TERMINATED BY TERMI-
NATION OF COVERAGE UNDER PARTS A AND B OF TITLE
XVIII.—
‘‘(1) IN GENERAL.—In addition to the causes of
termination specified in section 1838, the Secretary
shall terminate an individual’s coverage under the
program under this part if the individual is no
longer enrolled in both parts A and B of title XVIII.
‘‘(2) EFFECTIVE DATE.—The termination de-
scribed in paragraph (1) shall be effective on the ef-
fective date of termination of coverage under part A
of title XVIII or (if earlier) under part B of such
title.
‘‘(e) FIRST ENROLLMENT PERIOD.—The Secretary
shall ensure that eligible beneficiaries are permitted to en-
roll under this part prior to January 1, 2003, in order
to ensure that coverage under this part is effective as of
such date.
‘‘ELECTION OF A MEDICARE PRESCRIPTION PLUS PLAN
‘‘SEC. 2203. (a) IN GENERAL.—
‘‘(1) PROCESS.—
‘‘(A) IN GENERAL.—Subject to paragraph
(2), the Secretary shall establish a process
through which an eligible beneficiary who is en-
rolled under this part shall make an annual
election to enroll in a Medicare Prescription
Plus plan offered by an eligible entity that
serves the geographic area in which the bene-
ficiary resides.
‘‘(B) RULES.—In establishing the process
under subparagraph (A), the Secretary shall
use rules that are consistent with the rules for
enrollment 
and 
disenrollment 
with 
a
Medicare+Choice plan under section 1851,
including—
‘‘(i) annual, coordinated election peri-
ods, which shall be coordinated with such
periods under part C of title XVIII;
‘‘(ii) special election periods under
subsection (e)(4) of section 1851; and
‘‘(iii) the guaranteed issue require-
ments under subsection (g) of such section.
‘‘(2) MEDICARE+CHOICE ENROLLEES.—An eli-
gible beneficiary who is enrolled under this part and
enrolled in a Medicare+Choice plan offered by a
Medicare+Choice organization shall receive coverage
of benefits under this part through such plan if such
plan provides qualified prescription drug coverage. If
the Medicare+Choice plan in which the beneficiary
is enrolled does not provide such coverage, the bene-
ficiary shall receive such coverage through the elec-
tion of a Medicare Prescription Plus plan offered by
an eligible entity under this part.
‘‘(b) ASSURING ACCESS
TO PRESCRIPTION DRUG
COVERAGE IN AREAS WITH NO MEDICARE PRESCRIPTION
PLUS PLAN OR MEDICARE+CHOICE PLAN PROVIDING
DRUG COVERAGE AVAILABLE.—The Secretary shall de-
velop procedures for the provision of the benefits required
under section 2205(a) to each eligible beneficiary that re-
sides in an area where there are no Medicare Prescription
Plus plans or Medicare+Choice plans available that pro-
vide qualified prescription drug coverage.
‘‘BENEFICIARY INFORMATION
‘‘SEC. 2204. (a) IN GENERAL.—The Secretary shall
conduct activities that are designed to broadly disseminate
information to eligible beneficiaries (and prospective eligi-
ble beneficiaries) regarding the coverage provided under
this part.
‘‘(b) REQUIREMENTS.—The activities conducted
under this subsection shall be—
‘‘(1) similar to the activities performed by the
Secretary under section 1851(d), including the dis-
semination of comparative information; and
‘‘(2) coordinated with the activities performed
by the Secretary under such section and under sec-
tion 1804.
‘‘OUTPATIENT PRESCRIPTION DRUG AND OTHER
SUPPLEMENTAL BENEFITS
‘‘SEC. 2205. (a) REQUIREMENTS.—
‘‘(1) IN GENERAL.—For purposes of this part
and part C of title XVIII, the term ‘qualified pre-
scription drug coverage’ means either of the fol-
lowing:
‘‘(A) STANDARD COVERAGE WITH ACCESS
TO
NEGOTIATED
PRICES.—Standard coverage
(as defined in subsection (d)) and access to ne-
gotiated prices under subsection (f).
‘‘(B) ACTUARIALLY
EQUIVALENT
COV-
ERAGE
WITH
ACCESS
TO
NEGOTIATED
PRICES.—Coverage of covered outpatient drugs
which meets the alternative coverage require-
ments of subsection (e) and access to negotiated
prices under subsection (f).
‘‘(2) PERMITTING
ADDITIONAL
OUTPATIENT
PRESCRIPTION DRUG COVERAGE.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B) and section 2209(c)(2), nothing in
this part shall be construed as preventing quali-
fied prescription drug coverage from including
coverage of covered outpatient drugs that ex-
ceeds the coverage required under paragraph
(1).
‘‘(B) REQUIREMENT.—An eligible entity
may not offer a Medicare Prescription Plus
plan that provides additional benefits pursuant
to subparagraph (A) in an area unless the eligi-
ble entity offering such plan also offers a Medi-
care Prescription Plus plan in the area that
only provides the coverage of prescription drugs
that is required under subsection (a)(1).
‘‘(3) COST
CONTROL
MECHANISMS.—In pro-
viding qualified prescription drug coverage, the enti-
ty offering the Medicare Prescription Plus plan or
the Medicare+Choice plan may use cost control
mechanisms that are customarily used in employer-
sponsored health care plans that offer coverage for
outpatient prescription drugs, including the use of
formularies, tiered copayments, selective contracting
with providers of outpatient prescription drugs, and
mail order pharmacies.
‘‘(b) PERMITTING BENEFITS IN ADDITION TO OUT-
PATIENT PRESCRIPTION DRUG COVERAGE.—
‘‘(1) IN GENERAL.—Subject to paragraph (2)
and section 2209(c)(2), nothing in this part shall be
construed as preventing a Medicare Prescription
Plus plan from including coverage of benefits that
are in addition to the benefits available under title
XVIII, including coverage of beneficiary cost-sharing
for benefits under such title.
‘‘(2) REQUIREMENTS.—An eligible entity may
not offer a Medicare Prescription Plus plan that
provides additional benefits pursuant to paragraph
(1) in an area unless—
‘‘(A) the eligible entity offering such plan
also offers a Medicare Prescription Plus plan in
the area that only provides the coverage of pre-
scription drugs that is required under sub-
section (a)(1); and
‘‘(B) if the additional benefits include any
of the core group of basic benefits described in
section 1882(p)(2)(B), the Medicare Prescrip-
tion Plus plan provides all of such core group
of basic benefits.
‘‘(c) APPLICATION OF SECONDARY PAYOR PROVI-
SIONS.—The provisions of section 1852(a)(4) shall apply
under this part in the same manner as they apply under
part C of title XVIII.
‘‘(d) STANDARD COVERAGE.—For purposes of this
part and part C of title XVIII, the ‘standard coverage’
is coverage of covered outpatient drugs that meets the fol-
lowing requirements:
‘‘(1) DEDUCTIBLE.—The coverage has an an-
nual deductible—
‘‘(A) for 2003, that is equal to $250; or
‘‘(B) for a subsequent year, that is equal
to the amount specified under this paragraph
for the previous year increased by the percent-
age specified in paragraph (5) for the year in-
volved.
Any amount determined under subparagraph (B)
that is not a multiple of $5 shall be rounded to the
nearest multiple of $5.
‘‘(2) LIMITS ON COST-SHARING.—The coverage
has cost-sharing (for costs above the annual deduct-
ible specified in paragraph (1) and up to the initial
coverage limit under paragraph (3)) that is equal to
50 percent or that is actuarially consistent (using
processes established under subsection (g)) with an
average expected payment of 50 percent of such
costs.
‘‘(3) INITIAL
COVERAGE
LIMIT.—Subject to
paragraph (4), the coverage has an initial coverage
limit on the maximum costs that may be recognized
for payment purposes (above the annual deduct-
ible)—
‘‘(A) for 2003, that is equal to $2,100; or
‘‘(B) for a subsequent year, that is equal
to the amount specified in this paragraph for
the previous year, increased by the annual per-
centage increase described in paragraph (5) for
the year involved.
Any amount determined under subparagraph (B)
that is not a multiple of $25 shall be rounded to the
nearest multiple of $25.
‘‘(4) LIMITATION ON OUT-OF-POCKET EXPENDI-
TURES BY BENEFICIARY.—
‘‘(A) IN GENERAL.—Notwithstanding para-
graph (3), the coverage provides benefits with-
out any cost-sharing after the individual has in-
curred costs (as described in subparagraph (C))
for covered outpatient drugs in a year equal to
the annual out-of-pocket limit specified in sub-
paragraph (B).
‘‘(B) ANNUAL
OUT-OF-POCKET
LIMIT.—
For purposes of this part, the ‘annual out-of-
pocket limit’ specified in this subparagraph—
‘‘(i) for 2003, is equal to $6,000; or
‘‘(ii) for a subsequent year, is equal to
the amount specified in the subparagraph
for the previous year, increased by the an-
nual percentage increase described in para-
graph (5) for the year involved.
Any amount determined under clause (ii) that
is not a multiple of $100 shall be rounded to
the nearest multiple of $100.
‘‘(C) APPLICATION.—In applying subpara-
graph (A)—
‘‘(i) incurred costs shall only include
costs incurred for the annual deductible
(described in paragraph (1)), cost-sharing
(described in paragraph (2)), and amounts
for which benefits are not provided because
of the application of the initial coverage
limit described in paragraph (3); but
‘‘(ii) costs shall be treated as incurred
without regard to whether the individual or
another person, including a State program,
has paid for such costs, but shall not be
counted insofar as such costs are covered
as benefits under a Medicare Prescription
Plus plan, a Medicare+Choice plan, or
other third-party coverage.
‘‘(5) ANNUAL
PERCENTAGE
INCREASE.—For
purposes of this part, the annual percentage increase
specified in this paragraph for a year is equal to the
annual percentage increase in average per capita ag-
gregate expenditures for covered outpatient drugs in
the United States for medicare beneficiaries, as de-
termined by the Secretary for the 12-month period
ending in July of the previous year.
‘‘(e) ALTERNATIVE COVERAGE REQUIREMENTS.—A
Medicare Prescription Plus plan or Medicare+Choice plan
may provide a different prescription drug benefit design
from the standard coverage described in subsection (d) so
long as the following requirements are met:
‘‘(1) ASSURING AT LEAST ACTUARIALLY EQUIV-
ALENT COVERAGE.—
‘‘(A) ASSURING
EQUIVALENT
VALUE
OF
TOTAL COVERAGE.—The actuarial value of the
total coverage (as determined under subsection
(g)) is at least equal to the actuarial value (as
so determined) of standard coverage.
‘‘(B) 
ASSURING
EQUIVALENT
UNSUB-
SIDIZED
VALUE
OF
COVERAGE.—The unsub-
sidized value of the coverage is at least equal to
the unsubsidized value of standard coverage.
For purposes of this subparagraph, the unsub-
sidized value of coverage is the amount by
which the actuarial value of the coverage (as
determined under subsection (g)) exceeds the
actuarial value of the reinsurance subsidy pay-
ments under section 2212 with respect to such
coverage.
‘‘(C) ASSURING STANDARD PAYMENT FOR
COSTS AT INITIAL COVERAGE LIMIT.—The cov-
erage is designed, based upon an actuarially
representative pattern of utilization (as deter-
mined under subsection (g)), to provide for the