than an individual described in section 1903(x)(2)) 
who declares to be a citizen or national of the United 
States for purposes of establishing initial eligibility 
for medical assistance under this title (or, at State 
option, for purposes of renewing or redetermining 
such eligibility to the extent that such satisfactory 
documentary evidence of citizenship or nationality 
has not yet been presented), there is presented satis-
factory documentary evidence of citizenship or na-
tionality of the individual (using criteria determined 
by the State, which shall be no more restrictive than 
the documentation specified in section 1903(x)(3)); 
and 
‘‘(C) comply with the auditing requirements of 
section 1903(x)(4);’’; and 
(B) in subsection (b)(3), by inserting ‘‘or 
any citizenship documentation requirement for a 
child under 21 years of age that is more restric-
tive than what a State may provide under sec-
tion 1903(x)’’ before the period at the end. 
(2) AUDITING REQUIREMENT.—Section 1903(x) 
of such Act (as amended by section 405(c)(1)(A) of di-
vision B of the Tax Relief and Health Care Act of 
2006 (Public Law 109–432)) is amended by adding 
at the end the following new paragraph: 
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‘‘(4)(A) Regardless of whether a State has chosen to 
take the option specified in section 1902(a)(46)(B), each 
State shall audit a statistically-based sample of cases of 
children under 21 years of age in order to demonstrate to 
the satisfaction of the Secretary that the percentage of Fed-
eral Medicaid funds being spent for non-emergency benefits 
for aliens described in subsection (v)(1) who are under 21 
years of age does not exceed 3 percent of total expenditures 
for medical assistance under the plan for items and services 
for individuals under 21 years of age for the period for 
which the sample is taken. In conducting such audits, a 
State may rely on case reviews regularly conducted pursu-
ant to their Medicaid Quality Control or Payment Error 
Rate Measurement (PERM) eligibility reviews under sub-
section (u). 
‘‘(B) In conducting audits under subparagraph (A), 
payments for non-emergency benefits shall be treated as er-
roneous if the audit could not confirm the citizenship of 
the individual based either on documentation in the case 
file or on documentation obtained independently during the 
audit. 
‘‘(C) If the erroneous error rate described in subpara-
graph (A)— 
‘‘(i) exceeds 3 percent, the State shall— 
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‘‘(I) remit to the Secretary the Federal 
share of improper expenditures in excess of the 
3 percent level described in such subparagraph; 
‘‘(II) shall develop a corrective action plan; 
and 
‘‘(III) shall conduct another audit the fol-
lowing fiscal year, after the corrective action 
plan is implemented; or 
‘‘(ii) does not exceed 3 percent, the State is not 
required to conduct another audit under subpara-
graph (A) until the third fiscal year succeeding the 
fiscal year for which the audit was conducted.’’. 
(3) ELIMINATION OF DENIAL OF PAYMENTS FOR 
CHILDREN.—Section 1903(i)(22) of such Act (42 
U.S.C. 1396b(i)(22)) is amended by inserting ‘‘(other 
than a child under the age of 21)’’ after ‘‘for an indi-
vidual’’. 
(b) CLARIFICATION OF RULES FOR CHILDREN BORN 
IN THE UNITED STATES TO MOTHERS ELIGIBLE FOR MED-
ICAID.—Section 1903(x)(2) of such Act (42 U.S.C. 
1396b(x)(2)) is amended— 
(1) in subparagraph (C), by striking ‘‘or’’ at the 
end; 
(2) by redesignating subparagraph (D) as sub-
paragraph (E); and 
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(3) by inserting after subparagraph (C) the fol-
lowing new subparagraph: 
‘‘(D) pursuant to the application of section 
1902(e)(4) (and, in the case of an individual who is 
eligible for medical assistance on such basis, the indi-
vidual shall be deemed to have provided satisfactory 
documentary evidence of citizenship or nationality 
and shall not be required to provide further documen-
tary evidence on any date that occurs during or after 
the period in which the individual is eligible for med-
ical assistance on such basis; or’’. 
(c) DOCUMENTATION FOR NATIVE AMERICANS .—Sec-
tion 1903(x)(3)(B) of such Act is amended— 
(1) by redesignating clause (v) as clause (vi); 
and 
(2) by inserting after clause (iv) the following 
new clause: 
‘‘(v) For an individual who is a member of, or 
enrolled in or affiliated with, a federally-recognized 
Indian tribe, a document issued by such tribe evidenc-
ing such membership, enrollment, or affiliation with 
the tribe (such as a tribal enrollment card or certifi-
cate of degree of Indian blood), and, only with respect 
to those federally-recognized Indian tribes located 
within States having an international border whose 
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membership includes individuals who are not citizens 
of the United States, such other forms of documenta-
tion (including tribal documentation, if appropriate) 
as the Secretary, after consulting with such tribes, de-
termines to be satisfactory documentary evidence of 
citizenship or nationality for purposes of satisfying 
the requirement of this subparagraph.’’. 
(d) REASONABLE OPPORTUNITY.—Section 1903(x) of 
such Act, as amended by subsection (a)(2), is further 
amended by adding at the end the following new paragraph: 
‘‘(5) In the case of an individual declaring to be a 
citizen or national of the United States with respect to 
whom a State requires the presentation of satisfactory docu-
mentary evidence of citizenship or nationality under section 
1902(a)(46)(B), the individual shall be provided at least the 
reasonable opportunity to present satisfactory documentary 
evidence of citizenship or nationality under this subsection 
as is provided under clauses (i) and (ii) of section 
1137(d)(4)(A) to an individual for the submittal to the 
State of evidence indicating a satisfactory immigration sta-
tus and shall not be denied medical assistance on the basis 
of failure to provide such documentation until the indi-
vidual has had such an opportunity.’’. 
(e) EFFECTIVE DATE.— 
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(1) RETROACTIVE
APPLICATION.—The amend-
ments made by this section shall take effect as if in-
cluded in the enactment of the Deficit Reduction Act 
of 2005 (Public Law 109–171; 120 Stat. 4). 
(2) RESTORATION OF ELIGIBILITY.—In the case 
of an individual who, during the period that began 
on July 1, 2006, and ends on the date of the enact-
ment of this Act, was determined to be ineligible for 
medical assistance under a State Medicaid program 
solely as a result of the application of subsections 
(i)(22) and (x) of section 1903 of the Social Security 
Act (as in effect during such period), but who would 
have been determined eligible for such assistance if 
such subsections, as amended by this section, had ap-
plied to the individual, a State may deem the indi-
vidual to be eligible for such assistance as of the date 
that the individual was determined to be ineligible for 
such medical assistance on such basis. 
SEC. 144. ACCESS TO DENTAL CARE FOR CHILDREN. 
(a) 
DENTAL
EDUCATION
FOR
PARENTS
OF 
NEWBORNS.—The Secretary of Health and Human Services 
shall develop and implement, through entities that fund or 
provide perinatal care services to targeted low-income chil-
dren under a State child health plan under title XXI of 
the Social Security Act, a program to deliver oral health 
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educational materials that inform new parents about risks 
for, and prevention of, early childhood caries and the need 
for a dental visit within their newborn’s first year of life. 
(b) PROVISION
OF
DENTAL
SERVICES
THROUGH 
FQHCS.— 
(1) MEDICAID.—Section 1902(a) of the Social 
Security Act (42 U.S.C. 1396a(a)) is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (69); 
(B) by striking the period at the end of 
paragraph (70) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (70) the 
following new paragraph: 
‘‘(71) provide that the State will not prevent a 
Federally-qualified health center from entering into 
contractual relationships with private practice dental 
providers in the provision of Federally-qualified 
health center services.’’. 
(2) CHIP.—Section 2107(e)(1) of such Act (42 
U.S.C. 1397g(e)(1)), as amended by section 112(b), is 
amended by inserting after subparagraph (A) the fol-
lowing new subparagraph: 
‘‘(B) Section 1902(a)(71) (relating to lim-
iting FQHC contracting for provision of dental 
services).’’. 
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(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2008. 
(c) REPORTING INFORMATION ON DENTAL HEALTH.— 
(1) MEDICAID.—Section 1902(a)(43)(D)(iii) of 
such Act (42 U.S.C. 1396a(a)(43)(D)(iii)) is amended 
by inserting ‘‘and other information relating to the 
provision of dental services to such children described 
in section 2108(e)’’ after ‘‘receiving dental services,’’. 
(2) CHIP.—Section 2108 of such Act (42 U.S.C. 
1397hh) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(e) INFORMATION
ON DENTAL CARE
FOR CHIL-
DREN.— 
‘‘(1) IN GENERAL.—Each annual report under 
subsection (a) shall include the following information 
with respect to care and services described in section 
1905(r)(3) provided to targeted low-income children 
enrolled in the State child health plan under this title 
at any time during the year involved: 
‘‘(A) The number of enrolled children by age 
grouping used for reporting purposes under sec-
tion 1902(a)(43). 
‘‘(B) For children within each such age 
grouping, information of the type contained in 
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questions 12(a)–(c) of CMS Form 416 (that con-
sists of the number of enrolled targeted low in-
come children who receive any, preventive, or re-
storative dental care under the State plan). 
‘‘(C) For the age grouping that includes 
children 8 years of age, the number of such chil-
dren who have received a protective sealant on at 
least one permanent molar tooth. 
‘‘(2) INCLUSION OF INFORMATION ON ENROLLEES 
IN MANAGED CARE PLANS.—The information under 
paragraph (1) shall include information on children 
who are enrolled in managed care plans and other 
private health plans and contracts with such plans 
under this title shall provide for the reporting of such 
information by such plans to the State.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall be effective for annual reports 
submitted for years beginning after date of enactment. 
(d) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States shall provide for a study that exam-
ines— 
(A) access to dental services by children in 
underserved areas; and 
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(B) the feasibility and appropriateness of 
using qualified mid-level dental health providers, 
in coordination with dentists, to improve access 
for children to oral health services and public 
health overall. 
(2) REPORT.—Not later than 1 year after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report on the 
study conducted under paragraph (1). 
SEC. 145. PROHIBITING INITIATION OF NEW HEALTH OP-
PORTUNITY ACCOUNT DEMONSTRATION PRO-
GRAMS. 
After the date of the enactment of this Act, the Sec-
retary of Health and Human Services may not approve any 
new demonstration programs under section 1938 of the So-
cial Security Act (42 U.S.C. 1396u–8). 
Subtitle F—Quality and Program 
Integrity 
SEC. 151. PEDIATRIC HEALTH QUALITY MEASUREMENT 
PROGRAM. 
(a) 
QUALITY
MEASUREMENT
OF
CHILDREN’S 
HEALTH.— 
(1) ESTABLISHMENT OF PROGRAM TO DEVELOP 
QUALITY MEASURES FOR CHILDREN’S HEALTH.—The 
Secretary of Health and Human Services (in this sec-
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tion referred to as the ‘‘Secretary’’) shall establish a 
child health care quality measurement program (in 
this subsection referred to as the ‘‘children’s health 
quality measurement program’’) to develop and im-
plement— 
(A) pediatric quality measures on children’s 
health care that may be used by public and pri-
vate health care purchasers (and a system for re-
porting such measures); and 
(B) measures of overall program perform-
ance that may be used by public and private 
health care purchasers. 
The Secretary shall publish, not later than September 
30, 2009, the recommended measures under the pro-
gram for application under the amendments made by 
subsection (b) for years beginning with 2010. 
(2) MEASURES.— 
(A) SCOPE.—The measures developed under 
the children’s health quality measurement pro-
gram shall— 
(i) provide comprehensive information 
with respect to the provision and outcomes 
of health care for young children, school age 
children, and older children; 
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(ii) be designed to identify disparities 
by pediatric characteristics (including, at a 
minimum, those specified in subparagraph 
(C)) in child health and the provision of 
health care; 
(iii) be designed to ensure that the 
data required for such measures is collected 
and reported in a standard format that per-
mits comparison at a State, plan, and pro-
vider level, and between insured and unin-
sured children; 
(iv) take into account existing meas-
ures of child health quality and be periodi-
cally updated; 
(v) include measures of clinical health 
care quality which meet the requirements 
for pediatric quality measures in paragraph 
(1); 
(vi) improve and augment existing 
measures of clinical health care quality for 
children’s health care and develop new and 
emerging measures; and 
(vii) increase the portfolio of evidence- 
based pediatric quality measures available 
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to public and private purchasers, providers, 
and consumers. 
(B) SPECIFIC MEASURES.—Such measures 
shall include measures relating to at least the fol-
lowing aspects of health care for children: 
(i) The proportion of insured (and un-
insured) children who receive age-appro-
priate preventive health and dental care 
(including age appropriate immunizations) 
at each stage of child health development. 
(ii) The proportion of insured (and 
uninsured) children who receive dental care 
for restoration of teeth, relief of pain and 
infection, and maintenance of dental health. 
(iii) The effectiveness of early health 
care interventions for children whose assess-
ments indicate the presence or risk of phys-
ical or mental conditions that could ad-
versely affect growth and development. 
(iv) The effectiveness of treatment to 
ameliorate the effects of diagnosed physical 
and mental health conditions, including 
chronic conditions. 
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(v) The proportion of children under 
age 21 who are continuously insured for a 
period of 12 months or longer. 
(vi) The effectiveness of health care for 
children with disabilities. 
In carrying out clause (vi), the Secretary shall 
develop quality measures and best practices re-
lating to cystic fibrosis. 
(C) REPORTING METHODOLOGY FOR ANAL-
YSIS
BY
PEDIATRIC
CHARACTERISTICS.—The 
children’s health quality measurement program 
shall describe with specificity such measures and 
the process by which such measures will be re-
ported in a manner that permits analysis based 
on each of the following pediatric characteristics: 
(i) Age. 
(ii) Gender. 
(iii) Race. 
(iv) Ethnicity. 
(v) Primary language of the child’s 
parents (or caretaker relative). 
(vi) Disability or chronic condition 
(including cystic fibrosis). 
(vii) Geographic location. 
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(viii) Coverage status under public and 
private health insurance programs. 
(D) PEDIATRIC QUALITY MEASURE.—In this 
subsection, the term ‘‘pediatric quality measure’’ 
means a measurement of clinical care that as-
sesses one or more aspects of pediatric health 
care quality (in various settings) including the 
structure of the clinical care system, the process 
and outcome of care, or patient experience in 
such care. 
(3) CONSULTATION
IN
DEVELOPING
QUALITY 
MEASURES FOR CHILDREN’S HEALTH SERVICES.—In 
developing and implementing the children’s health 
quality measurement program, the Secretary shall 
consult with— 
(A) States; 
(B) pediatric hospitals, pediatricians, and 
other primary and specialized pediatric health 
care professionals (including members of the al-
lied health professions) who specialize in the care 
and treatment of children, particularly children 
with special physical, mental, and developmental 
health care needs; 
(C) dental professionals; 
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(D) health care providers that furnish pri-
mary health care to children and families who 
live in urban and rural medically underserved 
communities or who are members of distinct 
population sub-groups at heightened risk for 
poor health outcomes; 
(E) national organizations representing 
children, including children with disabilities and 
children with chronic conditions; 
(F) national organizations and individuals 
with expertise in pediatric health quality per-
formance measurement; and 
(G) voluntary consensus standards setting 
organizations and other organizations involved 
in the advancement of evidence based measures of 
health care. 
(4) USE OF GRANTS AND CONTRACTS.—In car-
rying out the children’s health quality measurement 
program, the Secretary may award grants and con-
tracts to develop, test, validate, update, and dissemi-
nate quality measures under the program. 
(5) TECHNICAL
ASSISTANCE.—The Secretary 
shall provide technical assistance to States to estab-
lish for the reporting of quality measures under titles 
XIX and XXI of the Social Security Act in accord-
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ance with the children’s health quality measurement 
program. 
(b) DISSEMINATION OF INFORMATION ON THE QUALITY 
OF PROGRAM PERFORMANCE.—Not later than January 1, 
2009, and annually thereafter, the Secretary shall collect, 
analyze, and make publicly available on a public website 
of the Department of Health and Human Services in an 
online format— 
(1) a complete list of all measures in use by 
States as of such date and used to measure the qual-
ity of medical and dental health services furnished to 
children enrolled under title XIX of XXI of the Social 
Security Act by participating providers, managed 
care entities, and plan issuers; and 
(2) information on health care quality for chil-
dren contained in external quality review reports re-
quired under section 1932(c)(2) of such Act (42 
U.S.C. 1396u–2) or produced by States that admin-
ister separate plans under title XXI of such Act. 
(c) REPORTS TO CONGRESS ON PROGRAM PERFORM-
ANCE.—Not later than January 1, 2010, and every 2 years 
thereafter, the Secretary shall report to Congress on— 
(1) the quality of health care for children en-
rolled under title XIX and XXI of the Social Security 
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Act under the children’s health quality measurement 
program; and 
(2) patterns of health care utilization with re-
spect to the measures specified in subsection (a)(2)(B) 
among children by the pediatric characteristics listed 
in subsection (a)(2)(C). 
SEC. 152. APPLICATION OF CERTAIN MANAGED CARE QUAL-
ITY SAFEGUARDS TO CHIP. 
(a) IN GENERAL.—Section 2103(f) of Social Security 
Act (42 U.S.C. 1397bb(f)) is amended by adding at the end 
the following new paragraph: 
‘‘(3) COMPLIANCE
WITH
MANAGED
CARE
RE-
QUIREMENTS.—The State child health plan shall pro-
vide for the application of subsections (a)(4), (a)(5), 
(b), (c), (d), and (e) of section 1932 (relating to re-
quirements for managed care) to coverage, State agen-
cies, enrollment brokers, managed care entities, and 
managed care organizations under this title in the 
same manner as such subsections apply to coverage 
and such entities and organizations under title 
XIX.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to contract years for health plans 
beginning on or after July 1, 2008. 
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SEC. 153. UPDATED FEDERAL EVALUATION OF CHIP. 
Section 2108(c) of the Social Security Act (42 U.S.C. 
1397hh(c)) is amended by striking paragraph (5) and in-
serting the following: 
‘‘(5) SUBSEQUENT EVALUATION USING UPDATED 
INFORMATION.— 
‘‘(A) IN GENERAL.—The Secretary, directly 
or through contracts or interagency agreements, 
shall conduct an independent subsequent evalua-
tion of 10 States with approved child health 
plans. 
‘‘(B) SELECTION OF STATES AND MATTERS 
INCLUDED.—Paragraphs (2) and (3) shall apply 
to such subsequent evaluation in the same man-
ner as such provisions apply to the evaluation 
conducted under paragraph (1). 
‘‘(C) SUBMISSION TO CONGRESS.—Not later 
than December 31, 2010, the Secretary shall sub-
mit to Congress the results of the evaluation con-
ducted under this paragraph. 
‘‘(D) FUNDING.—Out of any money in the 
Treasury of the United States not otherwise ap-
propriated, there are appropriated $10,000,000 
for fiscal year 2009 for the purpose of conducting 
the evaluation authorized under this paragraph. 
Amounts appropriated under this subparagraph 
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shall remain available for expenditure through 
fiscal year 2011.’’. 
SEC. 154. ACCESS TO RECORDS FOR IG AND GAO AUDITS 
AND EVALUATIONS. 
Section 2108(d) of the Social Security Act (42 U.S.C. 
1397hh(d)) is amended to read as follows: 
‘‘(d) ACCESS TO RECORDS FOR IG AND GAO AUDITS 
AND EVALUATIONS.—For the purpose of evaluating and au-
diting the program established under this title, the Sec-
retary, the Office of Inspector General, and the Comptroller 
General shall have access to any books, accounts, records, 
correspondence, and other documents that are related to the 
expenditure of Federal funds under this title and that are 
in the possession, custody, or control of States receiving 
Federal funds under this title or political subdivisions 
thereof, or any grantee or contractor of such States or polit-
ical subdivisions.’’. 
SEC. 155. REFERENCES TO TITLE XXI. 
Section 704 of the Medicare, Medicaid, and SCHIP 
Balanced Budget Refinement Act of 1999 (Appendix F, 113 
Stat. 1501A–321), as enacted into law by section 
1000(a)(6) of Public Law 106–113) is repealed and the item 
relating to such section in the table of contents of such Act 
is repealed. 
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SEC. 156. RELIANCE ON LAW; EXCEPTION FOR STATE LEGIS-
LATION. 
(a) RELIANCE ON LAW.—With respect to amendments 
made by this title or title VIII that become effective as of 
a date— 
(1) such amendments are effective as of such date 
whether or not regulations implementing such amend-
ments have been issued; and 
(2) Federal financial participation for medical 
assistance or child health assistance furnished under 
title XIX or XXI, respectively, of the Social Security 
Act on or after such date by a State in good faith re-
liance on such amendments before the date of promul-
gation of final regulations, if any, to carry out such 
amendments (or before the date of guidance, if any, 
regarding the implementation of such amendments) 
shall not be denied on the basis of the State’s failure 
to comply with such regulations or guidance. 
(b) EXCEPTION FOR STATE LEGISLATION.—In the case 
of a State plan under title XIX or State child health plan 
under XXI of the Social Security Act, which the Secretary 
of Health and Human Services determines requires State 
legislation in order for respective plan to meet one or more 
additional requirements imposed by amendments made by 
this title or title VIII, the respective State plan shall not 
be regarded as failing to comply with the requirements of 
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such title solely on the basis of its failure to meet such an 
additional requirement before the first day of the first cal-
endar quarter beginning after the close of the first regular 
session of the State legislature that begins after the date of 
enactment of this Act. For purposes of the previous sentence, 
in the case of a State that has a 2-year legislative session, 
each year of the session shall be considered to be a separate 
regular session of the State legislature. 
TITLE II—MEDICARE 
BENEFICIARY IMPROVEMENTS 
Subtitle A—Improvements in 
Benefits 
SEC. 201. COVERAGE AND WAIVER OF COST-SHARING FOR 
PREVENTIVE SERVICES. 
(a) PREVENTIVE SERVICES DEFINED; COVERAGE OF 
ADDITIONAL PREVENTIVE SERVICES.—Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) in subparagraph (Z), by striking ‘‘and’’ 
after the semicolon at the end; 
(B) in subparagraph (AA), by adding 
‘‘and’’ after the semicolon at the end; and 
(C) by adding at the end the following new 
subparagraph: 
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‘‘(BB) additional pre-
ventive services (described in 
subsection 
(ccc)(1)(M));’’; 
and 
(2) by adding at the end the following new sub-
section: 
‘‘Preventive Services 
‘‘(ccc)(1) The term ‘preventive services’ means the fol-
lowing: 
‘‘(A) Prostate cancer screening tests (as defined 
in subsection (oo)). 
‘‘(B) Colorectal cancer screening tests (as defined 
in subsection (pp)). 
‘‘(C) Diabetes outpatient self-management train-
ing services (as defined in subsection (qq)). 
‘‘(D) Screening for glaucoma for certain individ-
uals (as described in subsection (s)(2)(U)). 
‘‘(E) Medical nutrition therapy services for cer-
tain 
individuals 
(as 
described 
in 
subsection 
(s)(2)(V)). 
‘‘(F) An initial preventive physical examination 
(as defined in subsection (ww)). 
‘‘(G) Cardiovascular screening blood tests (as de-
fined in subsection (xx)(1)). 
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‘‘(H) Diabetes screening tests (as defined in sub-
section described in subsection (s)(2)(Y)). 
‘‘(I) Ultrasound screening for abdominal aortic 
aneurysm for certain individuals (as described in de-
scribed in subsection (s)(2)(AA)). 
‘‘(J) Pneumococcal and influenza vaccine and 
their administration (as described in subsection 
(s)(10)(A)). 
‘‘(K) Hepatitis B vaccine and its administration 
for certain individuals (as described in subsection 
(s)(10)(B)). 
‘‘(L) Screening mammography (as defined in 
subsection (jj)). 
‘‘(M) Screening pap smear and screening pelvic 
exam (as described in subsection (s)(14)). 
‘‘(N) Bone mass measurement (as defined in sub-
section (rr)). 
‘‘(O) Additional preventive services (as deter-
mined under paragraph (2)). 
‘‘(2)(A) The term ‘additional preventive services’ 
means items and services, including mental health services, 
not described in subparagraphs (A) through (N) of para-
graph (1) that the Secretary determines to be reasonable 
and necessary for the prevention or early detection of an 
illness or disability. 
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‘‘(B) In making determinations under subparagraph 
(1), the Secretary shall— 
‘‘(i) take into account evidence-based rec-
ommendations by the United States Preventive Serv-
ices Task Force and other appropriate organizations; 
and 
‘‘(ii) use the process for making national cov-
erage 
determinations 
(as 
defined 
in 
section 
1869(f)(1)(B)) under this title.’’. 
(b) PAYMENT AND ELIMINATION OF COST-SHARING.— 
(1) IN GENERAL.— 
(A) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
(i) in clause (T), by striking ‘‘80 per-
cent’’ and inserting ‘‘100 percent’’; 
(ii) by striking ‘‘and’’ before ‘‘(V)’’; 
and 
(iii) by inserting before the semicolon 
at the end the following: ‘‘, and (W) with 
respect to additional preventive services (as 
defined in section 1861(ccc)(2)) and other 
preventive services for which a payment 
rate is not otherwise established under this 
section, the amount paid shall be 100 per-
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100 
cent of the lesser of the actual charge for the 
services or the amount determined under a 
fee schedule established by the Secretary for 
purposes of this clause’’. 
(B) APPLICATION TO SIGMOIDOSCOPIES AND 
COLONOSCOPIES.—Section 1834(d) of such Act 
(42 U.S.C. 1395m(d)) is amended— 
(i) in paragraph (2)(C), by amending 
clause (ii) to read as follows: 
‘‘(ii) NO COINSURANCE.—In the case of 
a beneficiary who receives services described 
in clause (i), there shall be no coinsurance 
applied.’’; and 
(ii) in paragraph (3)(C), by amending 
clause (ii) to read as follows: 
‘‘(ii) NO COINSURANCE.—In the case of 
a beneficiary who receives services described 
in clause (i), there shall be no coinsurance 
applied.’’. 
(2) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.— 
(A) EXCLUSION
FROM
OPD
FEE
SCHED-
ULE.—Section 1833(t)(1)(B)(iv) of the Social 
Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is 
amended by striking ‘‘screening mammography 
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