I 
109TH CONGRESS 
1ST SESSION 
H. R. 801
To amend titles XVIII and XIX of the Social Security Act to provide for 
coverage under the Medicare and Medicaid Programs of certain screening 
procedures for diabetic retinopathy, and to amend the Public Health 
Service Act to establish pilot programs to foster such screening, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 15, 2005
Mr. COOPER (for himself, Mr. HALL, Mrs. MCCARTHY, Mr. MCDERMOTT, Mr. 
MCNULTY, Ms. MILLENDER-MCDONALD, Mr. PAYNE, Mr. RANGEL, Mr. 
SPRATT, Mr. FORD, Mr. TANNER, Mr. TOWNS, Mr. WILSON of South 
Carolina, Mr. OWENS, Mr. DAVIS of Tennessee, and Mr. STARK) intro-
duced 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 titles XVIII and XIX of the Social Security Act 
to provide for coverage under the Medicare and Medicaid 
Programs of certain screening procedures for diabetic 
retinopathy, and to amend the Public Health Service 
Act to establish pilot programs to foster such screening, 
and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Diabetic Retinopathy 
Prevention Act of 2005’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows: 
(1) Type 2 Diabetes affects 17,000,000 Ameri-
cans, with over 1,000,000 new cases diagnosed each 
year. Type 1 Diabetes affects over 1,000,000 Ameri-
cans, with over 13,000 new cases diagnosed each 
year. Diabetes costs the nation an estimated 
$138,000,000,000 per year. 
(2) Diabetic retinopathy is the most common 
complication resulting from diabetes, and causes 
degradation in visual acuity and eventual blindness. 
Diabetic retinopathy is the leading cause of blind-
ness in people aged 20 to 74, and up to 24,000 dia-
betics become legally blind each year. 
(3) During the first two decades of disease, 
nearly all patients with Type 1 and over 60 percent 
of patients with Type 2 Diabetes develop diabetic 
retinopathy, and the risk of diabetic retinopathy in-
creases with the duration of diabetes. Onset of Type 
2 diabetes is today occurring at younger ages, which 
will increase the prevalence of diabetic retinopathy 
in the future.
(4) Clinical trials have demonstrated that early 
detection and treatment of diabetic retinopathy can 
reduce vision loss by 90 percent, and remote assess-
ment of diabetic retinopathy has the potential to 
reach large numbers of diabetic patients who live in 
rural, remote or underserved areas and who lack 
geographical or financial access to regular, in-office 
eye examinations by eye specialists. 
SEC. 3. MEDICARE COVERAGE OF REMOTE ASSESSMENT OF 
DIABETIC RETINOPATHY. 
(a) COVERAGE.—Section 1861 of the Social Security 
Act (42 U.S.C. 1395x) is amended: 
(1) in subsection (s)(2)—
(A) in subparagraph (Y), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (Z), by adding ‘‘and’’ 
at the end; and 
(C) by inserting after subparagraph (Z) 
the following new subparagraph: 
‘‘(AA) remote assessment of diabetic retinop-
athy (as defined in subsection (bbb));’’; and 
(2) by adding at the end the following new sub-
section:
‘‘Remote Assessment of Diabetic Retinopathy 
‘‘(bbb) The term ‘remote assessment of diabetic ret-
inopathy’ means a diagnostic examination of the retina for 
the purpose of early detection of diabetic retinopathy 
that—
‘‘(1) is provided not more frequently than on an 
annual basis to an individual who has been diag-
nosed with diabetes; 
‘‘(2) meets technical standards set forth by the 
Secretary (which shall be determined in consultation 
with industry and practitioner groups with expertise 
in ophthalmology, ophthalmic imaging, telemedicine, 
or related fields); 
‘‘(3) is furnished via a telecommunications sys-
tem by a physician (as defined in subsection (r)), a 
practitioner (described in section 1842(b)(18)(C) of 
this title), or a non-physician technician deemed to 
be qualified by the Secretary under the regulations 
promulgated pursuant to this Act, to an eligible pa-
tient enrolled under this part, notwithstanding that 
the individual physician or practitioner providing the 
service is not at the same location as the beneficiary; 
and
‘‘(4) is conducted under the supervision of a 
board-certified ophthalmologist with retinal fellow-
ship training.’’. 
(b) PAYMENT NOTWITHSTANDING LIMITATION ON 
STORE AND FORWARD TECHNOLOGY.—Notwithstanding 
any limitations to the contrary that are set forth in section 
1834(m)(1) of the Social Security Act (42 U.S.C. 
1395m(m)(1)), the amendments made by subsection (a) 
shall be applicable to remote assessments of diabetic ret-
inopathy that are furnished through the use of store-and-
forward technologies that provide for the asynchronous 
transmission of health care information in single or multi-
media formats. 
(c) INTERIM PAYMENT PENDING PUBLICATION OF 
FINAL RULE.—For the period beginning 30 days after the 
date of the enactment of this Act and ending on the date 
the Secretary of Health and Human Services publishes a 
final regulation to carry out section 1861(s)(2)(AA) of the 
Social Security Act, as added by subsection (a), the Sec-
retary shall provide for payment of retinopathy assess-
ments furnished under such section during such period, 
and assign such temporary HCPCS code as is necessary 
to provide for such payment. 
(d) STUDY ON REIMBURSEMENT FOR REMOTE AS-
SESSMENTS OF DIABETIC RETINOPATHY.—(1) Not later
than 1 year after the date of the enactment of this Act, 
the Secretary of Health and Human Services shall conduct 
a study on the costs incurred by health care providers to 
provide remote assessment of diabetic retinopathy serv-
ices, including an analysis of—
(A) per-patient cost, and 
(B) start-up and administrative costs. 
(2) Not later than 2 years after the date of the enact-
ment of this Act, the Secretary shall submit a report to 
Congress on the study conducted under paragraph (1) and 
shall include recommendations with respect to—
(A) the adequacy of reimbursements for remote 
assessment of diabetic retinopathy under the medi-
care program; and 
(B) whether the study under paragraph (1) 
should be repeated, and if so, how frequently. 
(e) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to assessments performed on or 
after the date that is 30 days after the date of the enact-
ment of this Act. 
SEC. 4 MEDICAID COVERAGE OF REMOTE ASSESSMENT OF 
DIABETIC RETINOPATHY. 
(a) REQUIREMENT.—Section 1905(a)(13) of the So-
cial Security Act (42 U.S.C. 1396d(a)(13)) is amended by