SEC. 203. SCREENING FOR DIMINISHED VISUAL ACUITY. 
Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 202(a), is 
amended by adding at the end the following new para-
graph: 
‘‘(3)(A) Screening for diminished visual acuity. 
‘‘(B) For purposes of subparagraph (A), the 
term ‘screening for diminished visual acuity’ means 
a screening for diminished visual acuity that is fur-
nished by or under the supervision of an optometrist 
or ophthalmologist who is legally authorized to fur-
nish such services under State law (or the State reg-
ulatory mechanism provided by State law) of the 
State in which the services are furnished.’’. 
SEC. 204. SCREENING FOR TYPE II DIABETES MELLITUS 
FOR CERTAIN AT-RISK INDIVIDUALS. 
Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 203(a), is 
amended by adding at the end the following new para-
graph: 
‘‘(4) Screening for diabetes II mellitus for indi-
viduals with hypertension or hyperlipidenia if the in-
dividual involved has not had such a screening dur-
ing the preceding 3 years.’’.
SEC. 205. SCREENING FOR CHOLESTEROL. 
(a) IN GENERAL.—Section 1861(ww) of the Social 
Security Act (42 U.S.C. 1395x(s)(2)), as amended by sec-
tion 204(a), is amended by adding at the end the following 
new paragraph: 
‘‘(5)(A) Screening for cholesterol if the indi-
vidual involved has not had such a screening during 
the preceding 5 years. 
‘‘(B) Notwithstanding subparagraph (A), pay-
ment may be made under this part for a screening 
for cholesterol with respect to an individual even if 
the individual has had such a screening during the 
preceding 5 years if the individual exhibits major 
risk factors for coronary heart disease or a stroke, 
including, but not limited to, smoking, hypertension, 
and diabetes.’’. 
(b) CONFORMING
AMENDMENT
APPLYING
FRE-
QUENCY LIMITATIONS.—Section 1862(a)(1) of the Social 
Security Act (42 U.S.C. 1395y(a)(1)) is amended—
(1) in subparagraph (H), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (I), by striking the semi-
colon at the end and inserting ‘‘, and’’; and 
(3) by adding at the end the following new sub-
paragraph:
‘‘(J) in the case of supplemental preventive 
health services, which is performed more fre-
quently 
than 
is 
covered 
under 
section 
1861(ww);’’. 
SEC. 206. SCREENING FOR DEPRESSION. 
Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 205(a), is 
amended by adding at the end the following new para-
graph: 
‘‘(6)(A) Screenings for clinical depression to an 
individual through qualified health professionals in 
accordance with the requirements of this paragraph, 
if the individual has not had such a screening per-
formed during the preceding 12 months. 
‘‘(B) In this paragraph, the term ‘qualified 
health professional’ means an individual that—
‘‘(i) is—
‘‘(I) a physician (as defined in sub-
section (r)(1)); 
‘‘(II) a nurse practitioner (as defined 
in subsection (aa)(5)); or 
‘‘(III) a mental health care profes-
sional (including a clinical social worker, as 
defined in subsection 1861(hh)) that is li-
censed to perform mental health services
by the State in which a screening for clin-
ical depression is furnished; and 
‘‘(ii) is a participating physician or sup-
plier and has an agreement in effect with the 
Secretary under which the individual agrees to 
accept the amount determined under part B as 
full payment for such screening and to accept 
an 
assignment 
described 
in 
section 
1842(b)(3)(B)(ii) of the Social Security Act (42 
U.S.C. 1395u(b)(3)(B)(ii)) with respect to pay-
ment for each screening furnished by the pro-
fessional to an eligible beneficiary. 
‘‘(C)(i) The term ‘screening for clinical depres-
sion’ means a consultation during which a self-ad-
ministered written screening test (or an alternative 
format for such test pursuant to subparagraph (D)) 
is made available to an individual and a qualified 
health professional—
‘‘(I) interprets the results of such test; 
‘‘(II) discusses the beneficiary’s responses 
to the questions on the test with the bene-
ficiary; 
‘‘(III) assesses the beneficiary’s risk of 
clinical depression; and
‘‘(IV) if the qualified health professional 
determines that the beneficiary is at high risk 
for clinical depression, refers the eligible bene-
ficiary for a full diagnostic evaluation and such 
additional treatment as may be required. 
‘‘(ii) Nothing in clause (i)(IV) shall be con-
strued as prohibiting a qualified health professional 
performing the screening for clinical depression with 
respect to an individual from directly providing the 
diagnostic evaluation and additional treatment de-
scribed in such clause to such individual if legally 
authorized under State law to do so. 
‘‘(D) For purposes of this paragraph, the term 
‘self-administered written screening test’ means an 
instrument on which an individual writes answers to 
questions designed to enable a qualified health pro-
fessional to establish the level of risk of such eligible 
beneficiary for clinical depression. 
‘‘(E)(i) The Secretary, in consultation with pro-
fessionals experienced in conducting large-scale de-
pression screening projects, shall—
‘‘(I) establish or identify a self-adminis-
tered written screening test to be used under 
this paragraph; and
‘‘(II) not later than the date that is 3 
months before the date on which this paragraph 
is implemented, distribute such test to qualified 
health professionals that provide services, to-
gether with guidelines for making the test avail-
able to individuals. 
‘‘(ii) The Secretary shall also establish and 
distribute alternative formats for the self-ad-
ministered written screening test under clause 
(i) which shall be available for use when cir-
cumstances do not permit an individual to com-
plete the self-administered written screening 
test.’’. 
SEC. 207. EXPANSION OF ELIGIBILITY FOR BONE MASS 
MEASUREMENT. 
(a) EXPANSION.—Section 1861(rr)(2) of the Social 
Security Act (42 U.S.C. 1395x(rr)(2)) is amended to read 
as follows: 
‘‘(2) For purposes of this subsection, the term ‘quali-
fied individual’ means an individual who is (in accordance 
with regulations prescribed by the Secretary)—
‘‘(A) an estrogen-deficient woman (including 
those receiving hormone replacement therapy);
‘‘(B) an individual with low trauma or fragility 
fractures (including vertebral abnormalities and hip, 
rib, wrist, pelvic, or proximal humeral fractures); 
‘‘(C) an individual receiving long-term medica-
tions that have associations to bone loss or 
osteoporosis (including glucocorticoid therapy and 
androgen deprivation therapy); 
‘‘(D) an individual with a long-term medical 
condition that has association to osteoporosis (in-
cluding primary hyperparathyroidism); 
‘‘(E) a man with risk factors for osteoporosis 
such as hypogonadism; and 
‘‘(F) an individual being monitored to assess 
the response to, or efficacy of, an approved 
osteoporosis therapy.’’. 
(b) REFERENCE TO ELIMINATION OF COINSURANCE 
AND WAIVER OF APPLICATION OF DEDUCTIBLE.—For 
the elimination of the coinsurance for bone mass measure-
ment and for the waiver of the application of the part B 
deductible for such measurement, see section 301.
SEC. 208. COVERAGE OF MEDICAL NUTRITION THERAPY 
SERVICES FOR BENEFICIARIES WITH CAR-
DIOVASCULAR DISEASES. 
(a) IN GENERAL.—Section 1861(s)(2)(V) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)(V)) is amended 
to read as follows: 
‘‘(V) medical nutrition therapy services (as de-
fined in subsection (vv)(1)) in the case of a bene-
ficiary—
‘‘(i) with a cardiovascular disease (includ-
ing congestive heart failure, arteriosclerosis, 
hyperlipidemia, 
hypertension, 
and 
hypercholesterolemia), diabetes, or a renal dis-
ease (or a combination of such conditions) 
who—
‘‘(I) has not received diabetes out-
patient self-management training services 
within a time period determined by the 
Secretary; 
‘‘(II) is not receiving maintenance di-
alysis for which payment is made under 
section 1881; and 
‘‘(III) meets such other criteria deter-
mined by the Secretary after consideration 
of protocols established by dietitian or nu-
trition professional organizations; or
‘‘(ii) with a combination of such conditions 
who—
‘‘(I) is not described in clause (i) be-
cause of the application of subclause (I) or 
(II) of such clause; 
‘‘(II) receives such medical nutrition 
therapy services in a coordinated manner 
(as determined appropriate by the Sec-
retary) with any services described in such 
subclauses that the beneficiary is receiving; 
and 
‘‘(III) meets such other criteria deter-
mined by the Secretary after consideration 
of protocols established by dietitian or nu-
trition professional organizations;’’. 
(b) 
ELIMINATION
OF
COINSURANCE.—Section 
1833(a)(1)(T) of the Social Security Act (42 U.S.C. 
1395l(a)(1)(T)) is amended by striking ‘‘80 percent’’ and 
inserting ‘‘100 percent’’. 
(c) REFERENCE TO WAIVER OF APPLICATION OF DE-
DUCTIBLE.—For the waiver of the application of the part 
B deductible for medical nutrition therapy services, see 
section 301.
SEC. 209. PAYMENT FOR OFFICE VISIT IN CONNECTION 
WITH SCREENING COLONOSCOPY. 
(a) INCLUSION OF OFFICE VISIT IN BENEFIT.—Sec-
tion 1861(pp)(1) of the Social Security Act (42 U.S.C. 
1395x(pp)(1)) is amended by inserting ‘‘(and includes, in 
the case of screening colonoscopy, the office visit associ-
ated with the colonoscopy)’’ after ‘‘for the purpose of early 
detection of colorectal cancer’’. 
(b) CONFORMING PAYMENT.—Section 1834(d)(3)(B) 
of such Act (42 U.S.C. 1395m(d)(3)(B)) is amended by 
adding at the end the following: ‘‘Such payment shall take 
into account payment for the office visit associated with 
the colonoscopy.’’. 
SEC. 210. PROGRAM INTEGRITY. 
The Secretary, in consultation with the Inspector 
General of the Department of Health and Human Serv-
ices, shall integrate supplemental preventive health serv-
ices (as defined in section 1861(ww) of the Social Security 
Act (as added by the preceding provisions of this title)) 
with existing program integrity measures. 
SEC. 211. EFFECTIVE DATE. 
Except as otherwise provided in this title, the amend-
ments made by this title shall apply to services furnished 
on or after January 1, 2004.
TITLE III—INCREASING UTILIZA-
TION OF MEDICARE PREVEN-
TIVE SERVICES 
SEC. 301. ELIMINATION OF DEDUCTIBLES AND COINSUR-
ANCE FOR EXISTING PREVENTIVE HEALTH 
BENEFITS. 
(a) IN GENERAL.—Section 1833 of the Social Secu-
rity Act (42 U.S.C. 1395l) is amended by inserting after 
subsection (o) the following new subsection: 
‘‘(p) DEDUCTIBLES AND COINSURANCE WAIVED FOR 
PREVENTIVE HEALTH ITEMS AND SERVICES.—The Sec-
retary may not require the payment of any deductible or 
coinsurance under subsection (a) or (b), respectively, of 
any individual enrolled for coverage under this part for 
any of the following preventive health items and services: 
‘‘(1) Blood-testing strips, lancets, and blood 
glucose monitors for individuals with diabetes de-
scribed in section 1861(n). 
‘‘(2) 
Diabetes 
outpatient 
self-management 
training services (as defined in section 1861(qq)(1)). 
‘‘(3) Pneumococcal, influenza, and hepatitis B 
vaccines and administration described in section 
1861(s)(10). 
‘‘(4) Screening mammography (as defined in 
section 1861(jj)).
‘‘(5) Screening pap smear and screening pelvic 
exam (as defined in paragraphs (1) and (2) of sec-
tion 1861(nn), respectively). 
‘‘(6) Bone mass measurement (as defined in 
section 1861(rr)(1)). 
‘‘(7) Prostate cancer screening test (as defined 
in section 1861(oo)(1)). 
‘‘(8) Colorectal cancer screening test (as de-
fined in section 1861(pp)(1)). 
‘‘(9) Screening for glaucoma (as defined in sec-
tion 1861(uu)). 
‘‘(10) Medical nutrition therapy services (as de-
fined in section 1861(vv)(1)).’’. 
(b) WAIVER OF COINSURANCE.—
(1) IN GENERAL.—Section 1833(a)(1)(B) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)(B)) is 
amended to read as follows: ‘‘(B) with respect to 
preventive health items and services described in 
subsection (p), the amounts paid shall be 100 per-
cent of the fee schedule or other basis of payment 
under this title for the particular item or service,’’. 
(2) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.—The third sentence 
of section 1866(a)(2)(A) of the Social Security Act 
(42 U.S.C. 1395cc(a)(2)(A)), as amended by section
201(c)(3), is amended by inserting after ‘‘section 
1861(ww)’’ the following: ‘‘and preventive health 
items and services described in section 1833(p)’’. 
(c) WAIVER OF APPLICATION OF DEDUCTIBLE.—
Section 1833(b)(1) of the Social Security Act (42 U.S.C. 
1395l(b)(1)) is amended to read as follows: ‘‘(1) such de-
ductible shall not apply with respect to preventive health 
items and services described in subsection (p),’’. 
(d) ADDING ‘‘LANCET’’ TO DEFINITION OF DME.—
Section 1861(n) of the Social Security Act (42 U.S.C. 
1395x(n)) is amended by striking ‘‘blood-testing strips
and blood glucose monitors’’ and inserting ‘‘blood-testing 
strips, lancets, and blood glucose monitors’’. 
(e) CONFORMING AMENDMENTS.—
(1) ELIMINATION OF COINSURANCE FOR CLIN-
ICAL DIAGNOSTIC LABORATORY TESTS.—Paragraphs 
(1)(D)(i) and (2)(D)(i) of section 1833(a) of the So-
cial Security Act (42 U.S.C. 1395l(a)) are each 
amended by inserting ‘‘or which are described in 
subsection (p)’’ after ‘‘assignment-related basis’’. 
(2) ELIMINATION OF COINSURANCE FOR CER-
TAIN DME.—Section 1834(a)(1)(A) of the Social Se-
curity Act (42 U.S.C. 1395m(a)(1)(A)) is amended 
by inserting ‘‘(or 100 percent, in the case of such an