1441 
(1) IN GENERAL.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) as amended by sec-
tion 7419(a)(3)(A)(ii), is amended— 
(A) in subsection (a)— 
(i) by redesignating paragraph (34) as 
paragraph (35); 
(ii) in paragraph (33), by striking 
‘‘and’’ after the semicolon; and 
(iii) by inserting after paragraph (33) 
the following new paragraph: 
‘‘(34) peripheral artery disease screening tests 
furnished to at-risk beneficiaries (as such terms are 
defined in subsection (ss)); and’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(ss) PERIPHERAL ARTERY DISEASE SCREENING 
TEST; AT-RISK BENEFICIARY.— 
‘‘(1) PERIPHERAL ARTERY DISEASE SCREENING 
TEST.—The term ‘peripheral artery disease screen-
ing test’ means— 
‘‘(A) noninvasive physiologic studies of ex-
tremity arteries (commonly referred to as ankle- 
brachial index testing); 
‘‘(B) arterial duplex scans of lower extrem-
ity arteries vascular; and 
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‘‘(C) such other items and services as the 
Secretary determines, in consultation with rel-
evant stakeholders, to be appropriate for 
screening for peripheral artery disease for at- 
risk beneficiaries. 
‘‘(2) AT-RISK BENEFICIARY.—The term ‘at-risk 
beneficiary’ means an individual enrolled under a 
State plan (or a waiver of such plan)— 
‘‘(A) who is 65 years of age or older; 
‘‘(B) who is at least 50 years of age but 
not older than 64 years of age with risk factors 
for atherosclerosis (such as diabetes mellitus, a 
history of smoking, hyperlipidemia, and hyper-
tension) or a family history of peripheral artery 
disease; 
‘‘(C) who is younger than 50 years of age 
with diabetes mellitus and one additional risk 
factor for atherosclerosis; or 
‘‘(D) with a known atherosclerotic disease 
in another vascular bed such as coronary, ca-
rotid, subclavian, renal, or mesenteric artery 
stenosis, or abdominal aortic aneurysm. 
‘‘(3) FREQUENCY.—The Secretary shall, in con-
sultation with appropriate organizations, establish 
standards regarding the frequency for peripheral ar-
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tery disease screening tests described in subsection 
(a)(34) for purposes of coverage under a State plan 
under this title.’’. 
(2) NO COST SHARING.— 
(A) IN GENERAL.—Subsections (a)(2) and 
(b)(2) of section 1916 of the Social Security 
Act (42 U.S.C. 1396o), as amended by section 
7305(b)(1), are each amended— 
(i) in subparagraph (J), by striking 
‘‘or’’ after the comma at the end; 
(ii) in subparagraph (K), by striking 
‘‘; and’’ and inserting ‘‘, or’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(L) peripheral artery disease 
screening tests furnished to at-risk 
beneficiaries (as such terms are de-
fined in section 1905(hh)); and’’. 
(B) APPLICATION TO ALTERNATIVE COST 
SHARING.—Section 1916A(b)(3)(B) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1396o– 
1(b)(3)(B)), as amended by section 7305(b)(2), 
is amended by adding at the end the following 
new clause: 
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‘‘(xv) Peripheral artery disease screen-
ing tests furnished to at-risk beneficiaries 
(as such terms are defined in section 
1905(qq)).’’. 
(3) 
MANDATORY
COVERAGE.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)), as amended by section 
2007(d)(2), is amended by striking ‘‘and (32)’’ and 
inserting ‘‘(32), and (34)’’. 
(d) REQUIREMENT FOR GROUP HEALTH PLANS AND 
HEALTH INSURANCE ISSUERS OFFERING GROUP OR IN-
DIVIDUAL HEALTH INSURANCE COVERAGE TO PROVIDE 
COVERAGE FOR PERIPHERAL ARTERY DISEASE SCREEN-
ING TESTS FURNISHED TO AT-RISK ENROLLEES WITH-
OUT IMPOSITION OF COST SHARING REQUIREMENTS.— 
(1) IN GENERAL.—Section 2713 of the Public 
Health Service Act (42 U.S.C. 300gg–13) is amend-
ed— 
(A) by amending subsection (a), as amend-
ed by section 7419(a)(1)(A), to read as follows: 
‘‘(a) COVERAGE
OF PREVENTIVE HEALTH SERV-
ICES.— 
‘‘(1) IN GENERAL.—A group health plan and a 
health insurance issuer offering group or individual 
health insurance coverage shall, at a minimum, pro-
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vide coverage for and shall not impose any cost shar-
ing requirements for— 
‘‘(A) evidence-based items or services that 
have in effect a rating of ‘A’ or ‘B’ in the cur-
rent recommendations of the United States Pre-
ventive Services Task Force; 
‘‘(B) immunizations that have in effect a 
recommendation from the Advisory Committee 
on Immunization Practices of the Centers for 
Disease Control and Prevention with respect to 
the individual involved; 
‘‘(C) with respect to infants, children, and 
adolescents, evidence-informed preventive care 
and screenings provided for in the comprehen-
sive guidelines supported by the Health Re-
sources and Services Administration; 
‘‘(D) with respect to women, such addi-
tional preventive care and screenings not de-
scribed in subparagraph (A) as provided for in 
comprehensive guidelines supported by the 
Health Resources and Services Administration 
for purposes of this subparagraph; 
‘‘(E) any prescription drug approved by 
the Food and Drug Administration for the pre-
vention of HIV (other than a drug subject to 
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preauthorization requirements consistent with 
section 2729A), administrative fees for such 
drugs, laboratory and other diagnostic proce-
dures associated with the use of such drugs, 
and clinical follow-up and monitoring, including 
any related services recommended in current 
United States Public Health Service clinical 
practice guidelines, without limitation; and 
‘‘(F) with respect to at-risk enrollees, pe-
ripheral artery disease screening tests. 
‘‘(2) FREQUENCY.—The Secretary, in consulta-
tion with appropriate organizations, shall establish 
standards regarding the frequency for peripheral ar-
tery disease screening tests for purposes of coverage 
under this section. 
‘‘(3) CLARIFICATION REGARDING BREAST CAN-
CER SCREENING, MAMMOGRAPHY, AND PREVENTION 
RECOMMENDATIONS.—For the purposes of this Act, 
and for the purposes of any other provision of law, 
the current recommendations of the United States 
Preventive Services Task Force regarding breast 
cancer screening, mammography, and prevention 
shall be considered the most current other than 
those issued in or around November 2009. 
‘‘(4) DEFINITIONS.—In this subsection: 
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‘‘(A) AT-RISK ENROLLEE.—The term ‘at- 
risk enrollee’ means an individual enrolled in a 
group health plan or group or individual health 
insurance coverage— 
‘‘(i) who is 65 years of age or older; 
‘‘(ii) who is at least 50 years of age 
but not older than 64 years of age with 
risk factors for atherosclerosis (such as di-
abetes mellitus, a history of smoking, 
hyperlipidemia, and hypertension) or a 
family history of peripheral artery disease; 
‘‘(iii) who is younger than 50 years of 
age with diabetes mellitus and one addi-
tional risk factor for atherosclerosis; or 
‘‘(iv) with a known atherosclerotic dis-
ease in another vascular bed such as coro-
nary, carotid, subclavian, renal, or mesen-
teric artery stenosis, or abdominal aortic 
aneurysm. 
‘‘(B) 
PERIPHERAL
ARTERY
DISEASE 
SCREENING TEST.—The term ‘peripheral artery 
disease screening test’ means— 
‘‘(i) noninvasive physiologic studies of 
extremity arteries (commonly referred to 
as ankle-brachial index testing); 
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‘‘(ii) arterial duplex scans of lower ex-
tremity arteries vascular; and 
‘‘(iii) such other items and services as 
the Secretary determines, in consultation 
with relevant stakeholders, to be appro-
priate for screening for peripheral artery 
disease for at-risk enrollees. 
‘‘(5) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed to prohibit a plan 
or issuer from providing coverage for services in ad-
dition to those recommended by the United States 
Preventive Services Task Force or to deny coverage 
for services that are not recommended by such Task 
Force.’’; and 
(B) in subsection (b)(1)— 
(i) by striking ‘‘subsection (a)(1) or 
(a)(2) or a guideline under subsection 
(a)(3)’’ and inserting ‘‘subparagraph (A) 
or (B) of subsection (a)(1) or a guideline 
under subparagraph (C) of such sub-
section’’; and 
(ii) by striking ‘‘described in sub-
section (a)’’ and inserting ‘‘described in 
subsection (a)(1)’’. 
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(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply with respect to plan 
years beginning on or after January 1, 2025. 
(e) DISALLOWANCE
OF PAYMENT
FOR NONTRAU-
MATIC AMPUTATION SERVICES FURNISHED WITHOUT 
ANATOMICAL TESTING SERVICES.—Section 1834 of the 
Social Security Act (42 U.S.C. 1395m), as amended by 
section 4221(b)(2), is amended by adding at the end the 
following new subsection: 
‘‘(bb) DISALLOWANCE OF PAYMENT FOR NONTRAU-
MATIC AMPUTATION SERVICES FURNISHED WITHOUT 
ANATOMICAL TESTING SERVICES.— 
‘‘(1) IN
GENERAL.—In the case of nontrau-
matic amputation services furnished by a supplier on 
or after January 1, 2025, to an individual entitled 
to, or enrolled for, benefits under part A and en-
rolled for benefits under this part, for which pay-
ment is made under this part, payment may only be 
made under this part if— 
‘‘(A) such supplier furnishes anatomical 
testing services to such individual during the 3- 
month period preceding the date on which such 
nontraumatic amputation services is furnished; 
or 
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‘‘(B) such individual has a pre-existing 
dysfunctional or unsalvageable limb, life-threat-
ening sepsis, intractable infection, extensive 
gangrene or necrotic tissue loss beyond salvage, 
a poor functional status, severe dementia, or a 
short life expectancy after shared decision mak-
ing with a health care team and patient, family, 
or caregiver. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) ANATOMICAL
TESTING
SERVICES.— 
The term ‘anatomical testing services’ means 
arterial duplex scanning, computed tomography 
angiography, 
and 
magnetic 
resonance 
angiography. 
‘‘(B) NONTRAUMATIC AMPUTATION SERV-
ICES.—The term ‘nontraumatic amputation 
services’ means amputations as a result of ath-
erosclerotic vascular disease or a related comor-
bidity of such disease (including diabetes).’’. 
(f) DEVELOPMENT AND IMPLEMENTATION OF QUAL-
ITY MEASURES.— 
(1) DEVELOPMENT.—The Secretary of Health 
and Human Services (referred to in this subsection 
as the ‘‘Secretary’’) shall, in consultation with rel-
evant stakeholders, develop quality measures for 
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nontraumatic, lower-limb, major amputation that 
utilize appropriate diagnostic screening (including 
peripheral artery disease screening) in order to en-
courage 
alternative 
treatments 
(including 
revascularization) in lieu of such an amputation. 
(2) IMPLEMENTATION.—After appropriate test-
ing and validation of the measures developed under 
paragraph (1), the Secretary shall incorporate such 
measures in quality reporting programs for appro-
priate providers of services and suppliers under the 
Medicare program under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.), including for 
purposes of— 
(A) the merit-based incentive payment sys-
tem under section 1848(q) of such Act (42 
U.S.C. 1395w–4(q)); 
(B) incentive payments for participation in 
eligible alternative payment models under sec-
tion 1833(z) of such Act (42 U.S.C. 1395l(z)); 
(C) the shared savings program under sec-
tion 1899 of such Act (42 U.S.C. 1395jjj); 
(D) models under section 1115A of such 
Act (42 U.S.C. 1315a); and 
(E) such other payment systems or models 
as the Secretary may specify. 
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SEC. 7901C–2. ELIMINATING THE COINSURANCE REQUIRE-
MENT FOR CERTAIN COLORECTAL CANCER 
SCREENING TESTS FURNISHED UNDER THE 
MEDICARE PROGRAM. 
Section 1833(dd) of the Social Security Act (42 
U.S.C. 1395l(dd)) is amended— 
(1) in paragraph (1), by striking ‘‘and before 
January 1, 2030,’’; and 
(2) in paragraph (2)— 
(A) in subparagraph (A), by adding ‘‘and’’ 
at the end; 
(B) in subparagraph (B), by striking 
‘‘through 2026’’ and inserting ‘‘through 2024’’; 
and 
(C) by striking subparagraph (C) and in-
serting the following: 
‘‘(C) for 2025 and each subsequent year, 
100 percent.’’. 
SEC. 7901C–3. EXPANDING THE AVAILABILITY OF MEDICAL 
NUTRITION THERAPY SERVICES UNDER THE 
MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)(V), by striking ‘‘in the 
case of’’ and all that follows through ‘‘organiza-
tions’’; and 
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(2) in subsection (vv)— 
(A) in paragraph (1)— 
(i) by striking ‘‘disease management’’ 
and inserting ‘‘the prevention, manage-
ment, or treatment of a disease or condi-
tion specified in paragraph (4)’’; and 
(ii) by striking ‘‘by a physician’’ and 
all that follows through the period at the 
end and inserting the following: ‘‘by a— 
‘‘(A) physician (as defined in subsection 
(r)(1)); 
‘‘(B) physician assistant; 
‘‘(C) nurse practitioner; 
‘‘(D) clinical nurse specialist (as defined in 
subsection (aa)(5)(B)); or 
‘‘(E) in the case of such services furnished 
to manage such a disease or condition that is 
an eating disorder, a clinical psychologist (as 
defined by the Secretary). 
Such term shall not include any services furnished 
to an individual for the prevention, management, or 
treatment of a renal disease if such individual is re-
ceiving maintenance dialysis for which payment is 
made under section 1881.’’; and 
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(B) by adding at the end the following new 
paragraph: 
‘‘(4) For purposes of paragraph (1), the diseases and 
conditions specified in this paragraph are the following: 
‘‘(A) Diabetes and prediabetes. 
‘‘(B) A renal disease. 
‘‘(C) Obesity (as defined for purposes of sub-
section (yy)(2)(C) or as otherwise defined by the 
Secretary). 
‘‘(D) Hypertension. 
‘‘(E) Dyslipidemia. 
‘‘(F) Malnutrition. 
‘‘(G) Eating disorders. 
‘‘(H) Cancer. 
‘‘(I) Gastrointestinal diseases, including celiac 
disease. 
‘‘(J) HIV. 
‘‘(K) AIDS. 
‘‘(L) Cardiovascular disease. 
‘‘(M) Any other disease or condition— 
‘‘(i) specified by the Secretary relating to 
unintentional weight loss; 
‘‘(ii) for which the Secretary determines 
the services described in paragraph (1) to be 
medically necessary and appropriate for the 
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prevention, management, or treatment of such 
disease or condition, consistent with any appli-
cable recommendations of the United States 
Preventive Services Task Force; or 
‘‘(iii) for which the Secretary determines 
the services described in paragraph (1) are 
medically necessary, consistent with either pro-
tocols established by registered dietitians or nu-
trition professional organizations or with ac-
cepted clinical guidelines identified by the Sec-
retary.’’. 
(b) EXCLUSION MODIFICATION.—Section 1862(a)(1) 
of the Social Security Act (42 U.S.C. 1395y(a)(1)), as 
amended by sections 7901C(b)(2) and 7901C–1(b)(4), is 
amended— 
(1) in subparagraph (Q), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (R), by striking the semi-
colon at the end and inserting ‘‘, and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(S) in the case of medical nutrition therapy 
services (as defined in section 1861(vv)), which are 
not furnished for the prevention, management, or 
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treatment of a disease or condition specified in para-
graph (4) of such section;’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to items and services 
furnished on or after January 1, 2024. 
SEC. 7901C–4. ENCOURAGING THE DEVELOPMENT AND USE 
OF DISARM ANTIMICROBIAL DRUGS. 
(a) ADDITIONAL PAYMENT
FOR DISARM ANTI-
MICROBIAL DRUGS UNDER MEDICARE.— 
(1) IN GENERAL.—Section 1886(d)(5) of the 
Social Security Act (42 U.S.C. 1395ww(d)(5)) is 
amended by adding at the end the following new 
subparagraph: 
‘‘(N)(i)(I) Effective for discharges beginning on or 
after October 1, 2025, or such sooner date as specified 
by the Secretary, subject to subclause (II), the Secretary 
shall, after notice and opportunity for public comment (in 
the publications required by subsection (e)(5) for a fiscal 
year or otherwise), provide for an additional payment 
under a mechanism (separate from the mechanism estab-
lished under subparagraph (K)), with respect to such dis-
charges involving any DISARM antimicrobial drug, in an 
amount equal to— 
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‘‘(aa) the amount payable under section 1847A 
for such drug during the calendar quarter in which 
the discharge occurred; or 
‘‘(bb) if no amount for such drug is determined 
under section 1847A, an amount to be determined 
by the Secretary in a manner similar to the manner 
in which payment amounts are determined under 
section 1847A based on information submitted by 
the manufacturer or sponsor of such drug (as re-
quired under clause (v)). 
‘‘(II) In determining the amount payable under sec-
tion 1847A for purposes of items (aa) and (bb) of sub-
clause (I), subparagraphs (A) and (B) of subsection (b)(1) 
of such section shall be applied by substituting ‘102 per-
cent’ for ‘106 percent’ each place it appears and para-
graph (8)(B) of such section shall be applied by sub-
stituting ‘2 percent’ for ‘6 percent’. 
‘‘(ii) For purposes of this subparagraph, a DISARM 
antimicrobial drug is— 
‘‘(I) a drug— 
‘‘(aa) that— 
‘‘(AA) is approved by the Food and 
Drug Administration; 
‘‘(BB) is designated by the Food and 
Drug Administration as a qualified infec-
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‘‘(v) 
REQUIREMENTS
FOR
NEW 
SITES.— 
‘‘(I) IN
GENERAL.—The Sec-
retary may establish requirements for 
the furnishing of telehealth services at 
sites described in clause (ii)(XII) to 
provide for beneficiary and program 
integrity protections. 
‘‘(II) CLARIFICATION.—Nothing 
in this clause shall be construed to 
preclude the Secretary from estab-
lishing requirements for other origi-
nating sites described in clause (ii).’’. 
(d) NO ORIGINATING SITE FACILITY FEE FOR NEW 
SITES.—Section 1834(m)(2)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended— 
(1) in the heading, by striking ‘‘IF ORIGINATING 
SITE IS THE HOME’’ and inserting ‘‘FOR CERTAIN 
SITES’’; and 
(2) by striking ‘‘paragraph (4)(C)(ii)(X)’’ and 
inserting ‘‘subclause (X) or (XII) of paragraph 
(4)(C)’’. 
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