‘‘(III) A vision rehabilitation professional 
(as defined in paragraph (2)) while under the 
general supervision (as defined in subparagraph 
(D)) of a qualified physician. 
‘‘(B) In the case of vision rehabilitation services fur-
nished by a vision rehabilitation professional, the plan of 
care may only be established and reviewed by a qualified 
physician. 
‘‘(C) The term ‘qualified physician’ means—
‘‘(i) a physician (as defined in subsection 
(r)(1)) who is an ophthalmologist; or 
‘‘(ii) a physician (as defined in subsection (r)(4) 
(relating to a doctor of optometry)). 
‘‘(D) The term ‘general supervision’ means, with re-
spect to a vision rehabilitation professional, overall direc-
tion and control of that professional by the qualified physi-
cian who established the plan of care for the individual, 
but the presence of the qualified physician is not required 
during the furnishing of vision rehabilitation services by 
that professional to the individual. 
‘‘(2) The term ‘vision rehabilitation professional’ 
means any of the following individuals: 
‘‘(A) An orientation and mobility specialist (as 
defined in paragraph (3)).
‘‘(B) A rehabilitation teacher (as defined in 
paragraph (4)). 
‘‘(C) A low vision therapist (as defined in para-
graph (5)). 
‘‘(3) The term ‘orientation and mobility specialist’ 
means an individual who—
‘‘(A) if a State requires licensure or certifi-
cation of orientation and mobility specialists, is li-
censed or certified by that State as an orientation 
and mobility specialist; 
‘‘(B)(i) holds a baccalaureate or higher degree 
from an accredited college or university in the 
United States (or an equivalent foreign degree) with 
a concentration in orientation and mobility; and 
‘‘(ii) has successfully completed 350 hours of 
clinical practicum under the supervision of an ori-
entation and mobility specialist and has furnished 
not less than 9 months of supervised full-time ori-
entation and mobility services; 
‘‘(C) has successfully completed the national ex-
amination in orientation and mobility administered 
by the Academy for Certification of Vision Rehabili-
tation and Education Professionals; and 
‘‘(D) meets such other criteria as the Secretary 
establishes.
‘‘(4) The term ‘rehabilitation teacher’ means an indi-
vidual who—
‘‘(A) if a State requires licensure or certifi-
cation of rehabilitation teachers, is licensed or cer-
tified by the State as a rehabilitation teacher; 
‘‘(B)(i) holds a baccalaureate or higher degree 
from an accredited college or university in the 
United States (or an equivalent foreign degree) with 
a concentration in rehabilitation teaching, or holds 
such a degree in a health field; and 
‘‘(ii) has successfully completed 350 hours of 
clinical practicum under the supervision of a reha-
bilitation teacher and has furnished not less than 9 
months of supervised full-time rehabilitation teach-
ing services; 
‘‘(C) has successfully completed the national ex-
amination in rehabilitation teaching administered by 
the Academy for Certification of Vision Rehabilita-
tion and Education Professionals; and 
‘‘(D) meets such other criteria as the Secretary 
establishes. 
‘‘(5) The term ‘low vision therapist’ means an indi-
vidual who—
‘‘(A) if a State requires licensure or certifi-
cation of low vision therapists, is licensed or certified 
by the State as a low vision therapist; 
‘‘(B)(i) holds a baccalaureate or higher degree 
from an accredited college or university in the 
United States (or an equivalent foreign degree) with 
a concentration in low vision therapy, or holds such 
a degree in a health field; and 
‘‘(ii) has successfully completed 350 hours of 
clinical practicum under the supervision of a physi-
cian, and has furnished not less than 9 months of 
supervised full-time low vision therapy services; 
‘‘(C) has successfully completed the national ex-
amination in low vision therapy administered by the 
Academy for Certification of Vision Rehabilitation 
and Education Professionals; and 
‘‘(D) meets such other criteria as the Secretary 
establishes. 
‘‘(6) The term ‘vision impairment’ means vision loss 
that constitutes a significant limitation of visual capability 
resulting from disease, trauma, or a congenital or degen-
erative condition that cannot be corrected by conventional 
means, including refractive correction, medication, or sur-
gery, and that is manifested by 1 or more of the following:
‘‘(A) Best corrected visual acuity of less than 
20/60, or significant central field defect. 
‘‘(B) Significant peripheral field defect includ-
ing homonymous or heteronymous bilateral visual 
field defect or generalized contraction or constriction 
of field. 
‘‘(C) Reduced peak contrast sensitivity in con-
junction with a condition described in subparagraph 
(A) or (B). 
‘‘(D) Such other diagnoses, indications, or other 
manifestations as the Secretary may determine to be 
appropriate.’’. 
(c) PAYMENT UNDER PART B.—
(1) 
PHYSICIAN
FEE
SCHEDULE.—Section 
1848(j)(3) of the Social Security Act (42 U.S.C. 
1395w–4(j)(3)) is amended by inserting ‘‘(2)(AA),’’ 
after ‘‘(2)(W),’’. 
(2) CARVE OUT FROM HOSPITAL OUTPATIENT 
DEPARTMENT
PROSPECTIVE
PAYMENT
SYSTEM.—
Section 1833(t)(1)(B)(iv) of such Act (42 U.S.C. 
1395l(t)(1)(B)(iv)) is amended by inserting ‘‘vision 
rehabilitation 
services 
(as 
defined 
in 
section 
1861(bbb)(1)) or’’ after ‘‘does not include’’.
(3) CLARIFICATION
OF
BILLING
REQUIRE-
MENTS.—The first sentence of section 1842(b)(6) of 
such Act (42 U.S.C. 1395u(b)(6)) is amended—
(A) by striking ‘‘and’’ before ‘‘(G)’’; and 
(B) by inserting before the period the fol-
lowing: ‘‘, and (H) in the case of vision rehabili-
tation 
services 
(as 
defined 
in 
section 
1861(bbb)(1)) furnished by a vision rehabilita-
tion 
professional 
(as 
defined 
in 
section 
1861(bbb)(2)) while under the general super-
vision (as defined in section 1861(bbb)(1)(D)) 
of a qualified physician (as defined in section 
1861(bbb)(1)(C)), payment shall be made to (i) 
the qualified physician or (ii) the facility (such 
as a rehabilitation agency, a clinic, or other fa-
cility) through which such services are fur-
nished under the plan of care if there is a con-
tractual arrangement between the vision reha-
bilitation professional and the facility under 
which the facility submits the bill for such serv-
ices’’. 
(d) PLAN OF CARE.—Section 1835(a)(2) of the So-
cial Security Act (42 U.S.C. 1395n(a)(2)) is amended—
(1) in subparagraph (E), by striking ‘‘and’’ 
after the semicolon at the end;
(2) in subparagraph (F), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by inserting after subparagraph (F) the fol-
lowing new subparagraph: 
‘‘(G) in the case of vision rehabilitation 
services, (i) such services are or were required 
because the individual needed vision rehabilita-
tion services, (ii) an individualized, written plan 
for furnishing such services has been estab-
lished (I) by a qualified physician (as defined in 
section 1861(bbb)(1)(C)), (II) by a qualified oc-
cupational therapist, or (III) in the case of such 
services furnished by a vision rehabilitation pro-
fessional, by a qualified physician, (iii) the plan 
is periodically reviewed by the qualified physi-
cian, and (iv) such services are or were fur-
nished while the individual is or was under the 
care of the qualified physician.’’. 
(e) RELATIONSHIP
TO REHABILITATION ACT
OF 
1973.—The provision of vision rehabilitation services 
under the medicare program under title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) shall not be 
taken into account for any purpose under the Rehabilita-
tion Act of 1973 (29 U.S.C. 701 et seq.). 
(f) EFFECTIVE DATE.—
(1) INTERIM, FINAL REGULATIONS.—Not later 
than 180 days after the date of enactment of this 
Act, the Secretary of Health and Human Services 
shall cause to have published in in the Federal Reg-
ister a rule to carry out the provisions of this sec-
tion. Such rule shall be effective and final imme-
diately on an interim basis, but is subject to change 
and revision after public notice and opportunity for 
a period (of not less than 60 days) for public com-
ment. 
(2) CONSULTATION.—The Secretary shall con-
sult with the National Vision Rehabilitation Associa-
tion, the Association for Education and Rehabilita-
tion of the Blind and Visually Impaired, the Acad-
emy for Certification of Vision Rehabilitation and 
Education Professionals, the American Academy of 
Ophthalmology, the American Occupational Therapy 
Association, the American Optometric Association, 
and such other qualified professional and consumer 
organizations as the Secretary determines appro-
priate in promulgating regulations to carry out this 
Act.
SEC. 202. STUDY ON OBSTACLES FOR UNDERSERVED POPU-
LATIONS FOR VISION SERVICES UNDER THE 
MEDICARE PROGRAM. 
(a) STUDY.—The Secretary of Health and Human 
Services shall conduct a study on barriers faced by medi-
cally underserved populations (such as racial or ethnic mi-
norities) to vision services that are covered under the 
medicare program under title XVIII of the Social Security 
Act, including vision rehabilitation and other vision-related 
services. In conducting the study, the Secretary shall con-
sider economic barriers posed by cost-sharing require-
ments, such as copayments and deductibles and the aware-
ness of medicare beneficiaries of vision services benefits 
currently covered and those benefit for which coverage is 
not provided under the program. 
(b) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report on the study conducted under sub-
section (a). The report may include such recommendations 
for administrative action or legislation as the Secretary 
determines to be appropriate. 
SEC. 203. COMPREHENSIVE EYE EXAMINATIONS. 
The Secretary of Health and Human Services shall 
enter into an agreement with the Institute of Medicine of 
the National Academy of Sciences to conduct a study on
the cost benefit of providing a universal dilated eye exam 
under the medicare program.
Æ