I 
114TH CONGRESS 
2D SESSION 
H. R. 4642 
To amend title XVIII of the Social Security Act to establish a Medicare 
diabetic eye disease prevention and early treatment demonstration project. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 26, 2016 
Mr. COLLINS of New York (for himself and Mr. MCNERNEY) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to establish 
a Medicare diabetic eye disease prevention and early 
treatment demonstration project. 
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 Eye Disease 
Prevention Act of 2016’’. 
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SEC. 2. MEDICARE DIABETIC EYE DISEASE PREVENTION 
AND EARLY TREATMENT DEMONSTRATION 
PROJECT. 
Title XVIII of the Social Security Act is amended by 
inserting after section 1866E (42 U.S.C. 1395cc–5) the 
following new section: 
‘‘DIABETIC EYE DISEASE PREVENTION AND EARLY 
TREATMENT DEMONSTRATION PROJECT 
‘‘SEC. 1866F. (a) ESTABLISHMENT.—The Secretary 
shall conduct, during a 5-year period beginning no later 
than January 1, 2017, a diabetic eye disease prevention 
and early treatment demonstration project (in this section 
referred to as the ‘demonstration project’) to provide in-
centives to primary care practices to refer to local eye doc-
tors for comprehensive dilated eye exams— 
‘‘(1) diabetic Medicare beneficiaries at the time 
of their diagnosis of diabetes; and 
‘‘(2) diabetic Medicare beneficiaries who have 
been diagnosed with diabetes mellitus and have not 
received a comprehensive dilated eye examination in 
the previous 5 years. 
‘‘(b) REQUIREMENT.—The demonstration project 
shall test the extent to which such incentives result in— 
‘‘(1) improving early detection and treatment of 
diabetes-related vision problems and the reduction of 
significant eye and vision loss and blindness associ-
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ated with delayed diagnosis and treatment of diabe-
tes-related eye and vision conditions; 
‘‘(2) reducing the cost of health care services 
covered under this title; and 
‘‘(3) achieving beneficiary satisfaction. 
‘‘(c) CONDUCT
OF PROJECT.—The demonstration 
project shall be conducted consistent with the following: 
‘‘(1) IDENTIFICATION OF PRIMARY CARE PRAC-
TICES.—The demonstration project shall identify at 
least 100 primary care practices, in each of at least 
10 States which have high per capita costs of diabe-
tes care for diabetic Medicare beneficiaries, for par-
ticipation in the demonstration project. 
‘‘(2) LISTING
OF
PARTICIPATING
EYE
DOC-
TORS.—Each practice so identified shall be provided 
with a list of eye doctors who are located in the area 
of such practice and who have agreed to participate 
in the demonstration project. 
‘‘(3) REQUIREMENTS FOR PARTICIPATING EYE 
DOCTORS.—As part of the participation agreement 
of an eye doctor under the demonstration project, 
the eye doctor agrees— 
‘‘(A) to offer to furnish to each diabetic 
Medicare beneficiary referred to the doctor by a 
primary care practice so identified a com-
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prehensive dilated eye examination and needed 
diabetes-related eye care covered under this 
title; and 
‘‘(B) to report back to such practice on the 
results of such an examination or care within 
72 hours after the time of conducting such ex-
amination or furnishing such care. 
‘‘(d) INCENTIVE PAYMENT METHODOLOGY.— 
‘‘(1) IN GENERAL.—Under the demonstration 
project, subject to paragraph (2), the Secretary shall 
pay an incentive on an annual basis to each primary 
care practice participating in the demonstration 
project for each beneficiary the practice refers in the 
year for an eye examination under the demonstra-
tion project. Such amount shall be set at a level so 
as to encourage primary care practices to participate 
in the demonstration project. 
‘‘(2) BUDGET
NEUTRALITY.—The Secretary 
shall ensure that the aggregate payments made 
under this title, including incentive payments made 
under this section, with respect to individuals par-
ticipating in the demonstration project do not exceed 
the aggregate amounts that the Secretary estimates 
would have been paid under title with respect to 
such individuals if the demonstration project had not 
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been implemented. In order to carry out the previous 
sentence, the Secretary is authorized to reduce pay-
ment rates under part B for eye care services for di-
abetic Medicare beneficiaries (other than those de-
scribed in subsection (a)) to take into account the 
costs of comprehensive dilated eye examinations fur-
nished to individuals otherwise eligible to participate 
in the demonstration project. 
‘‘(3) FUNDING.—The costs, including incentive 
payments, of carrying out the demonstration project 
shall be paid from the Federal Supplementary Med-
ical Insurance Trust Fund established under section 
1841. 
‘‘(e) WAIVER.—The Secretary may waive such provi-
sions of this title and title XI as the Secretary determines 
necessary in order to implement the demonstration 
project. 
‘‘(f) EVALUATION AND REPORTS.— 
‘‘(1) EVALUATION.—The Secretary shall con-
duct an independent evaluation of the demonstration 
project to assess whether the project has the results 
described in subsection (b). 
‘‘(2) REPORTS.— 
‘‘(A) PRELIMINARY
REPORT.—Not later 
than 60 days after the completion of the first 
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year of the demonstration project, the Secretary 
shall submit to Congress a preliminary report 
on the results of the project. 
‘‘(B) FINAL
REPORT.—No later than 6 
months after the date of the completion of the 
demonstration project, the Secretary shall sub-
mit to Congress a final report on the results of 
the project and shall include in such report the 
findings of the evaluation conducted under 
paragraph (1). 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) DIABETIC MEDICARE BENEFICIARY.—The 
term ‘diabetic Medicare beneficiary’ means, with re-
spect to a primary care practice, an individual 
who— 
‘‘(A) is entitled to benefits under part A 
and enrolled for benefits under part B; 
‘‘(B) is not enrolled in a Medicare Advan-
tage plan under part C or a PACE program 
under section 1894; 
‘‘(C) has been determined to have diabetes 
mellitus; and 
‘‘(D) is receiving primary care services 
through one or more physicians or nurse practi-
tioners in such practice. 
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