I 
116TH CONGRESS 
1ST SESSION H. R. 5254 
To amend title XVIII of the Social Security Act to provide for coverage 
under the Medicare program of digital retinal imaging with remote inter-
pretation. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 22, 2019 
Ms. SEWELL of Alabama (for herself, Mr. REED, and Ms. DEGETTE) 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 title XVIII of the Social Security Act to provide 
for coverage under the Medicare program of digital ret-
inal imaging with remote interpretation. 
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 Vision Loss 
and Blindness Prevention Act of 2019’’. 
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SEC. 2. MEDICARE COVERAGE OF DIGITAL RETINAL IMAG-
ING WITH REMOTE INTERPRETATION. 
(a) COVERAGE.—Section 1861 of the Social Security 
Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) in subparagraph (GG), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (HH), by adding 
‘‘and’’ at the end; and 
(C) by inserting after subparagraph (HH) 
the following new subparagraph: 
‘‘(II) digital retinal imaging with remote 
interpretation 
(as 
defined 
in 
subsection 
(kkk));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(kkk) DIGITAL RETINAL IMAGING WITH REMOTE 
INTERPRETATION.—The term ‘digital retinal imaging 
with remote interpretation’ means a diagnostic procedure 
for the purpose of early detection or assessment 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 and who does not have prior dia-
betic retinopathy known to the primary care practi-
tioner of the individual; 
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‘‘(2) is provided by or under the general super-
vision of a primary care practitioner (as defined in 
section 1833(x)) or board-certified endocrinologist; 
‘‘(3) utilizes a retinal camera with optical reso-
lution compliant with the International Organization 
for Standardization ISO 10940 to take digital im-
ages of structures behind the lens of the eye, such 
as the retina, choroid, and optic nerve; and 
‘‘(4) involves the electronic transmission of such 
images for evaluation for diabetic retinopathy and 
other diseases of the eye by a State-licensed ophthal-
mologist or optometrist.’’. 
(b) PAYMENT.—The payment amount for digital ret-
inal imaging with remote interpretation provided pursuant 
to the amendments made by section (a) shall be equal to— 
(1) for the period beginning on October 1, 
2019, and ending on December 31, 2019, and for 
2020, $51.54; and 
(2) for a subsequent year, the payment amount 
specified in subparagraph (1) or this subparagraph 
for the preceding year increased by the percentage 
increase in the MEI (as defined in section 
1842(i)(3) of the Social Security Act (42 U.S.C. 
1395u(i)(3)) for such subsequent year. 
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Digital retinal imaging with remote interpretation shall 
not be considered a telehealth service for purposes of sec-
tion 1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)). 
(c) PATIENT EDUCATION AND AWARENESS.— 
(1) ANNUAL EYE EXAM RECOMMENDATION.— 
The Secretary of Health and Human Services shall 
ensure that diabetes outpatient self-management 
training services described in section 1861(qq) of the 
Social Security Act (42 U.S.C. 1395x(qq)) educate 
Medicare beneficiaries regarding the importance of 
receiving an annual comprehensive eye exam. 
(2) PATIENT AWARENESS.—The Secretary shall 
undertake efforts to ensure that patients receiving 
digital retinal imaging with remote interpretation as 
described in subsection (kkk) of section 1861 of the 
Social Security Act (42 U.S.C. 1395x), as added by 
subsection (a), are aware of the availability of and 
coverage for diabetes outpatient self-management 
training services under subsection (s)(2)(S) of such 
section. 
Æ 
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