I
106TH CONGRESS
1ST SESSION
H. R. 1968
To amend title XVIII of the Social Security Act to provide for additional
benefits under the Medicare Program to prevent or delay the onset
of illnesses, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MAY 26, 1999
Mr. STARK introduced the following bill; which was referred to the Committee
on 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 additional benefits under the Medicare Program to
prevent or delay the onset of illnesses, and for other
purposes.
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 ‘‘Medicare Preventive
Care Improvement Act of 1999’’.
SEC. 2. AUTHORITY TO PROVIDE PREVENTIVE SERVICES
UNDER PART B OF THE MEDICARE PROGRAM.
(a) PREVENTIVE SERVICES BENEFIT.—
(1) IN GENERAL.—Section 1861(s) of the So-
cial Security Act (42 U.S.C. 1395x(s)) is amended—
(A) by redesignating paragraphs (16) and
(17) as paragraphs (17) and (18), respectively;
and
(B) by inserting after paragraph (15) the
following new paragraph:
‘‘(16) qualified preventive services, as defined in
subsection (uu);’’.
(2) 
CONFORMING
AMENDMENTS.—Sections
1864(a) 1902(a)(9)(C), and 1915(a)(1)(B)(ii)(I) of
such Act (42 U.S.C. 1395aa(a), 1396a(a)(9)(C), and
1396n(a)(1)(B)(ii)(I)) are each amended by striking
‘‘paragraphs (16) and (17)’’ each place it appears
and inserting ‘‘paragraphs (17) and (18)’’.
(b) DEFINITION OF PREVENTIVE SERVICES.—Sec-
tion 1861 of such Act (42 U.S.C. 1395x) is amended by
adding at the end the following new subsection:
‘‘Qualified Preventive Services
‘‘(uu)(1) Subject to paragraph (2), the term ‘quali-
fied preventive services’ means items and services deter-
mined by the Secretary to be reasonable and necessary for
the prevention or early detection of an illness or disability.
‘‘(2) An item or service described in paragraph (1)
shall be qualified as a preventive service if the Secretary
determines by authoritative evidence that the provision of
such item or service is cost effective. In determining if
such an item or service is cost effective, the Secretary shall
consider the following:
‘‘(A) Whether furnishing such an item or serv-
ice for an illness or disability results in reductions
in estimated expenditures under the Social Security
Act for the illness or disability, or avoids treatment
in a more expensive setting.
‘‘(B) Whether the item or service improves the
health of the individual for whom the item or service
is furnished.
‘‘(C) In the case of an individual entitled to
benefits under this title by reason of section 226(b),
whether the item or service facilitates the return to
work of the individual.’’.
(c) EXCLUSION
FROM
COVERAGE
CONFORMING
AMENDMENT.—Section 1862(a)(1)(B) of such Act (42
U.S.C. 1395y(a)(1)(B)) is amended by striking ‘‘section
1861(s)(10)’’ and inserting ‘‘section 1834(e)(6)’’.
SEC. 3. PAYMENT FOR PREVENTIVE SERVICES.
(a) IN GENERAL.—Section 1834 of the Social Secu-
rity Act (42 U.S.C. 1395m) is amended by inserting after
subsection (d) the following new subsection:
‘‘(e) ALTERNATIVE
PAYMENT
FOR
PREVENTIVE
SERVICES.—
‘‘(1) GENERAL PAYMENT RULE.—
‘‘(A) QUALIFIED PREVENTIVE SERVICES.—
The Secretary shall establish by regulation a
payment amount for qualified preventive serv-
ices, as defined in section 1861(uu).
‘‘(B) OTHER PREVENTIVE SERVICES.—The
Secretary may establish by regulation a pay-
ment amount for each type of preventive service
described in subparagraphs (A) through (H) of
paragraph (6).
‘‘(2) MINIMUM PAYMENT AMOUNT.—In the case
of a preventive service described in paragraph (6)
that may be performed as a diagnostic or thera-
peutic service under this title, the payment amount
under this subsection for a service performed as a
preventive service may not be less than the payment
amount established under this title for such service
performed as a diagnostic or therapeutic service.
‘‘(3) MANNER OF PAYMENT.—In the case of a
preventive service described in paragraph (6) that
may be performed as a diagnostic or therapeutic
service under this title, the Secretary shall apply the
same method of payment under this subsection for
a service performed as a preventive service as the
Secretary applies under this title for such service
performed as a diagnostic or therapeutic service.
‘‘(4) AUTHORITY
TO
WAIVE
COINSURANCE.—
Notwithstanding any other provision of this title, in
the case of a preventive service described in para-
graph (6), the Secretary may waive the imposition of
any applicable coinsurance amount with respect to
such service.
‘‘(5) PROHIBITION ON BALANCE BILLING.—The
provisions of subparagraphs (A) and (B) of section
1842(b)(18) shall apply to the furnishing of preven-
tive services described in paragraph (6) for which
payment is made under this subsection in the same
manner as such subparagraphs apply to services fur-
nished by a practitioner described in subparagraph
(C) of such section.
‘‘(6) PREVENTIVE SERVICES DESCRIBED.—For
purposes of this subsection, the preventive services
described in this paragraph are any of the following
services: