I
106TH CONGRESS
2D SESSION
H. R. 4107
To amend title XVIII of the Social Security Act to provide for coverage
of a program of coordinated lifestyle changes to reverse individuals at
significant clinical risk for a heart attack under part B of the medicare
program.
IN THE HOUSE OF REPRESENTATIVES
MARCH 28, 2000
Mr. RANGEL introduced the following bill; which was referred to the Com-
mittee 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 jurisdic-
tion of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
for coverage of a program of coordinated lifestyle
changes to reverse individuals at significant clinical risk
for a heart attack under part B of the Medicare Pro-
gram.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. COVERAGE OF LIFESTYLE CHANGES FOR INDI-
VIDUALS AT SIGNIFICANT RISK OF HEART
ATTACKS.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) in subparagraph (S), by striking ‘‘and’’ at
the end;
(2) in subparagraph (T), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(U) services furnished under a coordinated
lifestyle change program (as defined in subsection
(uu)(1)) for certain individuals (described in sub-
section (uu)(2)) who are at a significant risk of a
heart attack;’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) is amended by adding at the end
the following new subsection:
‘‘Coordinated Lifestyle Change Program
‘‘(uu)(1) The term ‘coordinated lifestyle exchange
program’ means a program of 1 year’s duration that—
‘‘(A) is designed for individuals described in
paragraph (2);
‘‘(B) consists of lifestyle changes, including a
very low-fat, low-cholesterol diet, stress management
techniques, moderate exercise, smoking cessation,
and psychosocial support, without the use of choles-
terol-lowering drugs;
‘‘(C) has been validated to reverse disease in
the majority of patients, as measured by quan-
titative coronary arteriography in a scientific study
that is at least 5 years in duration and that used
randomly-assigned control and experimental groups;
and
‘‘(D) is conducted by a medical facility that is
experienced in conducting such a scientifically vali-
dated program, or whose staff has been trained by
such a facility.
‘‘(2) An individual described in this paragraph is an
individual—
‘‘(A) 
whose 
physician 
has 
recommended
revascularization (in the form of angioplasty or coro-
nary artery bypass graft surgery) in the near future;
and
‘‘(B) who has undergone at least one diagnostic
study which demonstrates clinically significant ven-
tricular myocardium at risk for infarction.’’.
(c) PAYMENT.—Section 1833(a)(1) of such Act (42
U.S.C. 1395l(a)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(S)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (T) with respect
to services furnished under a coordinated life-
style change program (as defined in subsection
(uu)(1)), the amount paid shall be 80 percent
of the lesser of the actual charge for the serv-
ices or the amount determined to be reasonable
and related to the costs of furnishing such serv-
ices (taking into account the period of time dur-
ing which the services are furnished)’’.
(d) PARTICIPATION AGREEMENTS.—Section 1866(e)
of such Act (42 U.S.C. 1395cc(e)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(1);
(2) by striking the period at the end of para-
graph (2) and inserting ‘‘; and’’; and
(3) by adding at the end the following new
paragraph:
‘‘(3) a medical facility described in section
1861(uu)(1)(D), but only with respect to the fur-
nishing of services under a coordinated lifestyle
change program (as defined in subsection (uu)(1)).’’.
(e) EFFECTIVE DATE.—The amendments made by
this section apply to services furnished on or after Janu-
ary 1, 2001.
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