I 
115TH CONGRESS 
2D SESSION 
H. R. 6886 
To amend title 10, United States Code, to modify the requirement for certain 
former members of the Armed Forces to enroll in Medicare Part B 
to be eligible for TRICARE for Life, and to amend title XVIII of 
the Social Security Act to provide for coverage of certain DNA specimen 
provenance assay tests under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 25, 2018 
Mr. SAM JOHNSON of Texas (for himself, Mr. LARSON of Connecticut, Mr. 
BUCSHON, and Mr. RUSH) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committees on Ways and Means, and Armed Services, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend title 10, United States Code, to modify the re-
quirement for certain former members of the Armed 
Forces to enroll in Medicare Part B to be eligible for 
TRICARE for Life, and to amend title XVIII of the 
Social Security Act to provide for coverage of certain 
DNA specimen provenance assay tests under the Medi-
care program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Equity and 
Access for Returning Troops and Servicemembers Act of 
2018’’ or the ‘‘HEARTS Act of 2018’’. 
SEC. 2. MODIFICATION OF REQUIREMENT FOR CERTAIN 
FORMER MEMBERS OF THE ARMED FORCES 
TO ENROLL IN MEDICARE PART B TO BE ELI-
GIBLE FOR TRICARE FOR LIFE. 
(a) TRICARE ELIGIBILITY.— 
(1) IN
GENERAL.—Subsection (d) of section 
1086 of title 10, United States Code, is amended by 
adding at the end the following new paragraph: 
‘‘(6)(A) The requirement in paragraph (2)(A) to en-
roll in the supplementary medical insurance program 
under part B of title XVIII of the Social Security Act (42 
U.S.C. 1395j et seq.) shall not apply to a person described 
in subparagraph (B) during any month in which such per-
son is not entitled to a benefit described in subparagraph 
(A) of section 226(b)(2) of the Social Security Act (42 
U.S.C. 426(b)(2)) if such person has received the coun-
seling and information under subparagraph (C). 
‘‘(B) A person described in this subparagraph is a 
person— 
‘‘(i) who is under 65 years of age; 
‘‘(ii) who is entitled to hospital insurance bene-
fits under part A of title XVIII of the Social Secu-
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rity Act pursuant to subparagraph (A) or (C) of sec-
tion 226(b)(2) of such Act (42 U.S.C. 426(b)(2)); 
‘‘(iii) whose entitlement to a benefit described 
in subparagraph (A) of such section has terminated 
due to performance of substantial gainful activity; 
and 
‘‘(iv) who is retired under chapter 61 of this 
title. 
‘‘(C) The Secretary of Defense shall coordinate with 
the Secretary of Health and Human Services and the 
Commissioner of Social Security to notify persons de-
scribed in subparagraph (B) of, and provide information 
and counseling regarding, the effects of not enrolling in 
the supplementary medical insurance program under part 
B of title XVIII of the Social Security Act (42 U.S.C. 
1395j et seq.), as described in subparagraph (A).’’. 
(2) 
CONFORMING
AMENDMENT.—Paragraph 
(2)(A) of such subsection is amended by striking ‘‘is 
enrolled’’ and inserting ‘‘except as provided by para-
graph (6), is enrolled’’. 
(3) IDENTIFICATION
OF
PERSONS.—Section 
1110a of such title is amended by adding at the end 
the following new subsection: 
‘‘(c) CERTAIN INDIVIDUALS NOT REQUIRED TO EN-
ROLL IN MEDICARE PART B.—In carrying out subsection 
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(a), the Secretary of Defense shall coordinate with the 
Secretary of Health and Human Services and the Commis-
sioner of Social Security to— 
‘‘(1) identify persons described in subparagraph 
(B) of section 1086(d)(6) of this title; and 
‘‘(2) provide information and counseling pursu-
ant to subparagraph (D) of such section.’’. 
(b) NON-APPLICATION OF MEDICARE PART B LATE 
ENROLLMENT PENALTY.—Section 1839(b) of the Social 
Security Act (42 U.S.C. 1395r(b)) is amended, in the sec-
ond sentence, by inserting ‘‘or months for which the indi-
vidual can demonstrate that the individual is an individual 
described in paragraph (6)(B) of section 1086(d) of title 
10, United States Code, who is enrolled in the TRICARE 
program pursuant to such section’’ after ‘‘an individual 
described in section 1837(k)(3)’’. 
(c) REPORT.—Not later than October 1, 2024, the 
Secretary of Defense, the Secretary of Health and Human 
Services, and the Commissioner of Social Security shall 
jointly submit to the Committees on Armed Services of 
the House of Representatives and the Senate, the Com-
mittee on Ways and Means of the House of Representa-
tives, and the Committee on Finance of the Senate a re-
port on the implementation of section 1086(d)(6) of title 
10, United States Code, as added by subsection (a). Such 
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report shall include, with respect to the period covered by 
the report— 
(1) the number of individuals enrolled in 
TRICARE for Life who are not enrolled in the sup-
plementary medical insurance program under part B 
of title XVIII of the Social Security Act (42 U.S.C. 
1395j et seq.) by reason of such section 1086(d)(6); 
and 
(2) the number of individuals who— 
(A) are retired from the Armed Forces 
under chapter 61 of title 10, United States 
Code; 
(B) are entitled to hospital insurance bene-
fits under part A of title XVIII of the Social 
Security Act pursuant to receiving benefits for 
24 months as described in subparagraph (A) or 
(C) of section 226(b)(2) of such Act (42 U.S.C. 
426(b)(2)); and 
(C) because of such entitlement, are no 
longer 
enrolled 
in 
TRICARE 
Standard, 
TRICARE 
Prime, 
TRICARE 
Extra, 
or 
TRICARE Select under chapter 55 of title 10, 
United States Code. 
(d) DEPOSIT OF SAVINGS INTO MEDICARE IMPROVE-
MENT FUND.—Section 1898(b)(1) of the Social Security 
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Act (42 U.S.C. 1395iii(b)(1)) is amended by striking 
‘‘during and after fiscal year 2021, $0’’ and inserting 
‘‘during and after fiscal year 2024, $5,000,000’’. 
(e) APPLICATION.—The amendments made by sub-
sections (a) and (b) shall apply with respect to a person 
who, on or after October 1, 2023, is a person described 
in section 1086(d)(6)(B) of title 10, United States Code, 
as added by subsection (a). 
SEC. 3. COVERAGE OF CERTAIN DNA SPECIMEN PROVE-
NANCE ASSAY TESTS UNDER MEDICARE. 
(a) BENEFIT.— 
(1) COVERAGE.—Section 1861 of the Social Se-
curity Act (42 U.S.C. 1395x) is amended— 
(A) in subsection (s)(2)— 
(i) in subparagraph (FF), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (GG), by insert-
ing ‘‘and’’ at the end; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(HH) a prostate cancer DNA Specimen Prove-
nance Assay test (DSPA test) (as defined in sub-
section (jjj)); and’’; and 
(B) by adding at the end the following new 
subsection: 
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‘‘(jjj) PROSTATE CANCER DNA SPECIMEN PROVE-
NANCE ASSAY TEST.—The term ‘prostate cancer DNA 
Specimen Provenance Assay Test’ (DSPA test) means a 
test that, after a determination of cancer in one or more 
prostate biopsy specimens obtained from an individual, as-
sesses the identity of the DNA in such specimens by com-
paring such DNA with the DNA that was separately taken 
from such individual at the time of the biopsy.’’. 
(2) EXCLUSION
FROM
COVERAGE.—Section 
1862(a)(1) of the Social Security Act (42 U.S.C. 
1395y(a)(1)) is amended— 
(A) in subparagraph (O), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (P), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(Q) in the case of a prostate cancer DNA 
Specimen Provenance Assay test (DSPA test) (as 
defined in section 1861(jjj)), unless such test is fur-
nished on or after January 1, 2020, and before Jan-
uary 1, 2025, and such test is ordered by the physi-
cian who furnished the prostate cancer biopsy that 
obtained the specimen tested;’’. 
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(b) PAYMENT AMOUNT
AND RELATED REQUIRE-
MENTS.—Section 1834 of the Social Security Act (42 
U.S.C. 1395m) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(w) PROSTATE CANCER DNA SPECIMEN PROVE-
NANCE ASSAY TESTS.— 
‘‘(1) PAYMENT FOR COVERED TESTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the payment amount for a prostate 
cancer DNA Specimen Provenance Assay test 
(DSPA test) (as defined in section 1861(jjj)) 
shall be $200. Such payment shall be payment 
for all of the specimens obtained from the bi-
opsy furnished to an individual that are tested. 
‘‘(B) LIMITATION.—Payment for a DSPA 
test under subparagraph (A) may only be made 
on an assignment-related basis. 
‘‘(C) PROHIBITION
ON
SEPARATE
PAY-
MENT.—No separate payment shall be made for 
obtaining DNA that was separately taken from 
an individual at the time of a biopsy described 
in subparagraph (A). 
‘‘(2) HCPCS CODE
AND
MODIFIER
ASSIGN-
MENT.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
assign one or more HCPCS codes to a prostate 
cancer DNA Specimen Provenance Assay test 
and may use a modifier to facilitate making 
payment under this section for such test. 
‘‘(B) IDENTIFICATION OF DNA MATCH ON 
CLAIM.—The Secretary shall require an indica-
tion on a claim for a prostate cancer DNA 
Specimen Provenance Assay test of whether the 
DNA of the prostate biopsy specimens match 
the DNA of the individual diagnosed with pros-
tate cancer. Such indication may be made 
through use of a HCPCS code, a modifier, or 
other means, as determined appropriate by the 
Secretary. 
‘‘(3) DNA MATCH REVIEW.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
review at least three years of claims under part 
B for prostate cancer DNA Specimen Prove-
nance Assay tests to identify whether the DNA 
of the prostate biopsy specimens match the 
DNA of the individuals diagnosed with prostate 
cancer. 
‘‘(B) POSTING ON INTERNET WEBSITE.— 
Not later than July 1, 2023, the Secretary shall 
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post on the Internet website of the Centers for 
Medicare & Medicaid Services the findings of 
the review conducted under subparagraph 
(A).’’. 
(c) COST-SHARING.—Section 1833(a)(1) of the So-
cial Security Act (42 U.S.C. 1395l(a)(1)) is amended— 
(1) by striking ‘‘and (BB)’’ and inserting 
‘‘(BB)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (CC) with respect to a prostate 
cancer DNA Specimen Provenance Assay test 
(DSPA test) (as defined in section 1861(jjj)), the 
amount paid shall be an amount equal to 80 percent 
of the lesser of the actual charge for the test or the 
amount specified under section 1834(w)’’. 
Æ 
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