I 
116TH CONGRESS 
1ST SESSION H. R. 4665 
To amend title XVIII of the Social Security Act to provide coverage for 
certain vision items and services under part B of the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 11, 2019 
Ms. SCHRIER
(for herself, Mr. O’HALLERAN, Ms. SLOTKIN, and Ms. 
DELBENE) introduced the following bill; which was referred to the Com-
mittee 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 
coverage for certain vision items and services under part 
B of the Medicare program. 
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 Vision Act 
of 2019’’. 
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SEC. 2. PROVIDING COVERAGE FOR VISION CARE UNDER 
THE MEDICARE PROGRAM. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended— 
(1) in subparagraph (GG), by striking ‘‘and’’ 
after the semicolon at the end; 
(2) in subparagraph (HH), by striking the pe-
riod at the end and adding ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(II) vision services (as defined in subsection 
(kkk));’’. 
(b) VISION SERVICES DEFINED.—Section 1861 of 
the Social Security Act (42 U.S.C. 1395x) is amended by 
adding at the end the following new subsection: 
‘‘(kkk) VISION SERVICES.—The term ‘vision services’ 
means— 
‘‘(1) routine eye examinations, including proce-
dures performed during the course of such examina-
tion to determine the refractive state of the eyes; 
and 
‘‘(2) contact lens fitting services, 
furnished on or after January 1, 2022, by or under the 
direct supervision of an optometrist or ophthalmologist 
who is legally authorized to furnish such examinations, 
procedures, or fitting services (as applicable) under State 
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law (or the State regulatory mechanism provided by State 
law) of the State in which the examinations, procedures, 
or fitting services are furnished.’’. 
(c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 
(1) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
(A) by striking ‘‘and’’ before ‘‘(CC)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (DD) with respect 
to vision services (as defined in section 
1861(kkk)), the amount paid shall be equal to 
80 percent of the lesser of the actual charge or 
the amount determined under the payment 
basis determined under section 1848’’. 
(2) LIMITS SPECIFIED.—Section 1834 of the 
Social Security Act (42 U.S.C. 1395m) is amended 
by adding at the end the following new subsection: 
‘‘(x) LIMITATION FOR VISION SERVICES.—With re-
spect to vision services (as defined in section 1861(kkk)) 
and an individual, payment may be made under this part 
for only 1 routine eye examination described in paragraph 
(1) of such section and 1 contact lens fitting service de-
scribed in paragraph (2) of such section during a 2-year 
period.’’. 
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(d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 
(1) IN
GENERAL.—Section 1848(j)(3) of the 
Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 
amended by inserting ‘‘(2)(II),’’ before ‘‘(3)’’. 
(2) 
BUDGET
NEUTRALITY.—Section 
1848(c)(2)(B)(iv) of the Social Security Act (42 
U.S.C. 1395–w(c)(2)(B)(iv)) is amended— 
(A) in subclause (III), by striking ‘‘and’’ at 
the end; 
(B) in subclause (IV), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(V) the amendment made by 
section 2(d)(1) of the Medicare Vision 
Act of 2019 shall not be taken into 
account in applying clause (ii)(II) for 
2022 and 2023.’’. 
(e) COVERAGE OF CONVENTIONAL EYEGLASSES AND 
CONTACT LENSES.—Section 1861(s)(8) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(8)) is amended by striking 
‘‘, and including one pair of conventional eyeglasses or 
contact lenses furnished subsequent to each cataract sur-
gery with insertion of an intraocular lens’’ and inserting 
‘‘, including one pair of conventional eyeglasses or contact 
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lenses furnished subsequent to each cataract surgery with 
insertion of an intraocular lens, if furnished before Janu-
ary 1, 2022, and including conventional eyeglasses or con-
tact lenses, whether or not furnished subsequent to such 
a surgery, if furnished on or after January 1, 2022’’. 
(f) SPECIAL PAYMENT RULES FOR EYEGLASSES AND 
CONTACT LENSES.— 
(1) LIMITATIONS.—Section 1834(h) of the So-
cial Security Act (42 U.S.C. 1395m(h)) is amended 
by adding at the end the following new paragraph: 
‘‘(6) PAYMENT LIMITATIONS FOR EYEGLASSES 
AND CONTACT LENSES.—With respect to eyeglasses 
and contact lenses furnished to an individual on or 
after January 1, 2022, payment may be made under 
this part only— 
‘‘(A) during any 2-year period, for either 1 
pair of eyeglasses (including lenses and frames) 
or a 2-year supply that is provided in not more 
than 180-day increments of contact lenses; 
‘‘(B) with respect to amounts attributable 
to the frames of such a pair of eyeglasses and 
amounts attributable to contact lenses fur-
nished during a year, in an amount not greater 
than— 
‘‘(i) for 2022, $100; and 
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‘‘(ii) for a subsequent year, the 
amount specified under this subparagraph 
for the previous year, increased by the per-
centage change in the Consumer Price 
Index for All Urban Consumers during 
such previous year; 
‘‘(C) for types of eyeglass lenses, and for 
types of contact lenses, as determined appro-
priate by the Secretary; and 
‘‘(D) if furnished pursuant to a written 
order of a physician described in section 
1861(kkk).’’. 
(2) APPLICATION
OF
COMPETITIVE
ACQUISI-
TION.— 
(A) IN GENERAL.—Section 1834(h)(1)(H) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(h)(1)(H)) is amended— 
(i) in the header by inserting ‘‘, EYE-
GLASSES, AND
CONTACT
LENSES’’ after 
‘‘ORTHOTICS’’; 
(ii) by inserting ‘‘and of eyeglasses 
and contact lenses described in paragraph 
(2)(D) of such section,’’ after ‘‘2009,’’; 
and 
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(iii) in clause (i), by inserting ‘‘or 
such eyeglasses and contact lenses’’ after 
‘‘orthotics’’. 
(B) CONFORMING AMENDMENT.— 
(i) IN GENERAL.—Section 1847(a)(2) 
of the Social Security Act (42 U.S.C. 
1395w–3(a)(2)) is amended by adding at 
the end the following new subparagraph: 
‘‘(D) 
EYEGLASSES
AND
CONTACT 
LENSES.—Eyeglasses and contact lenses for 
which payment would otherwise be made under 
section 1834(h).’’. 
(ii) EXEMPTION
OF
CERTAIN
ITEMS 
FROM
COMPETITIVE
ACQUISITION.—Sec-
tion 1847(a)(7) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(7)) is amended by 
adding at the end the following new sub-
paragraph: 
‘‘(C) CERTAIN EYEGLASSES AND CONTACT 
LENSES.—Those items and services described in 
paragraph (2)(D) if furnished by a physician or 
other practitioner (as defined by the Secretary) 
to the physician’s or practitioner’s own patients 
as part of the physician’s or practitioner’s pro-
fessional service.’’. 
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(g) EXCLUSION MODIFICATIONS.—Section 1862(a) 
of the Social Security Act (42 U.S.C. 1395y(a)) is amend-
ed— 
(1) in paragraph (1)— 
(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 vision services (as defined 
in section 1861(kkk)) that are routine eye examina-
tions and contact lens fitting services (as described 
in paragraph (1) or (2), respectively, of such sec-
tion), which are furnished more frequently than once 
during a 2-year period;’’; and 
(2) in paragraph (7)— 
(A) by inserting ‘‘(other than such an ex-
amination that is a vision service that is cov-
ered under section 1861(s)(2)(II))’’ after ‘‘eye 
examinations’’; and 
(B) by inserting ‘‘(other than such a proce-
dure that is a vision service that is covered 
under section 1861(s)(2)(II))’’ after ‘‘refractive 
state of the eyes’’. 
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SEC. 3. IMPLEMENTATION FUNDING. 
The Secretary of Health and Human Services shall 
provide for the transfer from the Federal Supplementary 
Medical Insurance Trust Fund under section 1841 of the 
Social Security Act (42 U.S.C. 1395t) to the Centers for 
Medicare & Medicaid Services Program Management Ac-
count for the period of 2020 through 2024 of such sums 
as may be necessary for purposes of implementing the 
amendments made by section 2. 
Æ 
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