I
103D CONGRESS
1ST SESSION
H. R. 19
To amend title XVIII of the Social Security Act to provide for coverage
of certain preventive services under part B of the medicare program.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 5, 1993
Mr. ROSTENKOWSKI (for himself and Mr. STARK) introduced the following
bill; which was referred to the Committee on Ways and Means, Energy
and Commerce
A BILL
To amend title XVIII of the Social Security Act to provide
for coverage of certain preventive 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 Prevention
Benefit Act of 1993’’.
SEC. 2. ANNUAL SCREENING MAMMOGRAPHY.
(a) 
ANNUAL
SCREENING
MAMMOGRAPHY
FOR
WOMEN OVER AGE 64.—Section 1834(c)(2)(A) of the So-
cial Security Act (42 U.S.C. 1395m(b)(2)(A)) is amend-
ed—
(1) in clause (iv), by striking ‘‘but under 65
years of age,’’; and
(2) by striking clause (v).
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to screening mammography per-
formed on or after January 1, 1994.
SEC. 3. COVERAGE OF COLORECTAL SCREENING.
(a) IN GENERAL.—Section 1834 of the Social Secu-
rity Act (42 U.S.C. 1395m) is amended by inserting after
subsection (c) the following new subsection:
‘‘(d) FREQUENCY
AND
PAYMENT
LIMITS
FOR
SCREENING FECAL-OCCULT BLOOD TESTS AND SCREEN-
ING FLEXIBLE SIGMOIDOSCOPIES.—
‘‘(1) 
SCREENING
FECAL-OCCULT
BLOOD
TESTS.—
‘‘(A) PAYMENT LIMIT.—In establishing fee
schedules under section 1833(h) with respect to
screening fecal-occult blood tests provided for
the purpose of early detection of colon cancer,
except as provided by the Secretary under para-
graph (3)(A), the payment amount established
for tests performed—
‘‘(i) in 1994 shall not exceed $5; and
‘‘(ii) in a subsequent year, shall not
exceed the limit on the payment amount
established under this subsection for such
tests for the preceding year, adjusted by
the applicable adjustment under section
1833(h) for tests performed in such year.
‘‘(B) FREQUENCY LIMIT.—Subject to revi-
sion by the Secretary under paragraph (3)(B),
no payment may be made under this part for
a screening fecal-occult blood test provided to
an individual for the purpose of early detection
of colon cancer—
‘‘(i) if the individual is under 50 years
of age; or
‘‘(ii) if the test is performed within 11
months after a previous screening fecal-oc-
cult blood test.
‘‘(2) 
SCREENING
FLEXIBLE
SIGMOIDOS-
COPIES.—
‘‘(A) PAYMENT AMOUNT.—The Secretary
shall establish a payment amount under section
1848 
with 
respect 
to 
screening 
flexible
sigmoidoscopies provided for the purpose of
early detection of colon cancer that is consistent
with payment amounts under such section for
quired to assure that such tests of an appro-
priate quality are readily and conveniently
available during the year.
‘‘(B) REVISION OF FREQUENCY.—
‘‘(i) REVIEW.—The Secretary, in con-
sultation with the Director of the National
Cancer Institute, shall review periodically
the appropriate frequency for performing
screening fecal-occult blood tests and
screening flexible sigmoidoscopies based on
age and such other factors as the Sec-
retary believes to be pertinent.
‘‘(ii) REVISION OF FREQUENCY.—The
Secretary, taking into consideration the re-
view made under clause (i), may revise
from time to time the frequency with
which such tests and procedures may be
paid for under this subsection, but no such
revision shall apply to tests or procedures
performed before January 1, 1997.’’.
(b) CONFORMING AMENDMENTS.—(1) Paragraphs
(1)(D) and (2)(D) of section 1833(a) of such Act (42
U.S.C. 1395l(a)) are each amended by striking ‘‘sub-
section (h)(1),’’ and inserting ‘‘subsection (h)(1) or section
1834(d)(1),’’.
(2) Section 1833(h)(1)(A) of such Act (42 U.S.C.
1395l(h)(1)(A)) is amended by striking ‘‘The Secretary’’
and inserting ‘‘Subject to paragraphs (1) and (3)(A) of
section 1834(d), the Secretary’’.
(3) Clauses (i) and (ii) of section 1848(a)(2)(A) of
such Act (42 U.S.C. 1395w–4(a)(2)(A)) are each amended
by striking ‘‘a service’’ and inserting ‘‘a service (other
than a screening flexible sigmoidoscopy provided to an in-
dividual for the purpose of early detection of colon can-
cer)’’.
(4) Section 1862(a) of such Act (42 U.S.C. 1395y(a))
is amended—
(A) in paragraph (1)—
(i) in subparagraph (E), by striking ‘‘and’’
at the end,
(ii) in subparagraph (F), by striking the
semicolon at the end and inserting ‘‘, and’’, and
(iii) by adding at the end the following new
subparagraph:
‘‘(G) in the case of screening fecal-occult
blood 
tests 
and 
screening 
flexible
sigmoidoscopies provided for the purpose of
early detection of colon cancer, which are per-
formed more frequently than is covered under
section 1834(d);’’; and
(B) in paragraph (7), by striking ‘‘paragraph
(1)(B) or under paragraph (1)(F)’’ and inserting
‘‘subparagraphs (B), (F), or (G) of paragraph (1)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to screening fecal-occult blood tests
and screening flexible sigmoidoscopies performed on or
after January 1, 1994.
SEC. 4. COVERAGE OF CERTAIN IMMUNIZATIONS.
(a) IN GENERAL.—Section 1861(s)(10) of the Social
Security Act (42 U.S.C. 1395x(s)(10)) is amended—
(1) in subparagraph (A)—
(A) by striking ‘‘, subject to section
4071(b) of the Omnibus Budget Reconciliation
Act of 1987,’’, and
(B) by striking ‘‘; and’’ and inserting a
comma;
(2) in subparagraph (B), by striking the semi-
colon at the end and inserting ‘‘, and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(C) tetanus-diphtheria booster and its ad-
ministration;’’.
(b) 
LIMITATION
ON
FREQUENCY.—Section
1862(a)(1) of such Act (42 U.S.C. 1395y(a)(1)), as
amended by section 3(b)(4)(A), is amended—
(1) in subparagraph (F), by striking ‘‘and’’ at
the end;
(2) in subparagraph (G), by striking the semi-
colon at the end and inserting ‘‘, and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(H) in the case of an influenza vaccine,
which is administered within the 11 months
after a previous influenza vaccine, and, in the
case of a tetanus-diphtheria booster, which is
administered within the 119 months after a
previous tetanus-diphtheria booster;’’.
(c) CONFORMING AMENDMENT.—Section 1862(a)(7)
of such Act (42 U.S.C. 1395y(a)(7)), as amended by sec-
tion 3(b)(4)(B), is amended by striking ‘‘or (G)’’ and in-
serting ‘‘(G), or (H)’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to influenza vaccines and tetanus-
diphtheria boosters administered on or after January 1,
1994.
SEC. 5. COVERAGE OF WELL-CHILD CARE.
(a) IN GENERAL.—Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (O);
(2) by striking the semicolon at the end of sub-
paragraph (P) and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(Q) well-child services (as defined in sub-
section (ll)(1)) provided to an individual entitled to
benefits under this title who is under 7 years of
age;’’.
(b) SERVICES DEFINED.—Section 1861 of such Act
(42 U.S.C. 1395x) is amended—
(1) by redesignating the subsection (jj) as sub-
section (kk); and
(2) by inserting after subsection (kk) (as so re-
designated) the following new subsection:
‘‘Well-Child Services
‘‘(ll)(1) The term ‘well-child services’ means well-
child care, including routine office visits, routine immuni-
zations (including the vaccine itself), routine laboratory
tests, and preventive dental care, provided in accordance
with the periodicity schedule established with respect to
the services under paragraph (2).
‘‘(2) The Secretary, in consultation with the Amer-
ican Academy of Pediatrics, the Advisory Committee on
Immunization Practices, and other entities considered ap-
propriate by the Secretary, shall establish a schedule of