I
106TH CONGRESS
2D SESSION
H. R. 3887
To promote primary and secondary health promotion and disease prevention
services and activities among the elderly, to amend title XVIII of the
Social Security Act to add preventive benefits, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 9, 2000
Mr. LEVIN (for himself, Mr. FOLEY, Mr. PALLONE, Mr. LEACH, Mr. MORAN
of Virginia, Mr. BONIOR, and Ms. BERKLEY) introduced the following
bill; which was referred to the Committee on Commerce, and in addition
to the Committees on Ways and Means, and Rules, 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 con-
cerned
A BILL
To promote primary and secondary health promotion and
disease prevention services and activities among the el-
derly, to amend title XVIII of the Social Security Act
to add preventive benefits, 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; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Wellness Act of 2000’’.
(b) TABLE OF CONTENTS.—The table of contents is
as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Finding.
Sec. 3. Definitions.
TITLE I—HEALTHY SENIORS PROMOTION PROGRAM
Sec. 101. Healthy Seniors Promotion Program.
Sec. 102. Sense of Congress regarding the response of HCFA to preventive
health issues.
Sec. 103. Sense of Congress regarding the efforts of HCFA to study health
promotion and disease prevention for medicare beneficiaries.
Sec. 104. Sense of Congress regarding the establishment of a medicare health
promotion and disease prevention clearinghouse.
TITLE II—MEDICARE COVERAGE OF PREVENTIVE SERVICES
Sec. 201. Counseling for cessation of tobacco use.
Sec. 202. Screening for hypertension.
Sec. 203. Counseling for hormone replacement therapy.
Sec. 204. Screening for glaucoma.
Sec. 205. Screening for diminished visual acuity.
Sec. 206. Screening for hearing impairment.
Sec. 207. Screening and counseling for osteoporosis.
Sec. 208. Screening for cholesterol.
Sec. 209. Medical nutrition therapy services for beneficiaries with diabetes, a
cardiovascular disease, or a renal disease.
Sec. 210. Elimination of cost-sharing for current preventive benefits.
Sec. 211. National falls prevention education and awareness campaign.
Sec. 212. Program integrity.
TITLE III—MEDICARE HEALTH EDUCATION AND RISK APPRAISAL
PROGRAM
Sec. 301. Medicare Health Education and Risk Appraisal Program.
TITLE IV—DISEASE SELF-MANAGEMENT DEMONSTRATION
PROJECTS
Sec. 401. Disease self-management demonstration projects.
TITLE V—STUDIES AND REPORTS ADVANCING ORIGINAL RE-
SEARCH IN THE FIELD OF DISEASE PREVENTION AND THE
ELDERLY
Sec. 501. MedPAC biannual report.
Sec. 502. National Institute on Aging study and report.
Sec. 503. Institute of Medicine 5-year medicare prevention benefit study and
report.
Sec. 504. Fast-track consideration of prevention benefit legislation.
TITLE VI—CLINICAL DEPRESSION SCREENING DEMONSTRATION
PROJECTS
Sec. 601. Clinical depression screening demonstration projects.
SEC. 2. FINDING.
Congress finds that despite significant advancements
in general research for health promotion and disease pre-
vention among the elderly, there has been a failure in
translating that research into practical intervention.
SEC. 3. DEFINITIONS.
As used in this Act:
(1) 
COST-EFFECTIVE
BENEFIT.—The 
term
‘‘cost-effective benefit’’ means a benefit or technique
that has—
(A) been subject to peer review;
(B) been described in scientific journals;
and
(C) demonstrated value as measured by
unit costs relative to health outcomes achieved.
(2) COST-SAVING BENEFIT.—The term ‘‘cost-
saving benefit’’ means a benefit or technique that
has—
(A) been subject to peer review;
(B) been described in scientific journals;
and
(C) caused a net reduction in health care
costs for medicare beneficiaries.
(3) MEDICALLY EFFECTIVE.—The term ‘‘medi-
cally effective’’ means, with respect to a benefit or
technique, that the benefit or technique has been—
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal
under normal programmatic conditions.
(4) MEDICAL
EFFICACY; MEDICALLY
EFFICA-
CIOUS.—The terms ‘‘medical efficacy’’ and ‘‘medi-
cally efficacious’’ mean, with respect to a benefit or
technique, that the benefit or technique has been—
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal
under controlled conditions.
(5) 
MEDICARE
BENEFICIARY.—The 
term
‘‘medicare beneficiary’’ means any individual who is
entitled to benefits under part A or enrolled under
part B of the medicare program, including any indi-
vidual enrolled in a Medicare+Choice plan offered
by a Medicare+Choice organization under part C of
such program.
(6) MEDICARE PROGRAM.—The term ‘‘medicare
program’’ means the health benefits program under
title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.).
(7) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
TITLE I—HEALTHY SENIORS
PROMOTION PROGRAM
SEC. 101. HEALTHY SENIORS PROMOTION PROGRAM.
(a) DEFINITIONS.—As used in this section:
(1) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means an entity that the Working Group (as de-
fined in paragraph (2)) determines has dem-
onstrated expertise in research regarding health pro-
motion and disease prevention among the elderly.
(2) WORKING
GROUP.—The term ‘‘Working
Group’’ means the Healthy Seniors Working Group
established under subsection (d).
(b) PROGRAM AUTHORIZED.—The Secretary, subject
to the general policies and criteria established by the
Working Group and in accordance with the provisions of
this Act, is authorized to make grants to eligible entities
to pay for the costs of the activities described in subsection
(c).
(c) USE OF FUNDS.—An eligible entity may use pay-
ments received under this section in any fiscal year to
study—
(1) whether using different types of providers of
care who are not physicians and alternative settings
(including community-based senior centers) for the
implementation of a successful health promotion and
disease prevention strategy, including the implica-
tions regarding the payment of such providers, is
medically efficacious or medically effective;
(2) the most medically effective means of edu-
cating medicare beneficiaries and providers of serv-
ices regarding the importance of health promotion
and disease prevention among the elderly and identi-
fication of incentives that would increase the use of
new and existing preventive services and healthy be-
haviors by medicare beneficiaries; and
(3) other topics designated by the Secretary.
(d) HEALTHY SENIORS WORKING GROUP.—
(1) ESTABLISHMENT.—There is established
within the Department of Health and Human Serv-
ices a Healthy Seniors Working Group.
(2) COMPOSITION.—Subject to paragraph (3),
the Working Group established pursuant to sub-
section (b) shall be composed of 5 members as fol-
lows:
(A) The Administrator of the Health Care
Financing Administration.
(B) The Director of the Centers for Dis-
ease Control and Prevention.
(C) The Administrator of the Agency for
Health Care Policy and Research.
(D) The Assistant Secretary for Aging.
(E) The Director of the National Institute
on Aging.
(3) ALTERNATIVE MEMBERSHIP.—
(A) APPOINTMENT.—Any member of the
Working Group described in a subparagraph of
paragraph (2) may appoint an individual who is
an officer or employee of the Federal Govern-
ment to serve as a member of the Working
Group instead of the member described in such
subparagraph.
(B) DEADLINE.—If a member described in
subparagraph (A) elects to appoint an indi-
vidual under such subparagraph, such indi-
vidual shall be appointed not later than Decem-
ber 31, 2001.
(4) GENERAL
POLICIES
AND
CRITERIA.—The
Working Group shall establish general policies and
criteria with respect to the functions of the Sec-
retary under this section including—
(A) priorities for the approval of applica-
tions submitted under subsection (e);
(B) procedures for developing, monitoring,
and evaluating research efforts conducted under
this section; and
(C) such other matters as are rec-
ommended by the Working Group and approved
by the Secretary.
(5) CHAIRPERSON.—The Chairperson of the
Working Group shall be the Administrator of the
Agency for Health Care Policy and Research.
(6) QUORUM.—A majority of the members of
the Working Group shall constitute a quorum, but
a lesser number of members may hold hearings.
(7) MEETINGS.—The Working Group shall
meet at the call of the Chairperson, except that—
(A) it shall meet not less than 4 times each
year; and
(B) it shall meet whenever a majority of
the appointed members request a meeting in
writing.
(8) COMPENSATION OF MEMBERS.—Each mem-
ber of the Working Group shall be an officer or em-
ployee of the Federal Government and shall serve
without compensation in addition to that received for
their service as an officer or employee of the Federal
Government.
(e) APPLICATION.—
(1) IN GENERAL.—Each eligible entity which
desires to receive a grant under this section shall
submit an application to the Secretary, at such time,
in such manner, and accompanied by such additional
information as the Secretary may reasonably re-
quire.
(2) CONTENTS.—Each application submitted
pursuant to paragraph (1) shall—
(A) describe the activities for which assist-
ance under this section is sought;
(B) describe how the research effort pro-
posed to be conducted will reflect the medical,
behavioral, and social aspects of care for the el-
derly, lead to the development of cost-effective
benefits and cost-saving benefits, and impact
the quality of life of medicare beneficiaries;
(C) provide evidence that the eligible entity
meets the general policies and criteria estab-
lished by the Working Group pursuant to sub-
section (d)(4);
(D) provide assurances that the eligible en-
tity will take such steps as may be available to
it to continue the activities for which the eligi-
ble entity is making application after the period
for which assistance is sought; and
(E) provide such additional assurances as
the Secretary determines to be essential to en-
sure compliance with the requirements of this
Act.
(3) JOINT APPLICATION.—A consortium of eli-
gible entities may file a joint application under the
provisions of paragraph (1) of this subsection.
(f) APPROVAL
OF
APPLICATION.—The Secretary
shall approve applications in accordance with the general
policies and criteria established by the Working Group
under subsection (d)(4).
(g) PAYMENTS.—The Secretary shall pay to each eli-
gible entity having an application approved under sub-
section (f) the cost of the activities described in the appli-
cation.
(h) EVALUATION AND REPORT.—
(1) EVALUATION.—The Secretary shall conduct
an annual evaluation of grants made under this sec-
tion to determine—
(A) the results of the overall applied re-
search conducted under this Act;
(B) the extent to which research assisted
under this section has improved or expanded
the general research for health promotion and
disease prevention among the elderly and identi-
fied practical interventions based upon such re-
search;
(C) a list of specific recommendations
based upon research conducted under this sec-
tion which show promise as practical interven-
tions for health promotion and disease preven-
tion among the elderly;
(D) whether or not as a result of the ap-
plied research effort certain health promotion
and disease prevention benefits or education ef-
forts should be added to the medicare program,
including discussions of quality of life, trans-
lating the applied research results into a benefit
under the medicare program, and whether each
additional benefit would be a cost-effective ben-
efit or a cost-saving benefit for each proposed
addition;
(E) the utility of, potential for, and issues
surrounding health risk appraisals sponsored
under the medicare program and targeted fol-
lowup; and
(F) how best to increase utilization of ex-
isting and recommended health promotion and
disease prevention services, including an edu-
cation and public awareness component discus-
sion of financial incentives for providers of serv-
ices and medicare beneficiaries to improve utili-
zation and other administrative means of in-
creasing utilization.
(2) ANNUAL REPORT.—Not later than Decem-
ber 31, 2002, and each year thereafter through
2005, the Secretary shall submit a report to Con-
gress based on the annual studies made under para-
graph (1), which shall contain a detailed statement
of the findings and conclusions of the Working
Group together with its recommendations for such
legislation and administrative actions as it considers
appropriate.
(i) AUTHORIZATION
OF APPROPRIATIONS.—There
are authorized to be appropriated $40,000,000 for each
of the fiscal years 2001, 2002, 2003, and 2004 to carry
out the provisions of this section.
SEC. 102. SENSE OF CONGRESS REGARDING THE RESPONSE
OF HCFA TO PREVENTIVE HEALTH ISSUES.
It is the sense of Congress that in administering the
medicare program the Secretary should ensure that the
Administrator of the Health Care Financing Administra-
tion encourages the inclusion of preventive measures as
part of all treatments described in such program.
SEC. 103. SENSE OF CONGRESS REGARDING THE EFFORTS
OF HCFA TO STUDY HEALTH PROMOTION
AND DISEASE PREVENTION FOR MEDICARE
BENEFICIARIES.
It is the sense of Congress that the Secretary should
ensure that the Administrator of the Health Care Financ-
ing Administration expands the study of the most prom-
ising behavioral modification of risk factors associated
with health promotion and disease prevention for all medi-
care beneficiaries.
SEC. 104. SENSE OF CONGRESS REGARDING THE ESTAB-
LISHMENT OF A MEDICARE HEALTH PRO-
MOTION AND DISEASE PREVENTION CLEAR-
INGHOUSE.
It is the sense of Congress that the National Library
of Medicine should collect information regarding innova-
tive and successful health promotion and disease preven-
tion interventions from both published and unpublished
sources, establish a clearinghouse targeting all medicare
beneficiaries in a variety of settings for the consolidation
and coordination of all such information, and make the
clearinghouse available to the public and accessible
through the Internet.
TITLE II—MEDICARE COVERAGE
OF PREVENTIVE SERVICES
SEC. 201. COUNSELING FOR CESSATION OF TOBACCO USE.
(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) counseling for cessation of tobacco use (as
defined in subsection (uu)) for individuals who have
a history of tobacco use;’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) is amended by adding at the end
the following new subsection:
‘‘Counseling for Cessation of Tobacco Use
‘‘(uu)(1) Except as provided in paragraph (2), the
term ‘counseling for cessation of tobacco use’ means diag-
nostic, therapy, and counseling services for cessation of
tobacco use which are furnished—
‘‘(A) by or under the supervision of a physician;
or
‘‘(B) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.
‘‘(2) The term ‘counseling for cessation of tobacco
use’ does not include coverage for drugs or biologicals that
are not otherwise covered under this title.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—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 counseling for cessation of tobacco use (as
defined in section 1861(uu)), the amount paid
shall be 100 percent of the lesser of the actual
charge for the services or the amount deter-
mined by a fee schedule established by the Sec-
retary for the purposes of this subparagraph’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) is amended—
(A) by striking ‘‘and’’ before ‘‘(6)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (7) such deductible shall not
apply with respect to counseling for cessation of
tobacco use (as defined in section 1861(uu))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 202. SCREENING FOR HYPERTENSION.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 201(a)) is amended—
(1) in subparagraph (T), by striking ‘‘and’’ at
the end;
(2) in subparagraph (U), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(V) screening for hypertension (as defined in
subsection (vv)) not more frequently than once every
2 years for individuals with normotensive blood pres-
sure measurements and annually for individuals with
blood 
pressure 
measurements 
that 
are 
not
normotensive;’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 201(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening for Hypertension
‘‘(vv) The term ‘screening for hypertension’ means di-
agnostic services for hypertension which are furnished—
‘‘(1) by or under the supervision of a physician;
or
‘‘(2) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 201(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(T)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (U) with respect
to screening for hypertension (as defined in sec-
tion 1861(vv)), the amount paid shall be 100
percent of the lesser of the actual charge for
the services or the amount determined by a fee
schedule established by the Secretary for the
purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 201(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(7)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (8) such deductible shall not
apply with respect to screening for hypertension
(as defined in section 1861(vv))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 203. COUNSELING FOR HORMONE REPLACEMENT
THERAPY.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 202(a)) is amended—
(1) in subparagraph (U), by striking ‘‘and’’ at
the end;
(2) in subparagraph (V), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(W) counseling for hormone replacement ther-
apy (as defined in subsection (ww));’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 202(b))
is amended by adding at the end the following new sub-
section:
‘‘Counseling for Hormone Replacement Therapy
‘‘(ww)(1) Except as provided in paragraph (2), the
term ‘counseling for hormone replacement therapy’ means
diagnostic, therapy, and counseling services for hormone
replacement which are furnished—
‘‘(A) by or under the supervision of a physician;
or
‘‘(B) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.
‘‘(2) The term ‘counseling for hormone replacement
therapy’ does not include coverage for drugs or biologicals
that are not otherwise covered under this title.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 202(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(U)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (V) with respect
to counseling for hormone replacement therapy
(as defined in section 1861(ww)), the amount
paid shall be 100 percent of the lesser of the
actual charge for the services or the amount de-
termined by a fee schedule established by the
Secretary for the purposes of this subpara-
graph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 202(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(8)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (9) such deductible shall not
apply with respect to counseling for hormone
replacement therapy (as defined in section
1861(ww))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 204. SCREENING FOR GLAUCOMA.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 203(a)) is amended—
(1) in subparagraph (V), by striking ‘‘and’’ at
the end;
(2) in subparagraph (W), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(X) screening for glaucoma (as defined in sub-
section (xx)) for individuals determined to be at high
risk for glaucoma, individuals with a family history
of glaucoma, and individuals with diabetes or myo-
pia;’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 203(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening for Glaucoma
‘‘(xx) The term ‘screening for glaucoma’ means a di-
lated eye examination with an intraocular pressure meas-
urement, and a direct ophthalmoscopy or a slit-lamp bio-
microscopic examination for the early detection of glau-
coma which is furnished by or under the supervision of
an optometrist or ophthalmologist who is legally author-
ized to furnish such services under State law (or the State
regulatory mechanism provided by State law) of the State
in which the services are furnished, as would otherwise
be covered if furnished by a physician or as an incident
to a physician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 203(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(V)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (W) with respect
to screening for glaucoma (as defined in section
1861(xx)), the amount paid shall be 100 per-
cent of the lesser of the actual charge for the
services or amount determined by a fee schedule
established by the Secretary for the purposes of
this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 203(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(9)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (10) such deductible shall not
apply with respect to screening for glaucoma
(as defined in section 1861(xx))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 205. SCREENING FOR DIMINISHED VISUAL ACUITY.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 204(a)) is amended—
(1) in subparagraph (W), by striking ‘‘and’’ at
the end;
(2) in subparagraph (X), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(Y) screening for diminished visual acuity (as
defined in subsection (yy));’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 204(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening for Diminished Visual Acuity
‘‘(yy) The term ‘screening for diminished visual acu-
ity’ means diagnostic services for screening for diminished
visual acuity which are furnished by or under the super-
vision of an optometrist or ophthalmologist who is legally
authorized to furnish such services under State law (or
the State regulatory mechanism provided by State law) of
the State in which the services are furnished, as would
otherwise be covered if furnished by a physician or as an
incident to a physician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 204(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(W)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (X) with respect
to screening for diminished visual acuity (as de-
fined in section 1861(yy)), the amount paid
shall be 100 percent of the lesser of the actual
charge for the services or the amount deter-
mined by a fee schedule established by the Sec-
retary for the purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 204(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(10)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (11) such deductible shall not
apply with respect to screening for diminished
visual acuity (as defined in section 1861(yy))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 206. SCREENING FOR HEARING IMPAIRMENT.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 205(a)) is amended—
(1) in subparagraph (X), by striking ‘‘and’’ at
the end;
(2) in subparagraph (Y), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(Z) screening for hearing impairment (as de-
fined in subsection (zz));’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 205(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening for Hearing Impairment
‘‘(zz) The term ‘screening for hearing impairment’
means diagnostic services for hearing impairment by use
of periodic questions, otoscopic examination and audio
metric testing if such questions indicate potential hearing
impairment, and counseling about hearing aid devices
which are furnished—
‘‘(1) by or under the supervision of a physician;
or
‘‘(2) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 205(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(X)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (Y) with respect
to screening for hearing impairment (as defined
in section 1861(zz)), the amount paid shall be
100 percent of the lesser of the actual charge
for the services or the amount determined by a
fee schedule established by the Secretary for the
purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 205(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(11)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (12) such deductible shall not
apply with respect to screening for hearing im-
pairment (as defined in section 1861(zz))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 
207. 
SCREENING 
AND 
COUNSELING 
FOR
OSTEOPOROSIS.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 206(a)) is amended—
(1) in subparagraph (Y), by striking ‘‘and’’ at
the end;
(2) in subparagraph (Z), by inserting ‘‘and’’ at
the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(AA) screening and counseling for osteoporosis
(as defined in subsection (aaa)) for—
‘‘(i) women; and
‘‘(ii) men with fractures;’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 206(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening and Counseling for Osteoporosis
‘‘(aaa) The term ‘screening and counseling for
osteoporosis’ means diagnostic and counseling services for
osteoporosis in addition to a bone mass measurement (as
defined in subsection (rr)) which are furnished in accord-
ance with methods approved by the Food and Drug
Administration—
‘‘(1) by or under the supervision of a physician;
or
‘‘(2) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 206(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(Y)’’; and
(B) by inserting before the semicolon at
the end and inserting the following: ‘‘, and (Z)
with respect to screening and counseling for
osteoporosis (as defined in section 1861(aaa)),
the amount paid shall be 100 percent of the
lesser of the actual charge for the services or
the amount determined by a fee schedule estab-
lished by the Secretary for the purposes of this
subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 206(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(12)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (13) such deductible shall not
apply with respect to screening and counseling
for 
osteoporosis 
(as 
defined 
in 
section
1861(aaa))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 208. SCREENING FOR CHOLESTEROL.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 207(a)) is amended—
(1) in subparagraph (Z), by striking ‘‘and’’ at
the end;
(2) in subparagraph (AA), by inserting ‘‘and’’
at the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(BB) screening for cholesterol (as defined in
subsection (bbb)) for individuals between the ages of
65 and 75 that exhibit major risk factors for coro-
nary heart disease, including smoking, hypertension,
and diabetes;’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) (as amended by section 207(b))
is amended by adding at the end the following new sub-
section:
‘‘Screening for Cholesterol
‘‘(bbb) The term ‘screening for cholesterol’ means di-
agnostic services for cholesterol that are furnished—
‘‘(1) by or under the supervision of a physician;
or
‘‘(2) by any other health care professional who
is legally authorized to furnish such services under
State law (or the State regulatory mechanism pro-
vided by State law) of the State in which the serv-
ices are furnished, as would otherwise be covered if
furnished by a physician or as an incident to a phy-
sician’s professional service.’’.
(c) ELIMINATION OF COST-SHARING.—
(1) ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 207(c)(1)) is amended—
(A) by striking ‘‘and’’ before ‘‘(Z)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (AA) with respect
to screening for cholesterol (as defined in sec-
tion 1861(bbb)), the amount paid shall be 100
percent of the lesser of the actual charge for
the services or the amount determined by a fee
schedule established by the Secretary for the
purposes of this subparagraph;’’.
(2) ELIMINATION OF DEDUCTIBLE.—The first
sentence of section 1833(b) of such Act (42 U.S.C.
1395l(b)) (as amended by section 207(c)(2)) is
amended—
(A) by striking ‘‘and’’ before ‘‘(13)’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, and (14) such deductible shall not
apply with respect to screening and counseling
for 
osteoporosis 
(as 
defined 
in 
section
1861(bbb))’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 209. MEDICAL NUTRITION THERAPY SERVICES FOR
BENEFICIARIES WITH DIABETES, A CARDIO-
VASCULAR DISEASE, OR A RENAL DISEASE.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec-
tion 208(a)) is amended—
(1) in subparagraph (AA) by striking ‘‘and’’ at
the end;
(2) in subparagraph (BB) by inserting ‘‘and’’
at the end; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(CC) medical nutrition therapy services (as de-
fined in subsection (ccc)(1)) in the case of a bene-
ficiary with diabetes, a cardiovascular disease (in-
cluding congestive heart failure, arteriosclerosis,
hyperlipidemia, 
hypertension, 
and
hypercholesterolemia), or a renal disease;’’.
(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x) (as amended by sec-
tion 208(b)) is amended by adding at the end the following
new subsection:
‘‘Medical Nutrition Therapy Services; Registered
Dietitian or Nutrition Professional
‘‘(ccc)(1) The term ‘medical nutrition therapy serv-
ices’ means nutritional diagnostic, therapy, and counseling
services which are furnished by a registered dietitian or
nutrition professional (as defined in paragraph (2)) pursu-
ant to a referral by a physician.
‘‘(2) Subject to paragraph (3), the term ‘registered
dietitian or nutrition professional’ means an individual
who—
‘‘(A) holds a baccalaureate or higher degree
granted by a regionally accredited college or univer-
sity in the United States (or an equivalent foreign
degree) with completion of the academic require-
ments of a program in nutrition or dietetics, as ac-
credited by an appropriate national accreditation or-
ganization recognized by the Secretary for this pur-
pose;
‘‘(B) has completed at least 900 hours of super-
vised dietetics practice under the supervision of a
registered dietitian or nutrition professional; and
‘‘(C)(i) is licensed or certified as a dietitian or
nutrition professional by the State in which the serv-
ices are performed; or
‘‘(ii) in the case of an individual in a State that
does not provide for such licensure or certification,
meets such other criteria as the Secretary estab-
lishes.
‘‘(3) Subparagraphs (A) and (B) of paragraph (2)
shall not apply in the case of an individual who, as of the
date of enactment of this subsection, is licensed or cer-
tified as a dietitian or nutrition professional by the State
in which medical nutrition therapy services are per-
formed.’’.
(c) 
ELIMINATION
OF
COINSURANCE.—Section
1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) (as
amended by section 208(c)(1)) is amended—
(1) by striking ‘‘and’’ before ‘‘(AA)’’; and
(2) by inserting before the semicolon at the end
the following: ‘‘, and (BB) with respect to medical
nutrition therapy services (as defined in section
1861(ccc)), the amount paid shall be 85 percent of
the lesser of the actual charge for the services or the
amount determined under the fee schedule estab-
lished under section 1848(b) for the same services if
furnished by a physician’’.
(d) EFFECTIVE DATE.—The amendments made by
this section apply to services furnished on or after Janu-
ary 1, 2002.
SEC. 210. ELIMINATION OF COST-SHARING FOR CURRENT
PREVENTIVE BENEFITS.
(a) WAIVER OF COINSURANCE AND DEDUCTIBLES.—
(1) IN GENERAL.—Section 1834 of the Social
Security Act (42 U.S.C. 1395m) is amended by add-
ing at the end the following new subsection:
‘‘(m) WAIVER OF COINSURANCE AND DEDUCTIBLE
FOR PREVENTIVE SERVICES.—
‘‘(1) COINSURANCE.—
‘‘(A) IN GENERAL.—Notwithstanding any
other provision of this part—
‘‘(i) the Secretary shall waive any co-
insurance applicable to services described
in subparagraph (B); and
‘‘(ii) with respect to payment for such
services, any reference to a percent that is
less than 100 percent shall be deemed to
be a reference to 100 percent.
‘‘(B) SERVICES DESCRIBED.—The services
described in this subparagraph are the following
services:
‘‘(i) Screening mammography (as de-
fined in section 1861(jj)).
‘‘(ii) Screening pelvic exam (as de-
fined in section 1861(nn)(2)).
‘‘(iii) Hepatitis B vaccine and its ad-
ministration 
(under 
section
1861(s)(10)(B)).
‘‘(iv) Colorectal cancer screening test
(as defined in section 1861(pp)).
‘‘(v) Bone mass measurement (as de-
fined in section 1861(rr)).
‘‘(vi) Prostate cancer screening test
(as defined in section 1861(oo)).
‘‘(vii) Diabetes outpatient self-man-
agement training services (as defined in
section 1861(qq)).
‘‘(2) DEDUCTIBLE.—
‘‘(A) IN GENERAL.—Notwithstanding any
other provision of this part, the deductible de-
scribed in section 1833(b) shall not apply with
respect to services described in subparagraph
(B).
‘‘(B) SERVICES DESCRIBED.—The services
described in this subparagraph are the following
services:
‘‘(i) Hepatitis B vaccine and its ad-
ministration 
(under 
section
1861(s)(10)(B)).
‘‘(ii) Colorectal cancer screening test
(as defined in section 1861(pp)).
‘‘(iii) Bone mass measurement (as de-
fined in section 1861(rr)).
‘‘(iv) Prostate cancer screening test
(as defined in section 1861(oo)).
‘‘(v) Diabetes outpatient self-manage-
ment training services (as defined in sec-
tion 1861(qq)).’’.
(2) 
CONFORMING
AMENDMENT.—Section
1833(a) of the Social Security Act (42 U.S.C.
1395l(a)) is amended by striking ‘‘section 1876’’
and inserting ‘‘sections 1834 and 1876’’ in the mat-
ter preceding paragraph (1).
(b) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 2002.
SEC. 211. NATIONAL FALLS PREVENTION EDUCATION AND
AWARENESS CAMPAIGN.
The Secretary, in consultation with the Director of
the Centers for Disease Control and Prevention, shall con-
duct a national falls prevention and awareness campaign
to reduce fall-related injuries among medicare bene-
ficiaries.
SEC. 212. PROGRAM INTEGRITY.
The Secretary, in consultation with the Inspector
General of the Department of Health and Human Serv-
ices, shall integrate the benefits described in sections 201
through 208 with existing program integrity measures.
TITLE III—MEDICARE HEALTH
EDUCATION 
AND 
RISK 
AP-
PRAISAL PROGRAM
SEC. 301. MEDICARE HEALTH EDUCATION AND RISK AP-
PRAISAL PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) is amended by adding at the end the fol-
lowing new section:
‘‘MEDICARE HEALTH EDUCATION AND RISK APPRAISAL
PROGRAM
‘‘SEC. 1897. (a) ESTABLISHMENT.—The Secretary,
in consultation with the Director of the Centers for Dis-
ease Control and Prevention, the Administrator of the
Agency for Health Care Policy and Research, and the Ad-
ministrator of the Health Care Financing Administration,
shall establish a health education and risk appraisal pro-
gram to inform the target individuals described in sub-
section (b) of the major behavioral risk factors described
in subsection (c) through the self-assessment described in
subsection (d) and shall conduct the periodic followup de-
scribed in subsection (e).
‘‘(b) TARGET INDIVIDUALS.—The target individuals
described in this subsection are the following:
‘‘(1) MEDICARE
BENEFICIARIES.—Individuals
that are beneficiaries under this title.
‘‘(2) INDIVIDUALS BETWEEN THE AGES OF 50
AND 64.—Individuals between the ages of 50 and 64.
‘‘(c) MAJOR
BEHAVIORAL
RISK
FACTORS.—The
major behavioral risk factors described in this subsection
include—
‘‘(1) the lack of proper nutrition;
‘‘(2) the use of alcohol;
‘‘(3) the lack of regular exercise;
‘‘(4) the use of tobacco;
‘‘(5) depression; and
‘‘(6) other risk factors identified by the Sec-
retary.
‘‘(d) SELF-ASSESSMENT.—
‘‘(1) IN
GENERAL.—The self-assessment de-
scribed in this subsection is a form delivered by the
Secretary to each target individual that—
‘‘(A) includes questions regarding major
behavioral risk factors;
‘‘(B) requests that such individual answer
the questions and return the form to the Sec-
retary; and
‘‘(C) is then assessed using—
‘‘(i) knowledge coupling computer
software that assesses overall health risks
and then provides options for management
of identified risk factors;
‘‘(ii) nurse hotlines; and
‘‘(iii) case managers as the Secretary
determines appropriate.
‘‘(2) INDIVIDUALS BETWEEN THE AGES OF 50
AND 64.—With respect to the target individuals de-
scribed in subsection (b)(2), the Secretary shall co-
ordinate the delivery of the self-assessment form
with the issuance of the statement described in sec-
tion 1143(c)(2).
‘‘(e) PERIODIC FOLLOWUP.—
‘‘(1) MEDICARE BENEFICIARIES.—Not less fre-
quently than once every 2 years, the Secretary shall
conduct periodic followup appraisals with respect to
the target individuals described in subsection (b)(1)
to reduce major behavioral risk factors described in
subsection (c)—
‘‘(A) by providing such individuals with—
‘‘(i) information regarding the results
of the self-administered risk appraisal;
‘‘(ii) recommendations regarding be-
havior modifications based on such ap-
praisal; and
‘‘(iii) information regarding any need
for further assessment or treatment; and
‘‘(B) by providing the information de-
scribed in subparagraph (A) to the provider
designated by such individual to receive such in-
formation.
‘‘(2) INDIVIDUALS BETWEEN THE AGES OF 50
AND 64.—The Secretary shall conduct such periodic
followup appraisals with respect to the target indi-
viduals described in subsection (b)(2) as the Sec-
retary determines appropriate.’’.
TITLE IV—DISEASE SELF-MAN-
AGEMENT 
DEMONSTRATION
PROJECTS
SEC. 401. DISEASE SELF-MANAGEMENT DEMONSTRATION
PROJECTS.
(a) DEMONSTRATION PROJECTS.—
(1) 
IN
GENERAL.—The 
Secretary, 
acting
through the Administrator of the Health Care Fi-
nancing Administration, shall conduct demonstration
projects for the purpose of promoting disease self-
management for conditions identified by the working
group established under paragraph (2) for target in-
dividuals (as defined in paragraph (3)).
(2) DISEASE
SELF-MANAGEMENT
WORKING
GROUP.—
(A) ESTABLISHMENT.—There is estab-
lished within the Department of Health and
Human Services a Disease Self-Management
Working Group.
(B) COMPOSITION.—The Disease Self-
Management Working Group established under
subparagraph (A) shall be composed of 4 mem-
bers as follows:
(i) The Administrator of the Health
Care Financing Administration.
(ii) The Director of the Centers for
Disease Control and Prevention.
(iii) The Administrator of the Agency
for Health Care Policy and Research.
(iv) The Director of the Administra-
tion on Aging.
(C) GENERAL POLICIES AND CRITERIA.—
The Disease Self-Management Working Group
established under paragraph (1) shall establish
general policies and criteria with respect to the
functions of the Secretary under this section
including—
(i) the identification of conditions for
which a demonstration project may be im-
plemented;
(ii) the prioritization of the conditions
identified under clause (i) based on poten-
tial of self-management of such condition
to be medically effective and for such self-
management to be a cost-effective benefit
or cost-saving benefit, as those terms are
defined in section 3 of this Act;
(iii) the identification of target indi-
viduals;
(iv) the development of procedures for
selecting areas in which a demonstration
project may be implemented; and
(v) such other matters as are rec-
ommended by the Disease Self-Manage-
ment Working Group and approved by the
Secretary.
(3) TARGET
INDIVIDUAL
DEFINED.—In this
section, the term ‘‘target individual’’ means an indi-
vidual that is at risk for or has a condition identified
by the working group described under paragraph (2)
and is eligible for benefits under the fee-for-service
program under parts A and B of title XVIII of the
Social Security Act (42 U.S.C. 1395c et seq.; 1395j
et seq.) or is enrolled under the Medicare+Choice
program under part C of title XVIII of such Act (42
U.S.C. 1395w–21 et seq.).
(b) NUMBER, PROJECT AREAS, AND DURATION.—
(1) NUMBER.—Not later than 2 years after the
date of enactment of this Act, the Secretary shall
implement a series of demonstration projects.
(2) PROJECT
AREAS.—The Secretary, acting
through the Administrator of the Health Care Fi-
nancing Administration, shall implement the dem-
onstration projects described in paragraph (1) in
urban, suburban, and rural areas.
(3) DURATION.—The demonstration projects
under this section shall be conducted for a period of
3 years, beginning on the date on which the Sec-
retary implements the initial demonstration project.
(c) REPORTS TO CONGRESS.—
(1) ANNUAL REPORTS.—
(A) IN GENERAL.—Not later than 1 year
after the Secretary implements the initial dem-
onstration project under this section, and bian-
nually thereafter, the Secretary shall submit to
Congress a report regarding the demonstration
projects conducted under this section.
(B) CONTENTS OF REPORT.—The report
in subparagraph (A) shall include the following:
(i) A description of the demonstration
projects conducted under this section.
(ii) An evaluation of—
(I) whether each benefit provided
under the demonstration project is a
cost-effective benefit or a cost-saving
benefit;
(II) the level of the disease self-
management attained by target indi-
viduals 
under 
the 
demonstration
projects; and
(III) the satisfaction of target in-
dividuals under the demonstration
project.
(iii) Any other information regarding
the 
demonstration 
projects 
conducted
under this section that the Secretary deter-
mines to be appropriate.
(2) FINAL
REPORT.—Not later than 1 year
after the conclusion of the demonstration projects
under this section, the Secretary shall submit a final
report to Congress on the demonstration projects
conducted under this section containing the rec-
ommendations of the Secretary regarding whether to
conduct the demonstration projects on a permanent
basis, together with such recommendations for legis-
lation and administrative action as the Secretary
considers appropriate.
(d) FUNDING.—The Secretary shall provide for the
transfer from the Federal Hospital Insurance Trust Fund
under section 1817 of the Social Security Act (42 U.S.C.
1395i) an amount not to exceed $30,000,000 for the costs
of carrying out the demonstration projects under this sec-
tion, establishing the Disease Self-Management Working
Group under subsection (a)(2), and submitting the reports
to Congress under subsection (c).
TITLE 
V—STUDIES 
AND 
RE-
PORTS ADVANCING ORIGINAL
RESEARCH IN THE FIELD OF
DISEASE 
PREVENTION 
AND
THE ELDERLY
SEC. 501. MEDPAC BIANNUAL REPORT.
(a) IN GENERAL.—Section 1805(b) of the Social Se-
curity Act (42 U.S.C. 1395b–6(b)) is amended—
(1) in paragraph (1)—
(A) in subparagraph (C), by striking
‘‘and’’ at the end;
(B) in subparagraph (D), by striking the
period and inserting ‘‘; and’’; and
(C) by adding at the end the following new
subparagraph:
‘‘(E) by not later than January 1, 2002,
and biannually thereafter, submit the report to
Congress described in paragraph (7).’’; and
(2) by adding at the end the following new
paragraph:
‘‘(7) EVALUATION OF ACTUARIAL EQUIVALENCE
OF MEDICARE AND PRIVATE SECTOR BENEFIT PACK-
AGES.—
‘‘(A) 
EVALUATION.—The 
Commission
shall—
‘‘(i) evaluate the benefit package of-
fered under the medicare program under
this title; and
‘‘(ii) determine the degree to which
such benefit package is actuarially equiva-
lent to that offered by health benefit pro-
grams available in the private sector to in-
dividuals over age 65.
‘‘(B) REPORT.—The Commission shall
submit a report to Congress that shall
contain—
‘‘(i) a detailed statement of the find-
ings and conclusions of the Commission re-
garding the evaluation conducted under
subparagraph (A);
‘‘(ii) the recommendations of the
Commission regarding changes in the ben-
efit package offered under the medicare
program under this title that would keep
the program modern and competitive in re-
lation to health benefit programs available
in the private sector; and
‘‘(iii) the recommendations of the
Commission for such legislation and ad-
ministrative actions as it considers appro-
priate.’’.
(b) EFFECTIVE DATE.—The amendments made by
this section shall take effect on the date of enactment of
this Act.
SEC. 502. NATIONAL INSTITUTE ON AGING STUDY AND RE-
PORT.
(a) STUDIES.—The Director of the National Institute
on Aging shall conduct 1 or more studies focusing on ways
to—
(1) improve quality of life for the elderly;
(2) develop better ways to prevent or delay the
onset of age-related functional decline and disease
and disability among the elderly; and
(3) develop means of assessing the long-term
development of cost-effective benefits and cost-sav-
ings benefits for health promotion and disease pre-
vention among the elderly.
(b) REPORT.—Not later than January 1, 2006, the
Director of the National Institute on Aging shall submit
a report to the Secretary regarding each study conducted
under subsection (a) and containing a detailed statement
of research findings and conclusions that are scientifically
valid and are demonstrated to prevent or delay the onset
of chronic illness or disability among the elderly.
(c) TRANSMISSION TO INSTITUTE OF MEDICINE.—
Upon receipt of each report described in subsection (b),
the Secretary shall transmit such report to the Institute
of Medicine of the National Academy of Sciences for con-
sideration in its effort to conduct the comprehensive study
of current literature and best practices in the field of
health promotion and disease prevention among the medi-
care beneficiaries described in section 503.
(d) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—There are authorized to be
appropriated $100,000,000 for fiscal years 2001
through 2006 to carry out the purposes of this sec-
tion.
(2) AVAILABILITY.—Any sums appropriated
under the authorization contained in this subsection
shall remain available, without fiscal year limitation,
until September 30, 2005.
SEC. 503. INSTITUTE OF MEDICINE 5-YEAR MEDICARE PRE-
VENTION BENEFIT STUDY AND REPORT.
(a) STUDY.—
(1) IN GENERAL.—The Secretary shall contract
with the Institute of Medicine of the National Acad-
emy of Sciences to conduct a comprehensive study of
current literature and best practices in the field of
health promotion and disease prevention among
medicare beneficiaries including the issues described
in paragraph (2) and to submit the report described
in subsection (b).
(2) ISSUES
STUDIED.—The study required
under paragraph (1) shall include an assessment
of—
(A) whether each covered benefit is—
(i) medically effective; and
(ii) a cost-effective benefit or a cost-
saving benefit;
(B) utilization of covered benefits (includ-
ing any barriers to or incentives to increase uti-
lization); and
(C) quality of life issues associated with
both health promotion and disease prevention
benefits covered under the medicare program
and those that are not covered under such pro-
gram that would affect all medicare bene-
ficiaries.
(b) REPORT.—
(1) IN GENERAL.—Not later than 5 years after
the date of enactment of this section, and every fifth
year thereafter, the Institute of Medicine of the Na-
tional Academy of Sciences shall submit to the
President a report that contains a detailed state-
ment of the findings and conclusions of the study
conducted under subsection (a) and the rec-
ommendations for legislation described in paragraph
(2).
(2) RECOMMENDATIONS
FOR
LEGISLATION.—
The Institute of Medicine of the National Academy
of Sciences, in consultation with the Partnership for
Prevention, shall develop recommendations in legis-
lative form that—
(A) prioritize the preventive benefits under
the medicare program; and
(B) modify preventive benefits offered
under the medicare program based on the study
conducted under subsection (a).
(c) TRANSMISSION TO CONGRESS.—
(1) IN GENERAL.—On the day on which the re-
port described in subsection (b) is submitted to the
President, the President shall transmit the report
and recommendations in legislative form described in
subsection (b)(2) to Congress.
(2) DELIVERY.—Copies of the report and rec-
ommendations in legislative form required to be
transmitted to Congress under paragraph (1) shall
be delivered—
(A) to both Houses of Congress on the
same day;
(B) to the Clerk of the House of Rep-
resentatives if the House is not in session; and
(C) to the Secretary of the Senate if the
Senate is not in session.
SEC. 504. FAST-TRACK CONSIDERATION OF PREVENTION
BENEFIT LEGISLATION.
(a) RULES OF HOUSE OF REPRESENTATIVES AND
SENATE.—This section is enacted by Congress—
(1) as an exercise of the rulemaking power of
the House of Representatives and the Senate, re-
spectively, and is deemed a part of the rules of each
House of Congress, but—
(A) is applicable only with respect to the
procedure to be followed in that House of Con-
gress in the case of an implementing bill (as de-
fined in subsection (d)); and
(B) supersedes other rules only to the ex-
tent that such rules are inconsistent with this
section; and
(2) with full recognition of the constitutional
right of either House of Congress to change the
rules (so far as relating to the procedure of that
House of Congress) at any time, in the same man-
ner and to the same extent as in the case of any
other rule of that House of Congress.
(b) INTRODUCTION AND REFERRAL.—
(1) INTRODUCTION.—
(A) IN GENERAL.—Subject to paragraph
(2), on the day on which the President trans-
mits the report pursuant to section 503(c) to
the House of Representatives and the Senate,
the recommendations in legislative form trans-
mitted by the President with respect to such re-
port shall be introduced as a bill (by request)
in the following manner:
(i) HOUSE OF REPRESENTATIVES.—In
the House of Representatives, by the Ma-
jority Leader, for himself and the Minority
Leader, or by Members of the House of
Representatives designated by the Majority
Leader and Minority Leader.
(ii) SENATE.—In the Senate, by the
Majority Leader, for himself and the Mi-
nority Leader, or by Members of the Sen-
ate designated by the Majority Leader and
Minority Leader.
(B) SPECIAL
RULE.—If either House of
Congress is not in session on the day on which
such recommendations in legislative form are
transmitted, the recommendations in legislative
form shall be introduced as a bill in that House
of Congress, as provided in subparagraph (A),
on the first day thereafter on which that House
of Congress is in session.
(2) REFERRAL.—Such bills shall be referred by
the presiding officers of the respective Houses to the
appropriate committee, or, in the case of a bill con-
taining provisions within the jurisdiction of 2 or
more committees, jointly to such committees for con-
sideration of those provisions within their respective
jurisdictions.
(c) CONSIDERATION.—After the recommendations in
legislative form have been introduced as a bill and referred
under subsection (b), such implementing bill shall be con-
sidered in the same manner as an implementing bill is con-
sidered under subsections (d), (e), (f), and (g) of section
151 of the Trade Act of 1974 (19 U.S.C. 2191).
(d) IMPLEMENTING BILL DEFINED.—In this section,
the term ‘‘implementing bill’’ means only the recommenda-
tions in legislative form of the Institute of Medicine of the
National Academy of Sciences described in section
503(b)(2), transmitted by the President to the House of
Representatives and the Senate under subsection 503(c),
and introduced and referred as provided in subsection (b)
as a bill of either House of Congress.
(e) COUNTING OF DAYS.—For purposes of this sec-
tion, any period of days referred to in section 151 of the
Trade Act of 1974 shall be computed by excluding—
(1) the days on which either House of Congress
is not in session because of an adjournment of more
than 3 days to a day certain or an adjournment of
Congress sine die; and
(2) any Saturday and Sunday, not excluded
under paragraph (1), when either House is not in
session.
TITLE 
VI—CLINICAL 
DEPRES-
SION 
SCREENING 
DEM-
ONSTRATION PROJECTS
SEC. 601. CLINICAL DEPRESSION SCREENING DEMONSTRA-
TION PROJECTS.
(a) DEMONSTRATION PROJECTS.—
(1) 
IN
GENERAL.—The 
Secretary, 
acting
through the Administrator of the Health Care Fi-
nancing Administration, shall conduct demonstration
projects for the purpose of evaluating the efficacy of
providing annual screenings for clinical depression
as a benefit under the medicare program.
(2) ANNUAL
SCREENING
FOR
CLINICAL
DE-
PRESSION DEFINED.—For purposes of this section,
the term ‘‘annual screening for clinical depression’’
means the following, conducted with respect to a
medicare beneficiary no more frequently than annu-
ally:
(A) A self-administered written screening
test (using an instrument to be chosen and dis-
tributed by the Secretary at least 3 months be-
fore date that benefits are first provided under
demonstration projects under this section)
which asks questions to establish a beneficiary’s
risk of clinical depression.
(B) After administering such a test, a con-
sultation as a followup to such a test with a
physician, nurse practitioner, or mental health
professional licensed under State law to deter-
mine whether the beneficiary has or is at high
risk of developing clinical depression.
(C) If the health care professional deter-
mines that the beneficiary is at high risk, a re-
ferral of the beneficiary to a physician or men-
tal health professional for a full diagnostic eval-
uation.
(3) PAYMENT
LEVEL.—The reimbursement
level for health care professionals will be set by the
Secretary in accordance with generally accepted pay-
ment levels for the type of service involved and shall
not require payment of any deductibles or coinsur-
ance.
(b) NUMBER, PROJECT AREAS, AND DURATION.—
(1) NUMBER.—Not later than 1 year after the
date of enactment of this Act, the Secretary shall
implement no fewer than 6, and no more than 10,
demonstration projects under this section.
(2) PROJECT
AREAS.—The Secretary, acting
through the Administrator of the Health Care Fi-
nancing Administration, shall implement the dem-
onstration projects described in paragraph (1) in
urban, suburban, and rural areas. Areas are to be
chosen in a manner that fosters geographic diversity
and a mix of screening sites (including doctors’ of-
fices, mental health clinics, and nursing homes) and
that gives preference to areas with a high concentra-
tion of medicare beneficiaries.
(3) DURATION.—The demonstration projects
under this section shall be conducted for a period of
3 years, beginning on the date on which the Sec-
retary implements the initial demonstration project.
(c) REPORTS TO CONGRESS.—
(1) ANNUAL REPORTS.—
(A) IN GENERAL.—Not later than 1 year
after the Secretary implements the initial dem-
onstration project under this section, and bian-
nually thereafter, the Secretary shall submit to
Congress a report regarding the demonstration
projects conducted under this section.
(B) CONTENTS OF REPORT.—The report
in subparagraph (A) shall include the following: