Medicare Vision Act of 2021
Bill: H.R.4187 | Sponsor: Rep. Schrier, Kim (D-WA)
Policy area: Health

Summary:
Medicare Vision Act of 2021
This bill expands Medicare coverage to include eyeglasses, contact lenses, and vision services, in accordance with specified limitations. Covered services include routine eye examinations and contact lens fittings.

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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Vision Act of 2021''.

SEC. 2. PROVIDING COVERAGE FOR VISION CARE UNDER THE MEDICARE PROGRAM.

    (a) Coverage.--Section 1861(s)(2) of the Social Security 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 period at the end 
        and adding ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(II) vision services (as defined in subsection 
                (lll));''.
    (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:
    ``(lll) Vision Services.--The term `vision services' means--
            ``(1) routine eye examinations to determine the refractive 
        state of the eyes, including procedures performed during the 
        course of such examination; and
            ``(2) contact lens fitting services;
furnished on or after January 1, 2024, 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 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 ``(DD)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (EE) with respect to vision 
                services (as defined in section 1861(lll)), 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:
    ``(z) Limitation for Vision Services.--With respect to vision 
services (as defined in section 1861(lll)) 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 described in paragraph (2) of such section during a 1-year 
period.''.
    (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 period 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 
                                2021 shall not be taken into account in 
                                applying clause (ii)(II) for 2024 and 
                                2025.''.
    (e) Coverage of Conventional Eyeglasses and Contact Lenses.--
Section 1861(s)(8) of the Social Security 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 
surgery with insertion of an intraocular lens'' and inserting ``, 
including one pair of conventional eyeglasses or contact lenses 
furnished subsequent to each cataract surgery with insertion of an 
intraocular lens, if furnished before January 1, 2024, and including 
conventional eyeglasses or contact lenses, whether or not furnished 
subsequent to such a surgery, if furnished on or after January 1, 
2024''.
    (f) Special Payment Rules for Eyeglasses and Contact Lenses.--
            (1) Limitations.--Section 1834(h) of the Social 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.--
                    ``(A) In general.--With respect to eyeglasses and 
                contact lenses furnished to an individual on or after 
                January 1, 2024, subject to subparagraph (B), payment 
                may be made under this part only--
                            ``(i) during a 1-year period, for either 1 
                        pair of eyeglasses (including lenses and 
                        frames) or a 1-year supply that is provided in 
                        not more than 180-day increments of contact 
                        lenses;
                            ``(ii) with respect to amounts attributable 
                        to the frames of such a pair of eyeglasses and 
                        amounts attributable to contact lenses 
                        furnished during a year, in an amount not 
                        greater than--
                                    ``(I) for 2024, $100; and
                                    ``(II) for a subsequent year, the 
                                amount specified under this 
                                subparagraph for the previous year, 
                                increased by the percentage change in 
                                the consumer price index for all urban 
                                consumers during such previous year;
                            ``(iii) for types of eyeglass lenses, and 
                        for types of contact lenses, as determined 
                        appropriate by the Secretary;
                            ``(iv) if furnished pursuant to a written 
                        order of a physician described in section 
                        1861(kkk); and
                            ``(v) if during the 1-year period described 
                        in clause (i), the individual did not already 
                        receive (as described in subparagraph (B)) one 
                        pair of conventional eyeglasses or contact 
                        lenses subsequent to a cataract surgery with 
                        insertion of an intraocular lens furnished 
                        during such period.
                    ``(B) Exception.--With respect to a 1-year period 
                described in subparagraph (A)(i), in the case of an 
                individual who receives cataract surgery with insertion 
                of an intraocular lens, notwithstanding subparagraph 
                (A), payment may be made under this part for one pair 
                of conventional eyeglasses or contact lenses furnished 
                subsequent to such cataract surgery during such 
                period.''.
            (2) Application of competitive acquisition.--
                    (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 ``, 
                        eyeglasses, 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
                            (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.--Section 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 subparagraph:
                    ``(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 professional service.''.
    (g) Exclusion Modifications.--Section 1862(a)(1) of the Social 
Security Act (42 U.S.C. 1395y(a)) is amended--
            (1) in subparagraph (O), by striking ``and'' at the end;
            (2) in subparagraph (P), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
            ``(Q) in the case of vision services (as defined in section 
        1861(lll)) that are routine eye examinations and contact lens 
        fitting services (as described in paragraph (1) or (2), 
        respectively, of such section), which are furnished more 
        frequently than once during a 1-year period;''.
    (h) Repeal of Ground for Exclusion.--Section 1862(a)(7) of the 
Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by striking ``, 
eyeglasses (other than eyewear described in section 1861(s)(8)) or eye 
examinations for the purpose of prescribing, fitting, or changing 
eyeglasses, procedures performed (during the course of any eye 
examination) to determine the refractive state of the eyes''.
    (i) Low Vision Aids.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Health and Human Services 
shall, in consultation with relevant stakeholders--
            (1) undergo a review and analysis of clinically indicated 
        magnifiers, spectacles, and other similar vision enhancement 
        devices used to assist individuals with low vision and visual 
        impairments;
            (2) based on such review identify such specific devices 
        that are not, but which pursuant to administrative action could 
        be, covered under the Medicare program under title XVIII of the 
        Social Security Act coverage; and
            (3) take such administrative actions as are necessary to 
        provide for such coverage of such devices so identified as the 
        Secretary determines appropriate.

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 Account for 
the period of 2022 through 2026 of such sums as may be necessary for 
purposes of implementing the amendments made by section 2.
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