Title: Medicare Vision Act of 2019
Policy area: Health

Summary:
Medicare Vision Act of 2019
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.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4665 Introduced in House (IH)]

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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 Committee 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 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 2019''.

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 (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 procedures 
        performed during the course of such examination 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 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 respect 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 described in paragraph (2) of such section during a 2-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 
                                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 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, 2022, and including 
conventional eyeglasses or contact 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 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.--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 furnished during a year, 
                in an amount not greater than--
                            ``(i) for 2022, $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;
                    ``(C) for types of eyeglass lenses, and for types 
                of contact lenses, as determined appropriate by the 
                Secretary; and
                    ``(D) if furnished pursuant to a written order of a 
                physician described in section 1861(kkk).''.
            (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) of the Social 
Security Act (42 U.S.C. 1395y(a)) is amended--
            (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 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 2-year period;''; and
            (2) in paragraph (7)--
                    (A) by inserting ``(other than such an examination 
                that is a vision service that is covered under section 
                1861(s)(2)(II))'' after ``eye examinations''; and
                    (B) by inserting ``(other than such a procedure 
                that is a vision service that is covered under section 
                1861(s)(2)(II))'' after ``refractive state of the 
                eyes''.

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 2020 through 2024 of such sums as may be necessary for 
purposes of implementing the amendments made by section 2.
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