To improve outpatient vision services under part B of the medicare program.

1. Adds SEC. ____. IMPROVEMENT OF OUTPATIENT VISION SERVICES UNDER PART B at the end of subtitle B of title IV

   Adds a section

   In S. 1 · Reported to Senate

   (b) Report.--Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the study conducted under subsection (a). The report shall include recommendations regarding the use of more current data in computing geographic cost of practice indices as well as the use of data directly representative of physicians' costs (rather than proxy measures of such costs).

   Inserted: SEC. ____. IMPROVEMENT OF OUTPATIENT VISION SERVICES UNDER PART B.

   Inserted: (a) Coverage Under Part B.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is amended--

   Inserted: (1) in subparagraph (U), by striking "and" after the semicolon at the end;

   Inserted: (2) in subparagraph (V)(iii), by adding "and" after the semicolon at the end; and

   Inserted: (3) by adding at the end the following new subparagraph:

   Inserted: "(W) vision rehabilitation services (as defined in subsection (ww)(1));".

   Inserted: (b) Services Described.--Section 1861 (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:

   Inserted: "Vision Rehabilitation Services; Vision Rehabilitation Professional

   Inserted: "(ww)(1)(A) The term 'vision rehabilitation services' means rehabilitative services (as determined by the Secretary in regulations) furnished--

   Inserted: "(i) to an individual diagnosed with a vision impairment (as defined in paragraph (6));

   Inserted: "(ii) pursuant to a plan of care established by a qualified physician (as defined in subparagraph (C)) or by a qualified occupational therapist that is periodically reviewed by a qualified physician;

   Inserted: "(iii) in an appropriate setting (including the home of the individual receiving such services if specified in the plan of care); and

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   Inserted: "(iv) by any of the following individuals:

   Inserted: "(I) A qualified physician.

   Inserted: "(II) A qualified occupational therapist.

   Inserted: "(III) A vision rehabilitation professional (as defined in paragraph (2)) while under the general supervision (as defined in subparagraph (D)) of a qualified physician.

   Inserted: "(B) In the case of vision rehabilitation services furnished by a vision rehabilitation professional, the plan of care may only be established and reviewed by a qualified physician.

   Inserted: "(C) The term 'qualified physician' means--

   Inserted: "(i) a physician (as defined in subsection (r)(1)) who is an ophthalmologist; or

   Inserted: "(ii) a physician (as defined in subsection (r)(4) (relating to a doctor of optometry)).

   Inserted: "(D) The term 'general supervision' means, with respect to a vision rehabilitation professional, overall direction and control of that professional by the qualified physician who established the plan of care for the individual, but the presence of the qualified physician is not required during the furnishing of vision rehabilitation services by that professional to the individual.

   Inserted: "(2) The term 'vision rehabilitation professional' means any of the following individuals:

   Inserted: "(A) An orientation and mobility specialist (as defined in paragraph (3)).

   Inserted: "(B) A rehabilitation teacher (as defined in paragraph (4)).

   Inserted: "(C) A low vision therapist (as defined in paragraph (5)).

   Inserted: "(3) The term 'orientation and mobility specialist' means an individual who--

   Inserted: "(A) if a State requires licensure or certification of orientation and mobility specialists, is licensed or certified by that State as an orientation and mobility specialist;

   Inserted: "(B)(i) holds a baccalaureate or higher degree from an accredited college or university in the United States (or an equivalent foreign degree) with a concentration in orientation and mobility; and

   Inserted: "(ii) has successfully completed 350 hours of clinical practicum under the supervision of an orientation and mobility specialist and has furnished not less than 9 months of supervised full-time orientation and mobility services;

   Inserted: "(C) has successfully completed the national examination in orientation and mobility administered by the Academy for Certification of Vision Rehabilitation and Education Professionals; and

   Inserted: "(D) meets such other criteria as the Secretary establishes.

   Inserted: "(4) The term 'rehabilitation teacher' means an individual who--

   Inserted: "(A) if a State requires licensure or certification of rehabilitation teachers, is licensed or certified by the State as a rehabilitation teacher;

   Inserted: "(B)(i) holds a baccalaureate or higher degree from an accredited college or university in the United States (or an equivalent foreign degree) with a concentration in rehabilitation teaching, or holds such a degree in a health field; and

   Inserted: "(ii) has successfully completed 350 hours of clinical practicum under the supervision of a rehabilitation teacher and has furnished not less than 9 months of supervised full-time rehabilitation teaching services;

   Inserted: "(C) has successfully completed the national examination in rehabilitation teaching administered by the Academy for Certification of Vision Rehabilitation and Education Professionals; and

   Inserted: "(D) meets such other criteria as the Secretary establishes.

   Inserted: "(5) The term 'low vision therapist' means an individual who--

   Inserted: "(A) if a State requires licensure or certification of low vision therapists, is licensed or certified by the State as a low vision therapist;

   Inserted: "(B)(i) holds a baccalaureate or higher degree from an accredited college or university in the United States (or an equivalent foreign degree) with a concentration in low vision therapy, or holds such a degree in a health field; and

   Inserted: "(ii) has successfully completed 350 hours of clinical practicum under the supervision of a physician, and has furnished not less than 9 months of supervised full-time low vision therapy services;

   Inserted: "(C) has successfully completed the national examination in low vision therapy administered by the Academy for Certification of Vision Rehabilitation and Education Professionals; and

   Inserted: "(D) meets such other criteria as the Secretary establishes.

   Inserted: "(6) The term 'vision impairment' means vision loss that constitutes a significant limitation of visual capability resulting from disease, trauma, or a congenital or degenerative condition that cannot be corrected by conventional means, including refractive correction, medication, or surgery, and that is manifested by 1 or more of the following:

   Inserted: "(A) Best corrected visual acuity of less than 20/60, or significant central field defect.

   Inserted: "(B) Significant peripheral field defect including homonymous or heteronymous bilateral visual field defect or generalized contraction or constriction of field.

   Inserted: "(C) Reduced peak contrast sensitivity in conjunction with a condition described in subparagraph (A) or (B).

   Inserted: "(D) Such other diagnoses, indications, or other manifestations as the Secretary may determine to be appropriate.".

   Inserted: (c) Payment Under Part B.--

   Inserted: (1) Physician fee schedule.--Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by inserting "(2)(W)," after "(2)(S),".

   Inserted: (2) Carve out from hospital outpatient department prospective payment system.--Section 1833(t)(1)(B)(iv) (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended by inserting "vision rehabilitation services (as defined in section 1861(ww)(1)) or" after "does not include".

   Inserted: (3) Clarification of billing requirements.--The first sentence of section 1842(b)(6) of such Act (42 U.S.C. 1395u(b)(6)) is amended--

   Inserted: (A) by striking "and" before "(G)"; and

   Inserted: (B) by inserting before the period the following: ", and (H) in the case of vision rehabilitation services (as defined in section 1861(ww)(1)) furnished by a vision rehabilitation professional (as defined in section 1861(ww)(2)) while under the general supervision (as defined in section 1861(ww)(1)(D)) of a qualified physician (as defined in section 1861(ww)(1)(C)), payment shall be made to (i) the qualified physician or (ii) the facility (such as a rehabilitation agency, a clinic, or other facility) through which such services are furnished under the plan of care if there is a contractual arrangement between the vision rehabilitation professional and the facility under which the facility submits the bill for such services".

   Inserted: (d) Plan of Care.--Section 1835(a)(2) (42 U.S.C. 1395n(a)(2)) is amended--

   Inserted: (1) in subparagraph (E), by striking "and" after the semicolon at the end;

   Inserted: (2) in subparagraph (F), by striking the period at the end and inserting "; and"; and

   Inserted: (3) by inserting after subparagraph (F) the following new subparagraph:

   Inserted: "(G) in the case of vision rehabilitation services, (i) such services are or were required because the individual needed vision rehabilitation services, (ii) an individualized, written plan for furnishing such services has been established (I) by a qualified physician (as defined in section 1861(ww)(1)(C)), (II) by a qualified occupational therapist, or (III) in the case of such services furnished by a vision rehabilitation professional, by a qualified physician, (iii) the plan is periodically reviewed by the qualified physician, and (iv) such services are or were furnished while the individual is or was under the care of the qualified physician.".

   Inserted: (e) Relationship to Rehabilitation Act of 1973.--The provision of vision rehabilitation services under the medicare program under title XVIII (42 U.S.C. 1395 et seq.) shall not be taken into account for any purpose under the Rehabilitation Act of 1973 (29 U.S.C. 701 et seq.).

   Inserted: (f) Effective Date.--

   Inserted: (1) Interim, final regulations.--The Secretary shall publish a rule under this section in the Federal Register by not later than 180 days after the date of enactment of this Act to carry out the provisions of this section. Such rule shall be effective and final immediately on an interim basis, but is subject to change and revision after public notice and opportunity for a period for public comment of not less than 60 days.

   Inserted: (2) Consultation.--The Secretary shall consult with the National Vision Rehabilitation Cooperative, the Association for Education and Rehabilitation of the Blind and Visually Impaired, the Academy for Certification of Vision Rehabilitation and Education Professionals, the American Academy of Ophthalmology, the American Occupational Therapy Association, the American Optometric Association, and such other qualified professional and consumer organizations as the Secretary determines appropriate in promulgating regulations to carry out this section.

   Original wording

   At the end of subtitle B of title IV, add the following:

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As printed