II
110th CONGRESS
1st Session
S. 2115
IN THE SENATE OF THE UNITED STATES
September 27, 2007
Mr. Cardin introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to extend
for 6 months the eligibility period for the Welcome to Medicare
physical examination and to provide for the coverage and waiver of cost-sharing
for preventive services under the Medicare program.
Short title
This Act may be cited as the
Medicare Preventive Services Coverage
Act of 2007
.
Extending the
eligibility period for a Welcome to Medicare
physical
examination from six months to one year
In general
Section 1862(a)(1)(K) of the Social Security Act (42
U.S.C. 1395y(a)(1)(K)) is amended by striking 6 months
and
inserting 1 year
.
Effective date
The amendment made by subsection (a) shall apply to initial preventive physician examinations performed on or after January 1, 2008.
Coverage and waiver of cost-sharing for preventive services
Preventive services defined; coverage of additional preventive services
Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
in subsection (s)(2)—
in subparagraph
(Z), by striking and
after the semicolon at the end;
in subparagraph
(AA), by adding and
after the semicolon at the end; and
by adding at the end the following new subparagraph:
additional preventive services (described in subsection (ccc)(1)(O));
; and
by adding at the end the following new subsection:
Preventive services
The term preventive services means the following:
Prostate cancer screening tests (as defined in subsection (oo)).
Colorectal cancer screening tests (as defined in subsection (pp)).
Diabetes outpatient self-management training services (as defined in subsection (qq)).
Screening for glaucoma for certain individuals (as described in subsection (s)(2)(U)).
Medical nutrition therapy services for certain individuals (as described in subsection (s)(2)(V)).
An initial preventive physical examination (as defined in subsection (ww)).
Cardiovascular screening blood tests (as defined in subsection (xx)(1)).
Diabetes screening tests (as defined in subsection (yy)).
Ultrasound screening for abdominal aortic aneurysm for certain individuals (as described in subsection (s)(2)(AA)).
Pneumococcal and influenza vaccine and their administration (as described in subsection (s)(10)(A)).
Hepatitis B vaccine and its administration for certain individuals (as described in subsection (s)(10)(B)).
Screening mammography (as defined in subsection (jj)).
Screening pap smear and screening pelvic exam (as described in subsection (s)(14)).
Bone mass measurement (as defined in subsection (rr)).
Additional preventive services (as determined under paragraph (2)).
The term additional preventive services means items and services, including mental health services, not described in subparagraphs (A) through (N) of paragraph (1) that the Secretary determines to be reasonable and necessary for the prevention or early detection of an illness or disability.
In making determinations under subparagraph (A), the Secretary shall—
take into account evidence-based recommendations by the United States Preventive Services Task Force and other appropriate organizations; and
use the process for making national coverage determinations (as defined in section 1869(f)(1)(B)) under this title.
.
Payment and Elimination of Cost-sharing
In general
In general
Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—
in
clause (T), by striking 80 percent
and inserting 100
percent
;
by
striking and
before (V)
; and
by
inserting before the semicolon at the end the following: , and (W) with
respect to additional preventive services (as defined in section 1861(ccc)(2))
and other preventive services for which a payment rate is not otherwise
established under this section, the amount paid shall be 100 percent of the
lesser of the actual charge for the services or the amount determined under a
fee schedule established by the Secretary for purposes of this
clause
.
Application to sigmoidoscopies and colonoscopies
Section 1834(d) of the Social Security Act (42 U.S.C. 1395m(d)) is amended—
in paragraph (2)(C), by amending clause (ii) to read as follows:
No coinsurance
In the case of a beneficiary who receives services described in clause (i), there shall be no coinsurance applied.
; and
in paragraph (3)(C), by amending clause (ii) to read as follows:
No coinsurance
In the case of a beneficiary who receives services described in clause (i), there shall be no coinsurance applied.
.
Elimination of coinsurance in outpatient hospital settings
Exclusion from OPD fee schedule
Section 1833(t)(1)(B)(iv) of the Social Security
Act (42 U.S.C.
1395l(t)(1)(B)(iv)) is amended by striking screening
mammography (as defined in section 1861(jj)) and diagnostic mammography
and inserting diagnostic mammography and preventive services (as defined
in section 1861(ccc)(1))
.
Conforming amendments
Section 1833(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)) is amended—
in
subparagraph (F), by striking and
after the semicolon at the
end;
in
subparagraph (G)(ii), by adding and
at the end; and
by adding at the end the following new subparagraph:
with respect to additional preventive services (as defined in section 1861(ccc)(2)) furnished by an outpatient department of a hospital, the amount determined under paragraph (1)(W);
.
Waiver of application of deductible for all preventive services
The first sentence of section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended—
in clause (1), by
striking items and services described in section 1861(s)(10)(A)
and inserting preventive services (as defined in section
1861(ccc)(1))
;
by inserting
and
before (4)
; and
by striking clauses (5) through (8).
Inclusion as part of initial preventive physical examination
Section 1861(ww)(2) of the Social Security Act (42 U.S.C. 1395x(ww)(2)) is amended by adding at the end the following new subparagraph:
Additional preventive services (as defined in subsection (ccc)(2)).
.
Effective date
The amendments made by this section shall apply to services furnished on or after January 1, 2008.