HEARTS Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 2371 To amend title 10, United States Code, to modify the requirement for certain former members of the Armed Forces to enroll in Medicare Part B to be eligible for TRICARE for Life, and to amend title XVIII of the Social Security Act to provide for coverage of certain DNA specimen provenance assay tests under the Medicare program. IN THE HOUSE OF REPRESENTATIVES APRIL 25, 2019 Mr. THOMPSON of California (for himself and Mr. FERGUSON) introduced the following bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, and Armed Services, for a period to be subsequently determined by the Speak- er, in each case for consideration of such provisions as fall within the ju- risdiction of the committee concerned A BILL To amend title 10, United States Code, to modify the re- quirement for certain former members of the Armed Forces to enroll in Medicare Part B to be eligible for TRICARE for Life, and to amend title XVIII of the Social Security Act to provide for coverage of certain DNA specimen provenance assay tests under the Medi- care program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS 2 •HR 2371 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Health Equity and 2 Access for Returning Troops and Servicemembers Act of 3 2019’’ or the ‘‘HEARTS Act of 2019’’. 4 SEC. 2. MODIFICATION OF REQUIREMENT FOR CERTAIN 5 FORMER MEMBERS OF THE ARMED FORCES 6 TO ENROLL IN MEDICARE PART B TO BE ELI- 7 GIBLE FOR TRICARE FOR LIFE. 8 (a) TRICARE ELIGIBILITY.— 9 (1) IN GENERAL.—Subsection (d) of section 10 1086 of title 10, United States Code, is amended by 11 adding at the end the following new paragraph: 12 ‘‘(6)(A) The requirement in paragraph (2)(A) 13 to enroll in the supplementary medical insurance 14 program under part B of title XVIII of the Social 15 Security Act (42 U.S.C. 1395j et seq.) shall not 16 apply to a person described in subparagraph (B) 17 during any month in which such person is not enti- 18 tled to a benefit described in subparagraph (A) of 19 section 226(b)(2) of the Social Security Act (42 20 U.S.C. 426(b)(2)) if such person has received the 21 counseling and information under subparagraph (C). 22 ‘‘(B) A person described in this subpara- 23 graph is a person— 24 ‘‘(i) who is under 65 years of age; 25 VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS 3 •HR 2371 IH ‘‘(ii) who is entitled to hospital insur- 1 ance benefits under part A of title XVIII 2 of the Social Security Act pursuant to sub- 3 paragraph (A) or (C) of section 226(b)(2) 4 of such Act (42 U.S.C. 426(b)(2)); 5 ‘‘(iii) whose entitlement to a benefit 6 described in subparagraph (A) of such sec- 7 tion has terminated due to performance of 8 substantial gainful activity; and 9 ‘‘(iv) who is retired under chapter 61 10 of this title. 11 ‘‘(C) The Secretary of Defense shall co- 12 ordinate with the Secretary of Health and 13 Human Services and the Commissioner of So- 14 cial Security to notify persons described in sub- 15 paragraph (B) of, and provide information and 16 counseling regarding, the effects of not enroll- 17 ing in the supplementary medical insurance 18 program under part B of title XVIII of the So- 19 cial Security Act (42 U.S.C. 1395j et seq.), as 20 described in subparagraph (A).’’. 21 (2) CONFORMING AMENDMENT.—Paragraph 22 (2)(A) of such subsection is amended by striking ‘‘is 23 enrolled’’ and inserting ‘‘except as provided by para- 24 graph (6), is enrolled’’. 25 VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS 4 •HR 2371 IH (3) IDENTIFICATION OF PERSONS.—Section 1 1110a of such title is amended by adding at the end 2 the following new subsection: 3 ‘‘(c) CERTAIN INDIVIDUALS NOT REQUIRED TO EN- 4 ROLL IN MEDICARE PART B.—In carrying out subsection 5 (a), the Secretary of Defense shall coordinate with the 6 Secretary of Health and Human Services and the Commis- 7 sioner of Social Security to— 8 ‘‘(1) identify persons described in subparagraph 9 (B) of section 1086(d)(6) of this title; and 10 ‘‘(2) provide information and counseling pursu- 11 ant to subparagraph (D) of such section.’’. 12 (b) NON-APPLICATION OF MEDICARE PART B LATE 13 ENROLLMENT PENALTY.—Section 1839(b) of the Social 14 Security Act (42 U.S.C. 1395r(b)) is amended, in the sec- 15 ond sentence, by inserting ‘‘or months for which the indi- 16 vidual can demonstrate that the individual is an individual 17 described in paragraph (6)(B) of section 1086(d) of title 18 10, United States Code, who is enrolled in the TRICARE 19 program pursuant to such section’’ after ‘‘an individual 20 described in section 1837(k)(3)’’. 21 (c) REPORT.—Not later than October 1, 2024, the 22 Secretary of Defense, the Secretary of Health and Human 23 Services, and the Commissioner of Social Security shall 24 jointly submit to the Committees on Armed Services of 25 VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS 5 •HR 2371 IH the House of Representatives and the Senate, the Com- 1 mittee on Ways and Means and the Committee on Energy 2 and Commerce of the House of Representatives, and the 3 Committee on Finance of the Senate a report on the im- 4 plementation of section 1086(d)(6) of title 10, United 5 States Code, as added by subsection (a). Such report shall 6 include, with respect to the period covered by the report— 7 (1) the number of individuals enrolled in 8 TRICARE for Life who are not enrolled in the sup- 9 plementary medical insurance program under part B 10 of title XVIII of the Social Security Act (42 U.S.C. 11 1395j et seq.) by reason of such section 1086(d)(6); 12 and 13 (2) the number of individuals who— 14 (A) are retired from the Armed Forces 15 under chapter 61 of title 10, United States 16 Code; 17 (B) are entitled to hospital insurance bene- 18 fits under part A of title XVIII of the Social 19 Security Act pursuant to receiving benefits for 20 24 months as described in subparagraph (A) or 21 (C) of section 226(b)(2) of such Act (42 U.S.C. 22 426(b)(2)); and 23 (C) because of such entitlement, are no 24 longer enrolled in TRICARE Standard, 25 VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS 6 •HR 2371 IH TRICARE Prime, TRICARE Extra, or 1 TRICARE Select under chapter 55 of title 10, 2 United States Code. 3 (d) DEPOSIT OF SAVINGS INTO MEDICARE IMPROVE- 4 MENT FUND.—Section 1898(b)(1) of the Social Security 5 Act (42 U.S.C. 1395iii(b)(1)) is amended by striking 6 ‘‘during and after fiscal year 2021, $0’’ and inserting 7 ‘‘during and after fiscal year 2024, $5,000,000’’. 8 (e) APPLICATION.—The amendments made by sub- 9 sections (a) and (b) shall apply with respect to a person 10 who, on or after October 1, 2023, is a person described 11 in section 1086(d)(6)(B) of title 10, United States Code, 12 as added by subsection (a). 13 SEC. 3. COVERAGE OF CERTAIN DNA SPECIMEN PROVE- 14 NANCE ASSAY TESTS UNDER MEDICARE. 15 (a) BENEFIT.— 16 (1) COVERAGE.—Section 1861 of the Social Se- 17 curity Act (42 U.S.C. 1395x) is amended— 18 (A) in subsection (s)(2)— 19 (i) in subparagraph (GG), by striking 20 ‘‘and’’ at the end; 21 (ii) in subparagraph (HH), by insert- 22 ing ‘‘and’’ at the end; and 23 (iii) by adding at the end the fol- 24 lowing new subparagraph: 25 VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS 7 •HR 2371 IH ‘‘(II) a prostate cancer DNA Specimen Prove- 1 nance Assay test (DSPA test) (as defined in sub- 2 section (kkk)); and’’; and 3 (B) by adding at the end the following new 4 subsection: 5 ‘‘(kkk) PROSTATE CANCER DNA SPECIMEN PROVE- 6 NANCE ASSAY TEST.—The term ‘prostate cancer DNA 7 Specimen Provenance Assay Test’ (DSPA test) means a 8 test that, after a determination of cancer in one or more 9 prostate biopsy specimens obtained from an individual, as- 10 sesses the identity of the DNA in such specimens by com- 11 paring such DNA with the DNA that was separately taken 12 from such individual at the time of the biopsy.’’. 13 (2) EXCLUSION FROM COVERAGE.—Section 14 1862(a)(1) of the Social Security Act (42 U.S.C. 15 1395y(a)(1)) is amended— 16 (A) in subparagraph (O), by striking 17 ‘‘and’’ at the end; 18 (B) in subparagraph (P), by striking the 19 semicolon at the end and inserting ‘‘, and’’; and 20 (C) by adding at the end the following new 21 subparagraph: 22 ‘‘(Q) in the case of a prostate cancer DNA 23 Specimen Provenance Assay test (DSPA test) (as 24 defined in section 1861(kkk)), unless such test is 25 VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS 8 •HR 2371 IH furnished on or after January 1, 2020, and before 1 January 1, 2025, and such test is ordered by the 2 physician who furnished the prostate cancer biopsy 3 that obtained the specimen tested;’’. 4 (b) PAYMENT AMOUNT AND RELATED REQUIRE- 5 MENTS.—Section 1834 of the Social Security Act (42 6 U.S.C. 1395m) is amended by adding at the end the fol- 7 lowing new subsection: 8 ‘‘(x) PROSTATE CANCER DNA SPECIMEN PROVE- 9 NANCE ASSAY TESTS.— 10 ‘‘(1) PAYMENT FOR COVERED TESTS.— 11 ‘‘(A) IN GENERAL.—Subject to subpara- 12 graph (B), the payment amount for a prostate 13 cancer DNA Specimen Provenance Assay test 14 (DSPA test) (as defined in section 1861(kkk)) 15 shall be $200. Such payment shall be payment 16 for all of the specimens obtained from the bi- 17 opsy furnished to an individual that are tested. 18 ‘‘(B) LIMITATION.—Payment for a DSPA 19 test under subparagraph (A) may only be made 20 on an assignment-related basis. 21 ‘‘(C) PROHIBITION ON SEPARATE PAY- 22 MENT.—No separate payment shall be made for 23 obtaining DNA that was separately taken from 24 VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS 9 •HR 2371 IH an individual at the time of a biopsy described 1 in subparagraph (A). 2 ‘‘(2) HCPCS CODE AND MODIFIER ASSIGN- 3 MENT.— 4 ‘‘(A) IN GENERAL.—The Secretary shall 5 assign one or more HCPCS codes to a prostate 6 cancer DNA Specimen Provenance Assay test 7 and may use a modifier to facilitate making 8 payment under this section for such test. 9 ‘‘(B) IDENTIFICATION OF DNA MATCH ON 10 CLAIM.—The Secretary shall require an indica- 11 tion on a claim for a prostate cancer DNA 12 Specimen Provenance Assay test of whether the 13 DNA of the prostate biopsy specimens match 14 the DNA of the individual diagnosed with pros- 15 tate cancer. Such indication may be made 16 through use of a HCPCS code, a modifier, or 17 other means, as determined appropriate by the 18 Secretary. 19 ‘‘(3) DNA MATCH REVIEW.— 20 ‘‘(A) IN GENERAL.—The Secretary shall 21 review at least three years of claims under part 22 B for prostate cancer DNA Specimen Prove- 23 nance Assay tests to identify whether the DNA 24 of the prostate biopsy specimens match the 25 VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS 10 •HR 2371 IH DNA of the individuals diagnosed with prostate 1 cancer. 2 ‘‘(B) POSTING ON INTERNET WEBSITE.— 3 Not later than July 1, 2023, the Secretary shall 4 post on the internet website of the Centers for 5 Medicare & Medicaid Services the findings of 6 the review conducted under subparagraph 7 (A).’’. 8 (c) COST-SHARING.—Section 1833(a)(1) of the So- 9 cial Security Act (42 U.S.C. 1395l(a)(1)) is amended— 10 (1) by striking ‘‘and (CC)’’ and inserting 11 ‘‘(CC)’’; and 12 (2) by inserting before the semicolon at the end 13 the following: ‘‘, and (DD) with respect to a prostate 14 cancer DNA Specimen Provenance Assay test 15 (DSPA test) (as defined in section 1861(kkk)), the 16 amount paid shall be an amount equal to 80 percent 17 of the lesser of the actual charge for the test or the 18 amount specified under section 1834(x)’’. 19 Æ VerDate Sep 11 2014 00:09 Apr 26, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H2371.IH H2371 kjohnson on DSK79L0C42 with BILLS