Medicare Demonstration of Coverage for Low Vision Devices Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4129 To provide for a Medicare demonstration project to evaluate the fiscal impact of covering low vision devices as durable medical equipment under part B of the Medicare program. IN THE HOUSE OF REPRESENTATIVES JULY 30, 2019 Mrs. CAROLYN B. MALONEY of New York (for herself, Mr. BILIRAKIS, Mr. SCHIFF, Mr. COHEN, and Mrs. WAGNER) 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 subse- quently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide for a Medicare demonstration project to evaluate the fiscal impact of covering low vision devices as durable medical equipment under part B of the Medicare pro- gram. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medicare Demonstra- 4 tion of Coverage for Low Vision Devices Act of 2019’’. 5 VerDate Sep 11 2014 03:38 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4129.IH H4129 kjohnson on DSK79L0C42 with BILLS 2 •HR 4129 IH SEC. 2. DEMONSTRATION PROJECT ON MEDICARE COV- 1 ERAGE OF LOW VISION DEVICES AS DURABLE 2 MEDICAL EQUIPMENT. 3 (a) ESTABLISHMENT OF DEMONSTRATION 4 PROJECT.— 5 (1) IN GENERAL.—Beginning not later than 1 6 year after the date of the enactment of this Act, the 7 Secretary of Health and Human Services (in this 8 section referred to as the ‘‘Secretary’’) shall com- 9 mence a project (in this section referred to as the 10 ‘‘demonstration project’’) to demonstrate and evalu- 11 ate the fiscal impact of covering low vision devices 12 (including subsets of such devices) under part B of 13 title XVIII of the Social Security Act (42 U.S.C. 14 1395j et seq.) in the same or similar manner as cov- 15 erage is provided for durable medical equipment 16 under such part. 17 (2) LOW VISION DEVICE DEFINED.—In this sec- 18 tion, the term ‘‘low vision device’’ means a device, 19 prescribed by a physician, that magnifies, enhances, 20 or otherwise augments or interprets visual images ir- 21 respective of the size, form, or technological features 22 of such device and does not include ordinary eye- 23 glasses or contact lenses. In the previous sentence, 24 the term ‘‘ordinary eyeglasses or contact lenses’’ 25 VerDate Sep 11 2014 03:38 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4129.IH H4129 kjohnson on DSK79L0C42 with BILLS 3 •HR 4129 IH means lenses that are intended to fully correct visual 1 acuity or fully eliminate refractive error. 2 (b) PROJECT DETAILS.— 3 (1) ELIGIBLE PARTICIPANTS.—An individual 4 enrolled under such part is eligible to participate in 5 the demonstration project if an ophthalmologist or 6 optometrist, after a clinical evaluation, has deter- 7 mined and certifies through a prescription that fur- 8 nishing a low vision device to the individual is medi- 9 cally necessary. 10 (2) NATIONAL SCOPE AND DURATION.—The 11 demonstration project shall be national in scope and 12 shall be conducted for a period of 5 years. 13 (3) PROJECT DESIGN.—The Secretary shall de- 14 sign the demonstration project in a manner so as to 15 provide a rich, well-structured, and defined data set 16 from which inferences about the fiscal impact on the 17 Federal Supplementary Medical Insurance Trust 18 Fund under section 1841 of the Social Security Act 19 (42 U.S.C. 1395t) resulting from the permanent 20 coverage under part B of title XVIII of the Social 21 Security Act (42 U.S.C. 1395j et seq.) of low vision 22 devices (including coverage for subcategories or sub- 23 sets of such devices) can be made using appropriate 24 statistical methods. To the maximum extent pos- 25 VerDate Sep 11 2014 03:38 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4129.IH H4129 kjohnson on DSK79L0C42 with BILLS 4 •HR 4129 IH sible, such demonstration project shall evaluate the 1 fiscal impact of permanent coverage under such part 2 for the most function-rich, most powerful, and most 3 expensive low vision devices. 4 (4) CONSULTATION.—In conducting the dem- 5 onstration project the Secretary shall consult with 6 organizations of consumers with vision loss and 7 other stakeholder organizations. 8 (c) REPORTS.— 9 (1) INTERIM REPORT.—Not later than 180 10 days after the last day of the third year of the dem- 11 onstration project, the Secretary shall submit to the 12 Committee on Finance of the Senate and to the 13 Committees on Ways and Means and Energy and 14 Commerce of the House of Representatives a report 15 that describes the progress and preliminary findings 16 from the demonstration project. 17 (2) FINAL REPORT.—Not later than 180 days 18 after the last day of the demonstration project and 19 after solicitation and consideration of formal written 20 input on the project from organizations representing 21 consumers with vision loss and other stakeholder or- 22 ganizations, the Secretary shall submit to such Com- 23 mittees a final report on the project. Such report 24 shall include an evaluation of the fiscal impact on 25 VerDate Sep 11 2014 03:38 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4129.IH H4129 kjohnson on DSK79L0C42 with BILLS 5 •HR 4129 IH the Medicare program under part B of title XVIII 1 of the Social Security Act (42 U.S.C. 1395 et seq.) 2 of providing coverage of low vision devices (including 3 coverage for subcategories or subsets of such de- 4 vices) and such other findings and recommendations 5 as the Secretary deems appropriate. 6 (d) FUNDING.—For fiscal year 2020 and for each of 7 the four succeeding fiscal years, out of any funds in the 8 Treasury not otherwise appropriated, $2,500,000 is ap- 9 propriated to the Secretary to carry out the demonstration 10 project. 11 Æ VerDate Sep 11 2014 03:38 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H4129.IH H4129 kjohnson on DSK79L0C42 with BILLS