Medicare Vision Act of 2019

IB Union Calendar No. 304 116TH CONGRESS 2D SESSION H. R. 4665 [Report No. 116–327, Parts I and II] 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 Com- mittee 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 DECEMBER 6, 2019 Reported from the Committee on Ways and Means with an amendment [Strike out all after the enacting clause and insert the part printed in italic] JANUARY 24, 2020 Additional sponsors: Ms. CASTOR of Florida, Ms. NORTON, Mr. CUELLAR, and Mr. WELCH JANUARY 24, 2020 Reported from the Committee on Energy and Commerce, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed [For text of introduced bill, see copy of bill as introduced on October 11, 2019] VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 4665 RH 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. VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6652 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 4665 RH 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 Vision Act of 4 2019’’. 5 SEC. 2. PROVIDING COVERAGE FOR VISION CARE UNDER 6 THE MEDICARE PROGRAM. 7 (a) COVERAGE.—Section 1861(s)(2) of the Social Secu- 8 rity Act (42 U.S.C. 1395x(s)(2)) is amended— 9 (1) in subparagraph (GG), by striking ‘‘and’’ 10 after the semicolon at the end; 11 (2) in subparagraph (HH), by striking the pe- 12 riod at the end and adding ‘‘; and’’; and 13 (3) by adding at the end the following new sub- 14 paragraph: 15 ‘‘(II) vision services (as defined in subsection 16 (kkk));’’. 17 (b) VISION SERVICES DEFINED.—Section 1861 of the 18 Social Security Act (42 U.S.C. 1395x) is amended by add- 19 ing at the end the following new subsection: 20 ‘‘(kkk) VISION SERVICES.—The term ‘vision services’ 21 means— 22 ‘‘(1) routine eye examinations to determine the 23 refractive state of the eyes, including procedures per- 24 formed during the course of such examination; and 25 VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 4665 RH ‘‘(2) contact lens fitting services; 1 furnished on or after January 1, 2022, by or under the di- 2 rect supervision of an optometrist or ophthalmologist who 3 is legally authorized to furnish such examinations, proce- 4 dures, or fitting services (as applicable) under State law 5 (or the State regulatory mechanism provided by State law) 6 of the State in which the examinations, procedures, or fit- 7 ting services are furnished.’’. 8 (c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 9 (1) IN GENERAL.—Section 1833(a)(1) of the So- 10 cial Security Act (42 U.S.C. 1395l(a)(1)) is amend- 11 ed— 12 (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 13 (B) by inserting before the semicolon at the 14 end the following: ‘‘, and (DD) with respect to 15 vision services (as defined in section 1861(kkk)), 16 the amount paid shall be equal to 80 percent of 17 the lesser of the actual charge or the amount de- 18 termined under the payment basis determined 19 under section 1848’’. 20 (2) LIMITS SPECIFIED.—Section 1834 of the So- 21 cial Security Act (42 U.S.C. 1395m) is amended by 22 adding at the end the following new subsection: 23 ‘‘(x) LIMITATION FOR VISION SERVICES.—With respect 24 to vision services (as defined in section 1861(kkk)) and an 25 VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 4665 RH individual, payment may be made under this part for only 1 1 routine eye examination described in paragraph (1) of 2 such section and 1 contact lens fitting service described in 3 paragraph (2) of such section during a 2-year period.’’. 4 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 5 (1) IN GENERAL.—Section 1848(j)(3) of the So- 6 cial Security Act (42 U.S.C. 1395w–4(j)(3)) is 7 amended by inserting ‘‘(2)(II),’’ before ‘‘(3)’’. 8 (2) BUDGET NEUTRALITY.—Section 9 1848(c)(2)(B)(iv) of the Social Security Act (42 10 U.S.C. 1395–w(c)(2)(B)(iv)) is amended— 11 (A) in subclause (III), by striking ‘‘and’’ at 12 the end; 13 (B) in subclause (IV), by striking the period 14 at the end and inserting ‘‘; and’’; and 15 (C) by adding at the end the following new 16 subclause: 17 ‘‘(V) the amendment made by sec- 18 tion 2(d)(1) of the Medicare Vision Act 19 of 2019 shall not be taken into account 20 in applying clause (ii)(II) for 2022 21 and 2023.’’. 22 (e) COVERAGE OF CONVENTIONAL EYEGLASSES AND 23 CONTACT LENSES.—Section 1861(s)(8) of the Social Secu- 24 rity Act (42 U.S.C. 1395x(s)(8)) is amended by striking ‘‘, 25 VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 4665 RH and including one pair of conventional eyeglasses or contact 1 lenses furnished subsequent to each cataract surgery with 2 insertion of an intraocular lens’’ and inserting ‘‘, including 3 one pair of conventional eyeglasses or contact lenses fur- 4 nished subsequent to each cataract surgery with insertion 5 of an intraocular lens, if furnished before January 1, 2022, 6 and including conventional eyeglasses or contact lenses, 7 whether or not furnished subsequent to such a surgery, if 8 furnished on or after January 1, 2022’’. 9 (f) SPECIAL PAYMENT RULES FOR EYEGLASSES AND 10 CONTACT LENSES.— 11 (1) LIMITATIONS.—Section 1834(h) of the Social 12 Security Act (42 U.S.C. 1395m(h)) is amended by 13 adding at the end the following new paragraph: 14 ‘‘(6) PAYMENT LIMITATIONS FOR EYEGLASSES 15 AND CONTACT LENSES.— 16 ‘‘(A) IN GENERAL.—With respect to eye- 17 glasses and contact lenses furnished to an indi- 18 vidual on or after January 1, 2022, subject to 19 subparagraph (B), payment may be made under 20 this part only— 21 ‘‘(i) during a 2-year period, for either 22 1 pair of eyeglasses (including lenses and 23 frames) or a 2-year supply that is provided 24 VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 4665 RH in not more than 180-day increments of 1 contact lenses; 2 ‘‘(ii) with respect to amounts attrib- 3 utable to the frames of such a pair of eye- 4 glasses and amounts attributable to contact 5 lenses furnished during a year, in an 6 amount not greater than— 7 ‘‘(I) for 2022, $100; and 8 ‘‘(II) for a subsequent year, the 9 amount specified under this subpara- 10 graph for the previous year, increased 11 by the percentage change in the con- 12 sumer price index for all urban con- 13 sumers during such previous year; 14 ‘‘(iii) for types of eyeglass lenses, and 15 for types of contact lenses, as determined 16 appropriate by the Secretary; 17 ‘‘(iv) if furnished pursuant to a writ- 18 ten order of a physician described in section 19 1861(kkk); and 20 ‘‘(v) if during the 2-year period de- 21 scribed in clause (i), the individual did not 22 already receive (as described in subpara- 23 graph (B)) one pair of conventional eye- 24 glasses or contact lenses subsequent to a cat- 25 VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 4665 RH aract surgery with insertion of an intra- 1 ocular lens furnished during such period. 2 ‘‘(B) EXCEPTION.—With respect to a 2-year 3 period described in subparagraph (A)(i), in the 4 case of an individual who receives cataract sur- 5 gery with insertion of an intraocular lens, not- 6 withstanding subparagraph (A), payment may 7 be made under this part for one pair of conven- 8 tional eyeglasses or contact lenses furnished sub- 9 sequent to such cataract surgery during such pe- 10 riod.’’. 11 (2) APPLICATION OF COMPETITIVE ACQUISI- 12 TION.— 13 (A) IN GENERAL.—Section 1834(h)(1)(H) of 14 the Social Security Act (42 U.S.C. 15 1395m(h)(1)(H)) is amended— 16 (i) in the header by inserting ‘‘, EYE- 17 GLASSES, AND CONTACT LENSES’’ after 18 ‘‘ORTHOTICS’’; 19 (ii) by inserting ‘‘and of eyeglasses and 20 contact lenses described in paragraph 21 (2)(D) of such section,’’ after ‘‘2009,’’ ; and 22 (iii) in clause (i), by inserting ‘‘or 23 such eyeglasses and contact lenses’’ after 24 ‘‘orthotics’’. 25 VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 4665 RH (B) CONFORMING AMENDMENT.— 1 (i) IN GENERAL.—Section 1847(a)(2) 2 of the Social Security Act (42 U.S.C. 3 1395w–3(a)(2)) is amended by adding at 4 the end the following new subparagraph: 5 ‘‘(D) EYEGLASSES AND CONTACT LENSES.— 6 Eyeglasses and contact lenses for which payment 7 would otherwise be made under section 8 1834(h).’’. 9 (ii) EXEMPTION OF CERTAIN ITEMS 10 FROM COMPETITIVE ACQUISITION.—Section 11 1847(a)(7) of the Social Security Act (42 12 U.S.C. 1395w–3(a)(7)) is amended by add- 13 ing at the end the following new subpara- 14 graph: 15 ‘‘(C) CERTAIN EYEGLASSES AND CONTACT 16 LENSES.—Those items and services described in 17 paragraph (2)(D) if furnished by a physician or 18 other practitioner (as defined by the Secretary) 19 to the physician’s or practitioner’s own patients 20 as part of the physician’s or practitioner’s pro- 21 fessional service.’’. 22 (g) EXCLUSION MODIFICATIONS.—Section 1862(a) of 23 the Social Security Act (42 U.S.C. 1395y(a)) is amended— 24 (1) in paragraph (1)— 25 VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 4665 RH (A) in subparagraph (O), by striking ‘‘and’’ 1 at the end; 2 (B) in subparagraph (P), by striking the 3 semicolon at the end and inserting ‘‘, and’’; and 4 (C) by adding at the end the following new 5 subparagraph: 6 ‘‘(Q) in the case of vision services (as defined in 7 section 1861(kkk)) that are routine eye examinations 8 and contact lens fitting services (as described in para- 9 graph (1) or (2), respectively, of such section), which 10 are furnished more frequently than once during a 2- 11 year period;’’; and 12 (2) in paragraph (7)— 13 (A) by inserting ‘‘(other than such an exam- 14 ination that is a vision service that is covered 15 under section 1861(s)(2)(II))’’ after ‘‘eye exami- 16 nations’’; and 17 (B) by inserting ‘‘(other than such a proce- 18 dure that is a vision service that is covered 19 under section 1861(s)(2)(II))’’ after ‘‘refractive 20 state of the eyes’’. 21 SEC. 3. IMPLEMENTATION FUNDING. 22 The Secretary of Health and Human Services shall 23 provide for the transfer from the Federal Supplementary 24 Medical Insurance Trust Fund under section 1841 of the 25 VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 4665 RH Social Security Act (42 U.S.C. 1395t) to the Centers for 1 Medicare & Medicaid Services Program Management Ac- 2 count for the period of 2020 through 2024 of such sums as 3 may be necessary for purposes of implementing the amend- 4 ments made by section 2. 5 VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS Union Calendar No. 304 116TH CONGRESS 2D SESSION H. R. 4665 [Report No. 116–327, Parts I and II] 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. JANUARY 24, 2020 Reported from the Committee on Energy and Commerce, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed VerDate Sep 11 2014 23:13 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6651 Sfmt 6651 E:\BILLS\H4665.RH H4665 kjohnson on DSK79L0C42PROD with BILLS