Diabetic Vision Loss and Blindness Prevention Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 5254 To amend title XVIII of the Social Security Act to provide for coverage under the Medicare program of digital retinal imaging with remote inter- pretation. IN THE HOUSE OF REPRESENTATIVES NOVEMBER 22, 2019 Ms. SEWELL of Alabama (for herself, Mr. REED, and Ms. DEGETTE) intro- duced 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 subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to provide for coverage under the Medicare program of digital ret- inal imaging with remote interpretation. 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 ‘‘Diabetic Vision Loss 4 and Blindness Prevention Act of 2019’’. 5 VerDate Sep 11 2014 23:49 Dec 09, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5254.IH H5254 aiking on DSK30JT082PROD with BILLS 2 •HR 5254 IH SEC. 2. MEDICARE COVERAGE OF DIGITAL RETINAL IMAG- 1 ING WITH REMOTE INTERPRETATION. 2 (a) COVERAGE.—Section 1861 of the Social Security 3 Act (42 U.S.C. 1395x) is amended— 4 (1) in subsection (s)(2)— 5 (A) in subparagraph (GG), by striking 6 ‘‘and’’ at the end; 7 (B) in subparagraph (HH), by adding 8 ‘‘and’’ at the end; and 9 (C) by inserting after subparagraph (HH) 10 the following new subparagraph: 11 ‘‘(II) digital retinal imaging with remote 12 interpretation (as defined in subsection 13 (kkk));’’; and 14 (2) by adding at the end the following new sub- 15 section: 16 ‘‘(kkk) DIGITAL RETINAL IMAGING WITH REMOTE 17 INTERPRETATION.—The term ‘digital retinal imaging 18 with remote interpretation’ means a diagnostic procedure 19 for the purpose of early detection or assessment of diabetic 20 retinopathy that— 21 ‘‘(1) is provided not more frequently than on an 22 annual basis to an individual who has been diag- 23 nosed with diabetes and who does not have prior dia- 24 betic retinopathy known to the primary care practi- 25 tioner of the individual; 26 VerDate Sep 11 2014 23:49 Dec 09, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5254.IH H5254 aiking on DSK30JT082PROD with BILLS 3 •HR 5254 IH ‘‘(2) is provided by or under the general super- 1 vision of a primary care practitioner (as defined in 2 section 1833(x)) or board-certified endocrinologist; 3 ‘‘(3) utilizes a retinal camera with optical reso- 4 lution compliant with the International Organization 5 for Standardization ISO 10940 to take digital im- 6 ages of structures behind the lens of the eye, such 7 as the retina, choroid, and optic nerve; and 8 ‘‘(4) involves the electronic transmission of such 9 images for evaluation for diabetic retinopathy and 10 other diseases of the eye by a State-licensed ophthal- 11 mologist or optometrist.’’. 12 (b) PAYMENT.—The payment amount for digital ret- 13 inal imaging with remote interpretation provided pursuant 14 to the amendments made by section (a) shall be equal to— 15 (1) for the period beginning on October 1, 16 2019, and ending on December 31, 2019, and for 17 2020, $51.54; and 18 (2) for a subsequent year, the payment amount 19 specified in subparagraph (1) or this subparagraph 20 for the preceding year increased by the percentage 21 increase in the MEI (as defined in section 22 1842(i)(3) of the Social Security Act (42 U.S.C. 23 1395u(i)(3)) for such subsequent year. 24 VerDate Sep 11 2014 23:49 Dec 09, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5254.IH H5254 aiking on DSK30JT082PROD with BILLS 4 •HR 5254 IH Digital retinal imaging with remote interpretation shall 1 not be considered a telehealth service for purposes of sec- 2 tion 1834(m) of the Social Security Act (42 U.S.C. 3 1395m(m)). 4 (c) PATIENT EDUCATION AND AWARENESS.— 5 (1) ANNUAL EYE EXAM RECOMMENDATION.— 6 The Secretary of Health and Human Services shall 7 ensure that diabetes outpatient self-management 8 training services described in section 1861(qq) of the 9 Social Security Act (42 U.S.C. 1395x(qq)) educate 10 Medicare beneficiaries regarding the importance of 11 receiving an annual comprehensive eye exam. 12 (2) PATIENT AWARENESS.—The Secretary shall 13 undertake efforts to ensure that patients receiving 14 digital retinal imaging with remote interpretation as 15 described in subsection (kkk) of section 1861 of the 16 Social Security Act (42 U.S.C. 1395x), as added by 17 subsection (a), are aware of the availability of and 18 coverage for diabetes outpatient self-management 19 training services under subsection (s)(2)(S) of such 20 section. 21 Æ VerDate Sep 11 2014 23:49 Dec 09, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H5254.IH H5254 aiking on DSK30JT082PROD with BILLS