[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4187 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 4187
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
June 25, 2021
Ms. Schrier (for herself, Mr. O'Halleran, Ms. DelBene, and Ms. Slotkin)
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 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 coverage for
certain vision items and services under part B of the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Vision Act of 2021''.
SEC. 2. PROVIDING COVERAGE FOR VISION CARE UNDER THE MEDICARE PROGRAM.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (GG), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (HH), by striking the period at the end
and adding ``; and''; and
(3) by adding at the end the following new subparagraph:
``(II) vision services (as defined in subsection
(lll));''.
(b) Vision Services Defined.--Section 1861 of the Social Security
Act (42 U.S.C. 1395x) is amended by adding at the end the following new
subsection:
``(lll) Vision Services.--The term `vision services' means--
``(1) routine eye examinations to determine the refractive
state of the eyes, including procedures performed during the
course of such examination; and
``(2) contact lens fitting services;
furnished on or after January 1, 2024, by or under the direct
supervision of an optometrist or ophthalmologist who is legally
authorized to furnish such examinations, procedures, or fitting
services (as applicable) under State law (or the State regulatory
mechanism provided by State law) of the State in which the
examinations, procedures, or fitting services are furnished.''.
(c) Payment; Coinsurance; and Limitations.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and'' before ``(DD)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (EE) with respect to vision
services (as defined in section 1861(lll)), the amount
paid shall be equal to 80 percent of the lesser of the
actual charge or the amount determined under the
payment basis determined under section 1848''.
(2) Limits specified.--Section 1834 of the Social Security
Act (42 U.S.C. 1395m) is amended by adding at the end the
following new subsection:
``(z) Limitation for Vision Services.--With respect to vision
services (as defined in section 1861(lll)) and an individual, payment
may be made under this part for only 1 routine eye examination
described in paragraph (1) of such section and 1 contact lens fitting
service described in paragraph (2) of such section during a 1-year
period.''.
(d) Payment Under Physician Fee Schedule.--
(1) In general.--Section 1848(j)(3) of the Social Security
Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
``(2)(II),'' before ``(3)''.
(2) Budget neutrality.--Section 1848(c)(2)(B)(iv) of the
Social Security Act (42 U.S.C. 1395-w(c)(2)(B)(iv)) is
amended--
(A) in subclause (III), by striking ``and'' at the
end;
(B) in subclause (IV), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(V) the amendment made by section
2(d)(1) of the Medicare Vision Act of
2021 shall not be taken into account in
applying clause (ii)(II) for 2024 and
2025.''.
(e) Coverage of Conventional Eyeglasses and Contact Lenses.--
Section 1861(s)(8) of the Social Security Act (42 U.S.C. 1395x(s)(8))
is amended by striking ``, and including one pair of conventional
eyeglasses or contact lenses furnished subsequent to each cataract
surgery with insertion of an intraocular lens'' and inserting ``,
including one pair of conventional eyeglasses or contact lenses
furnished subsequent to each cataract surgery with insertion of an
intraocular lens, if furnished before January 1, 2024, and including
conventional eyeglasses or contact lenses, whether or not furnished
subsequent to such a surgery, if furnished on or after January 1,
2024''.
(f) Special Payment Rules for Eyeglasses and Contact Lenses.--
(1) Limitations.--Section 1834(h) of the Social Security
Act (42 U.S.C. 1395m(h)) is amended by adding at the end the
following new paragraph:
``(6) Payment limitations for eyeglasses and contact
lenses.--
``(A) In general.--With respect to eyeglasses and
contact lenses furnished to an individual on or after
January 1, 2024, subject to subparagraph (B), payment
may be made under this part only--
``(i) during a 1-year period, for either 1
pair of eyeglasses (including lenses and
frames) or a 1-year supply that is provided in
not more than 180-day increments of contact
lenses;
``(ii) with respect to amounts attributable
to the frames of such a pair of eyeglasses and
amounts attributable to contact lenses
furnished during a year, in an amount not
greater than--
``(I) for 2024, $100; and
``(II) for a subsequent year, the
amount specified under this
subparagraph for the previous year,
increased by the percentage change in
the consumer price index for all urban
consumers during such previous year;
``(iii) for types of eyeglass lenses, and
for types of contact lenses, as determined
appropriate by the Secretary;
``(iv) if furnished pursuant to a written
order of a physician described in section
1861(kkk); and
``(v) if during the 1-year period described
in clause (i), the individual did not already
receive (as described in subparagraph (B)) one
pair of conventional eyeglasses or contact
lenses subsequent to a cataract surgery with
insertion of an intraocular lens furnished
during such period.
``(B) Exception.--With respect to a 1-year period
described in subparagraph (A)(i), in the case of an
individual who receives cataract surgery with insertion
of an intraocular lens, notwithstanding subparagraph
(A), payment may be made under this part for one pair
of conventional eyeglasses or contact lenses furnished
subsequent to such cataract surgery during such
period.''.
(2) Application of competitive acquisition.--
(A) In general.--Section 1834(h)(1)(H) of the
Social Security Act (42 U.S.C. 1395m(h)(1)(H)) is
amended--
(i) in the header by inserting ``,
eyeglasses, and contact lenses'' after
``orthotics'';
(ii) by inserting ``and of eyeglasses and
contact lenses described in paragraph (2)(D) of
such section,'' after ``2009,''; and
(iii) in clause (i), by inserting ``or such
eyeglasses and contact lenses'' after
``orthotics''.
(B) Conforming amendment.--
(i) In general.--Section 1847(a)(2) of the
Social Security Act (42 U.S.C. 1395w-3(a)(2))
is amended by adding at the end the following
new subparagraph:
``(D) Eyeglasses and contact lenses.--Eyeglasses
and contact lenses for which payment would otherwise be
made under section 1834(h).''.
(ii) Exemption of certain items from
competitive acquisition.--Section 1847(a)(7) of
the Social Security Act (42 U.S.C. 1395w-
3(a)(7)) is amended by adding at the end the
following new subparagraph:
``(C) Certain eyeglasses and contact lenses.--Those
items and services described in paragraph (2)(D) if
furnished by a physician or other practitioner (as
defined by the Secretary) to the physician's or
practitioner's own patients as part of the physician's
or practitioner's professional service.''.
(g) Exclusion Modifications.--Section 1862(a)(1) of the Social
Security Act (42 U.S.C. 1395y(a)) is amended--
(1) in subparagraph (O), by striking ``and'' at the end;
(2) in subparagraph (P), by striking the semicolon at the
end and inserting ``, and''; and
(3) by adding at the end the following new subparagraph:
``(Q) in the case of vision services (as defined in section
1861(lll)) that are routine eye examinations and contact lens
fitting services (as described in paragraph (1) or (2),
respectively, of such section), which are furnished more
frequently than once during a 1-year period;''.
(h) Repeal of Ground for Exclusion.--Section 1862(a)(7) of the
Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by striking ``,
eyeglasses (other than eyewear described in section 1861(s)(8)) or eye
examinations for the purpose of prescribing, fitting, or changing
eyeglasses, procedures performed (during the course of any eye
examination) to determine the refractive state of the eyes''.
(i) Low Vision Aids.--Not later than one year after the date of the
enactment of this Act, the Secretary of Health and Human Services
shall, in consultation with relevant stakeholders--
(1) undergo a review and analysis of clinically indicated
magnifiers, spectacles, and other similar vision enhancement
devices used to assist individuals with low vision and visual
impairments;
(2) based on such review identify such specific devices
that are not, but which pursuant to administrative action could
be, covered under the Medicare program under title XVIII of the
Social Security Act coverage; and
(3) take such administrative actions as are necessary to
provide for such coverage of such devices so identified as the
Secretary determines appropriate.
SEC. 3. IMPLEMENTATION FUNDING.
The Secretary of Health and Human Services shall provide for the
transfer from the Federal Supplementary Medical Insurance Trust Fund
under section 1841 of the Social Security Act (42 U.S.C. 1395t) to the
Centers for Medicare & Medicaid Services Program Management Account for
the period of 2022 through 2026 of such sums as may be necessary for
purposes of implementing the amendments made by section 2.
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