[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2830 Introduced in Senate (IS)]
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119th CONGRESS
1st Session
S. 2830
To amend title XVIII of the Social Security Act to improve the annual
wellness visit under the Medicare program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 17 (legislative day, September 16), 2025
Mr. King introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to improve the annual
wellness visit under 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 ``Wellness and Education for Longer
Lives for Seniors Act of 2025'' or the ``WELL Seniors Act of 2025''.
SEC. 2. IMPROVEMENTS TO THE MEDICARE ANNUAL WELLNESS VISIT.
(a) Additional Elements.--
(1) In general.--Section 1861(hhh)(2) of the Social
Security Act (42 U.S.C. 1395x(hhh)(2)) is amended--
(A) in subparagraph (F), by striking ``and
nutrition'' and inserting ``nutrition, mobility, food
security, housing security, transportation access,
social support, and other social determinants of health
as determined by the Secretary'';
(B) by moving subparagraphs (G) and (H) 2 ems to
the left;
(C) by redesignating subparagraph (I) as
subparagraph (J); and
(D) by inserting after subparagraph (H) the
following new subparagraph:
``(I) Screening for balance to identify risk for falls and
referral for treatment as appropriate.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to items and services furnished on or after January
1, 2026.
(b) Incentive Payments.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l) is amended by adding at the end the following new
subsection:
``(ee) Incentive Payments for Annual Wellness Visits That Include
Certain Elements.--
``(1) In general.--In the case of personalized prevention
plan services (as defined in paragraph (1) of section
1861(hhh)) that are furnished on or after January 1, 2026, and
that include the element described in subparagraph (F) of
paragraph (2) of such section 1861(hhh) and at least 2
additional elements described in subparagraphs (A) through (E)
and (G) through (J) of such paragraph (2), in addition to the
amount of payment that would otherwise be made for such
personalized prevention plan services under this part, there
also shall be paid an amount equal to 10 percent of the payment
amount for the service under this part.
``(2) Coordination with other payments.--The amount of the
additional payment for a service under this subsection and
subsection (m) shall be determined without regard to any
additional payment for the service under subsection (m) and
this subsection, respectively. The amount of the additional
payment for a service under this subsection and subsection (z)
shall be determined without regard to any additional payment
for the service under subsection (z) and this subsection,
respectively.''.
(c) Education and Outreach.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
conduct education and outreach activities regarding the
coverage of annual wellness visits under the Medicare program,
including changes to such visits under the amendments made by
subsections (a) and (b).
(2) National outreach campaign.--Not later than 1 year
after the date of enactment of this Act, the Secretary shall
conduct a national outreach campaign to educate beneficiaries
on the annual wellness visit under the Medicare program. In
conducting such outreach campaign, the Secretary may prioritize
education and outreach to low-income beneficiaries, non-
physician providers, and to providers working and beneficiaries
living in rural areas or health professional shortage areas.
(3) Authorization of appropriations.--There is authorized
to be appropriated for fiscal years 2026 through 2030 such sums
as may be necessary to carry out this subsection.
(d) Inclusion as Telehealth Service.--Section 1834(m)(4)(F)(i) of
the Social Security Act (42 U.S.C. 1395m(m)(4)(F)(i)) is amended by
adding at the end the following new sentence: ``Such term includes,
with respect to telehealth services furnished on or after January 1,
2026, an annual wellness visit (as defined in section 1861(hhh)).''
(e) Provider Eligibility.--
(1) In general.--Section 1861(hhh)(3) of the Social
Security Act (42 U.S.C. 1395x(hhh)(3)) is amended:
(A) by striking ``or'' at the end of subparagraph
(B);
(B) by redesignating subparagraph (C) as
subparagraph (D); and
(C) by inserting after subparagraph (B) the
following new subparagraph:
``(C) a physical therapist, an occupational therapist, or a
pharmacist; or''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to items and services furnished on or after January
1, 2026.
(f) Guidance Revision.--Not later than 1 year after the date of
enactment of this Act, the Secretary shall issue guidance amending
section 410.15 of title 42, Code of Federal Regulations (or any
successor regulation), to include guidance on processes, oversight, and
standards for the post-visit follow-up to ensure consistency and
compliance with the Health Risk Assessment, personalized prevention
plan, and referrals.
(g) Research and Evaluation.--
(1) Report.--
(A) In general.--Not later than 1 year after the
date of enactment of this Act, the Secretary, acting
through the Administrator of the Centers for Medicare &
Medicaid Services (in this subsection referred to as
the ``Administrator''), shall analyze and publish a
report on the prevalence in use of the annual wellness
visit (as defined in section 1861(hhh) of the Social
Security Act (42 U.S.C. 1395x(hhh))) by Medicare
beneficiaries, including current practices and
recommendations for increasing the use and
effectiveness of the annual wellness visit under the
Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.). Such report
shall include--
(i) information regarding the interviews
conducted under subparagraph (B);
(ii) data on the prevalence of annual
wellness visits furnished to Medicare
beneficiaries via telehealth during the COVID-
19 public health emergency; and
(iii) utilization and claims data for
annual wellness visits over the preceding 10
years broken down by State, demographic groups
(including age, race, ethnicity, income, and
education), the type of provider furnishing the
annual wellness visit, and whether the
beneficiary is enrolled for benefits under the
original Medicare-fee-for-service program under
parts A and B of title XVIII of the Social
Security Act or the Medicare Advantage program
under part C of title XVIII of the Social
Security Act.
(B) Interviews with stakeholders.--The
Administrator shall conduct interviews with
stakeholders, including provider groups, on their
concerns regarding billing for and using the annual
wellness visit under the Medicare program, including
whether and to what extent personalized prevention plan
services and appropriate referrals and follow-up are
taking place for beneficiaries who are at particular
risk and which referral models are most effective.
(2) Focus group study.--Not later than 6 months after the
date of enactment of this Act, the Secretary, acting through
the Administrator, shall conduct a focus group study among
providers, community-based organizations, and beneficiaries
towards increasing use of the annual wellness visit by Medicare
beneficiaries. The Secretary shall work with beneficiary and
stakeholder groups to develop the interview questions for such
focus group study, and shall include questions on--
(A) improving referrals to community services;
(B) barriers to utilization and recommendations to
increase uptake; and
(C) the types of providers in practices that
furnish the visits.
(3) Authorization of appropriations.--There is authorized
to be appropriated for fiscal years 2026 through 2030 such sums
as may be necessary to carry out this subsection.
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