SEC. 4101. SCREENING MAMMOGRAPHY.
(a) Providing Annual Screening Mammography for Women Over Age 39.-- Section 1834(c)(2)(A) (42 U.S.C. 1395m(c)(2)(A)) is amended-- (1) in clause (iii), to read as follows: (iii) In the case of a woman over 39 years of age, payment may not be made under this part for screening mammography performed within 11 months following the month in which a previous screening mammography was performed."; and (2) by striking clauses (iv) and (v).
(b) Waiver of Deductible.--The first sentence of section 1833(b) (42 U.S.C. 1395l(b)) is amended-- (1) by striking "and" before "(4)", and (2) by inserting before the period at the end the following: , and (5) such deductible shall not apply with respect to screening mammography (as described in section 1861(jj))".
(c) Conforming Amendment.--Section 1834(c)(1)(C) (42 U.S.C. 1395m(c)(1)(C)) is amended by striking ", subject to the deductible established under section 1833(b),".
(d) Effective Date.--The amendments made by this section shall apply to items and services furnished on or after January 1, 1998.
(a) Coverage of Pelvic Exam; Increasing Frequency of Coverage of Pap Smear.--Section 1861(nn) (42 U.S.C. 1395x(nn)) is amended-- (1) in the heading, by striking "Smear" and inserting "Smear; Screening Pelvic Exam"; (2) by inserting "or vaginal" after "cervical" each place it appears; (3) by striking "(nn)" and inserting "(nn)(1)"; (4) by striking "3 years" and all that follows and inserting "3 years, or during the preceding year in the case of a woman described in paragraph (3)."; and (5) by adding at the end the following new paragraphs: (2) The term 'screening pelvic exam' means a pelvic examination provided to a woman if the woman involved has not had such an examination during the preceding 3 years, or during the preceding year in the case of a woman described in paragraph (3), and includes a clinical breast examination.
(3) A woman described in this paragraph is a woman who-- (A) is of childbearing age and has had a test described in this subsection during any of the preceding 3 years that indicated the presence of cervical or vaginal cancer or other abnormality; or (B) is at high risk of developing cervical or vaginal cancer (as determined pursuant to factors identified by the Secretary).".
(b) Waiver of Deductible.--The first sentence of section 1833(b) (42 U.S.C. 1395l(b)), as amended by section 4101(b), is amended-- (1) by striking "and" before "(5)", and (2) by inserting before the period at the end the following: , and (6) such deductible shall not apply with respect to screening pap smear and screening pelvic exam (as described in section 1861(nn))".
(c) Conforming Amendments.--Sections 1861(s)(14) and 1862(a)(1)(F) (42 U.S.C. 1395x(s)(14), 1395y(a)(1)(F)) are each amended by inserting "and screening pelvic exam" after "screening pap smear".
(d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by striking "and (4)" and inserting "(4) and (14) (with respect to services described in section 1861(nn)(2))".
(e) Effective Date.--The amendments made by this section shall apply to items and services furnished on or after January 1, 1998.
(a) Coverage.--Section 1861 (42 U.S.C. 1395x) is amended-- (1) in subsection (s)(2)-- (A) by striking "and" at the end of subparagraphs (N) and (O), and (B) by inserting after subparagraph (O) the following new subparagraph: (P) prostate cancer screening tests (as defined in subsection (oo)); and"; and (2) by adding at the end the following new subsection:
(oo)(1) The term 'prostate cancer screening test' means a test that consists of any (or all) of the procedures described in paragraph (2) provided for the purpose of early detection of prostate cancer to a man over 50 years of age who has not had such a test during the preceding year.
(2) The procedures described in this paragraph are as follows: (A) A digital rectal examination.
(B) A prostate-specific antigen blood test.
(C) For years beginning after 2002, such other procedures as the Secretary finds appropriate for the purpose of early detection of prostate cancer, taking into account changes in technology and standards of medical practice, availability, effectiveness, costs, and such other factors as the Secretary considers appropriate.".
(b) Payment for Prostate-specific Antigen Blood Test Under Clinical Diagnostic Laboratory Test Fee Schedules.--Section 1833(h)(1)(A) (42 U.S.C. 1395l(h)(1)(A)) is amended by inserting after "laboratory tests" the following: (including prostate cancer screening tests under section 1861(oo) consisting of prostate-specific antigen blood tests)".
(c) Conforming Amendment.--Section 1862(a) (42 U.S.C. 1395y(a)) is amended-- (1) in paragraph (1)-- (A) in subparagraph (E), by striking "and" at the end, (B) in subparagraph (F), by striking the semicolon at the end and inserting ", and", and (C) by adding at the end the following new subparagraph: (G) in the case of prostate cancer screening tests (as defined in section 1861(oo)), which are performed more frequently than is covered under such section;"; and (2) in paragraph (7), by striking "paragraph (1)(B) or under paragraph (1)(F)" and inserting "subparagraphs (B), (F), or (G) of paragraph (1)".
(d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)), as amended by section 4102, is amended by inserting ", (2)(P) (with respect to services described in subparagraphs (A) and (C) of section 1861(oo)(2)," after "(2)(G)" (e) Effective Date.--The amendments made by this section shall apply to items and services furnished on or after January 1, 2000.
(a) Coverage.-- (1) In general.--Section 1861 (42 U.S.C. 1395x), as amended by section 4103(a), is amended-- (A) in subsection (s)(2)-- (i) by striking "and" at the end of subparagraph (P); (ii) by adding and" at the end of subparagraph (Q); and (iii) by adding at the end the following new subparagraph: (R) colorectal cancer screening tests (as defined in subsection (pp)); and"; and (B) by adding at the end the following new subsection:
(pp)(1) The term 'colorectal cancer screening test' means any of the following procedures furnished to an individual for the purpose of early detection of colorectal cancer: (A) Screening fecal-occult blood test.
(B) Screening flexible sigmoidoscopy.
(C) In the case of an individual at high risk for colorectal cancer, screening colonoscopy.
(D) Such other tests or procedures, and modifications to tests and procedures under this subsection, with such frequency and payment limits, as the Secretary determines appropriate, in consultation with appropriate organizations.
(2) In paragraph (1)(C), an 'individual at high risk for colorectal cancer' is an individual who, because of family history, prior experience of cancer or precursor neoplastic polyps, a history of chronic digestive disease condition (including inflammatory bowel disease, Crohn's Disease, or ulcerative colitis), the presence of any appropriate recognized gene markers for colorectal cancer, or other predisposing factors, faces a high risk for colorectal cancer.".
(2) Deadline for publication of determination on coverage of screening barium enema.--Not later than the earlier of the date that is January 1, 1998, or 90 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall publish notice in the Federal Register with respect to the determination under paragraph (1)(D) of section 1861(pp) of the Social Security Act (42 U.S.C. 1395x(pp)), as added by paragraph (1), on the coverage of a screening barium enema as a colorectal cancer screening test under such section.
(b) Frequency Limits and Payment.-- (1) In general.--Section 1834 (42 U.S.C. 1395m) is amended by inserting after subsection (c) the following new subsection: (d) Frequency Limits and Payment for Colorectal Cancer Screening Tests.-- (1) Screening fecal-occult blood tests.-- (A) Payment amount.--The payment amount for colorectal cancer screening tests consisting of screening fecal-occult blood tests is equal to the payment amount established for diagnostic fecal-occult blood tests under section 1833(h).
(B) Frequency limit.--No payment may be made under this part for a colorectal cancer screening test consisting of a screening fecal-occult blood test-- (i) if the individual is under 50 years of age; or (ii) if the test is performed within the 11 months after a previous screening fecal-occult blood test.
(2) Screening flexible sigmoidoscopies.-- (A) Fee schedule.--With respect to colorectal cancer screening tests consisting of screening flexible sigmoidoscopies, payment under section 1848 shall be consistent with payment under such section for similar or related services.
(B) Payment limit.--In the case of screening flexible sigmoidoscopy services, payment under this part shall not exceed such amount as the Secretary specifies, based upon the rates recognized for diagnostic flexible sigmoidoscopy services.
(C) Facility payment limit.-- (i) In general.--Notwithstanding subsections (i)(2)(A) and (t) of section 1833, in the case of screening flexible sigmoidoscopy services furnished on or after January 1, 1999, that--
(I) in accordance with regulations, may be performed in an ambulatory surgical center and for which the Secretary permits ambulatory surgical center payments under this part, and (II) are performed in an ambulatory surgical center or hospital outpatient department,
payment under this part shall be based on the lesser of the amount under the fee schedule that would apply to such services if they were performed in a hospital outpatient department in an area or the amount under the fee schedule that would apply to such services if they were performed in an ambulatory surgical center in the same area.
(ii) Limitation on deductible and coinsurance.-- Notwithstanding any other provision of this title, in the case of a beneficiary who receives the services described in clause (i)--
(I) in computing the amount of any applicable deductible or copayment, the computation of such deductible or coinsurance shall be based upon the fee schedule under which payment is made for the services, and (II) the amount of such coinsurance is equal to 25 percent of the payment amount under the fee schedule described in subclause (I).
(D) Special rule for detected lesions.--If during the course of such screening flexible sigmoidoscopy, a lesion or growth is detected which results in a biopsy or removal of the lesion or growth, payment under this part shall not be made for the screening flexible sigmoidoscopy but shall be made for the procedure classified as a flexible sigmoidoscopy with such biopsy or removal.
(E) Frequency limit.--No payment may be made under this part for a colorectal cancer screening test consisting of a screening flexible sigmoidoscopy-- (i) if the individual is under 50 years of age; or (ii) if the procedure is performed within the 47 months after a previous screening flexible sigmoidoscopy.
(3) Screening colonoscopy for individuals at high risk for colorectal cancer.-- (A) Fee schedule.--With respect to colorectal cancer screening test consisting of a screening colonoscopy for individuals at high risk for colorectal cancer (as defined in section 1861(pp)(2)), payment under section 1848 shall be consistent with payment amounts under such section for similar or related services.
(B) Payment limit.--In the case of screening colonoscopy services, payment under this part shall not exceed such amount as the Secretary specifies, based upon the rates recognized for diagnostic colonoscopy services.
(C) Facility payment limit.-- (i) In general.--Notwithstanding subsections (i)(2)(A) and (t) of section 1833, in the case of screening colonoscopy services furnished on or after January 1, 1999, that are performed in an ambulatory surgical center or a hospital outpatient department, payment under this part shall be based on the lesser of the amount under the fee schedule that would apply to such services if they were performed in a hospital outpatient department in an area or the amount under the fee schedule that would apply to such services if they were performed in an ambulatory surgical center in the same area.
(ii) Limitation on deductible and coinsurance.-- Notwithstanding any other provision of this title, in the case of a beneficiary who receives the services described in clause (i)--
(I) in computing the amount of any applicable deductible or coinsurance, the computation of such deductible or coinsurance shall be based upon the fee schedule under which payment is made for the services, and (II) the amount of such coinsurance is equal to 25 percent of the payment amount under the fee schedule described in subclause (I).
(D) Special rule for detected lesions.--If during the course of such screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the lesion or growth, payment under this part shall not be made for the screening colonoscopy but shall be made for the procedure classified as a colonoscopy with such biopsy or removal.
(E) Frequency limit.--No payment may be made under this part for a colorectal cancer screening test consisting of a screening colonoscopy for individuals at high risk for colorectal cancer if the procedure is performed within the 23 months after a previous screening colonoscopy.".
(c) Conforming Amendments.--(1) Paragraphs (1)(D) and (2)(D) of section 1833(a) (42 U.S.C. 1395l(a)) are each amended by inserting "or section 1834(d)(1)" after "subsection (h)(1)".
(2) Section 1833(h)(1)(A) (42 U.S.C. 1395l(h)(1)(A)) is amended by striking "The Secretary" and inserting "Subject to section 1834(d)(1), the Secretary".
(3) Section 1862(a) (42 U.S.C. 1395y(a)), as amended by section 4103(c), is amended-- (A) in paragraph (1)-- (i) in subparagraph (F), by striking "and" at the end, (ii) in subparagraph (G), by striking the semicolon at the end and inserting ", and", and (iii) by adding at the end the following new subparagraph: (H) in the case of colorectal cancer screening tests, which are performed more frequently than is covered under section 1834(d);"; and (B) in paragraph (7), by striking "or (G)" and inserting "(G), or (H)".
(d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)), as amended by sections 4102 and 4103, is amended by inserting "(2)(R) (with respect to services described in subparagraphs (B) , (C), and (D) of section 1861(pp)(1))," before "(3)".
(e) Effective Date.--The amendments made by this section shall apply to items and services furnished on or after January 1, 1998.
(a) Coverage of Diabetes Outpatient Self-management Training Services.-- (1) In general.--Section 1861 (42 U.S.C. 1395x), as amended by sections 4103(a) and 4104(a), is amended-- (A) in subsection (s)(2)-- (i) by striking "and" at the end of subparagraph (Q); (ii) by adding and" at the end of subparagraph (R); and (iii) by adding at the end the following new subparagraph: (S) diabetes outpatient self-management training services (as defined in subsection (qq)); and"; and (B) by adding at the end the following new subsection:
(qq)(1) The term 'diabetes outpatient self-management training services' means educational and training services furnished (at such times as the Secretary determines appropriate) to an individual with diabetes by a certified provider (as described in paragraph (2)(A)) in an outpatient setting by an individual or entity who meets the quality standards described in paragraph (2)(B), but only if the physician who is managing the individual's diabetic condition certifies that such services are needed under a comprehensive plan of care related to the individual's diabetic condition to ensure therapy compliance or to provide the individual with necessary skills and knowledge (including skills related to the self-administration of injectable drugs) to participate in the management of the individual's condition.
(2) In paragraph (1)-- (A) a 'certified provider' is a physician, or other individual or entity designated by the Secretary, that, in addition to providing diabetes outpatient self-management training services, provides other items or services for which payment may be made under this title; and (B) a physician, or such other individual or entity, meets the quality standards described in this paragraph if the physician, or individual or entity, meets quality standards established by the Secretary, except that the physician or other individual or entity shall be deemed to have met such standards if the physician or other individual or entity meets applicable standards originally established by the National Diabetes Advisory Board and subsequently revised by organizations who participated in the establishment of standards by such Board, or is recognized by an organization that represents individuals (including individuals under this title) with diabetes as meeting standards for furnishing the services.".
(2) Payment Under Physician Fee Schedule.--Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) as amended in sections 4102, 4103, and 4104, is amended by inserting "(2)(S)," before "(3),".
(3) Consultation with organizations in establishing payment amounts for services provided by physicians.--In establishing payment amounts under section 1848 of the Social Security Act for physicians' services consisting of diabetes outpatient self- management training services, the Secretary of Health and Human Services shall consult with appropriate organizations, including such organizations representing individuals or medicare beneficiaries with diabetes.
(b) Blood-testing Strips for Individuals With Diabetes.-- (1) Including strips and monitors as durable medical equipment.--The first sentence of section 1861(n) (42 U.S.C.
1395x(n)) is amended by inserting before the semicolon the following: , and includes blood-testing strips and blood glucose monitors for individuals with diabetes without regard to whether the individual has Type I or Type II diabetes or to the individual's use of insulin (as determined under standards established by the Secretary in consultation with the appropriate organizations)".
(2) 10 percent reduction in payments for testing strips.-- Section 1834(a)(2)(B)(iv) (42 U.S.C. 1395m(a)(2)(B)(iv)) is amended by adding before the period the following: (reduced by 10 percent, in the case of a blood glucose testing strip furnished after 1997 for an individual with diabetes)".
(c) Establishment of Outcome Measures for Beneficiaries With Diabetes.-- (1) In general.--The Secretary of Health and Human Services, in consultation with appropriate organizations, shall establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for purposes of evaluating the improvement of the health status of medicare beneficiaries with diabetes mellitus.
(2) Recommendations for modifications to screening benefits.-- Taking into account information on the health status of medicare beneficiaries with diabetes mellitus as measured under the outcome measures established under paragraph (1), the Secretary shall from time to time submit recommendations to Congress regarding modifications to the coverage of services for such beneficiaries under the medicare program.
(d) Effective Date.-- (1) In general.--Except as provided in paragraph (2), the amendments made by this section shall apply to items and services furnished on or after July 1, 1998.
(2) Testing strips.--The amendment made by subsection (b)(2) shall apply with respect to blood glucose testing strips furnished on or after January 1, 1998.
(a) In General.--Section 1861 (42 U.S.C. 1395x), as amended by sections 4103(a), 4104(a), and 4105(a), is amended-- (1) in subsection (s)-- (A) in paragraph (12)(C), by striking "and" at the end, (B) by striking the period at the end of paragraph (14) and inserting "; and", (C) by redesignating paragraphs (15) and (16) as paragraphs (16) and (17), respectively, and (D) by inserting after paragraph (14) the following new paragraph: (15) bone mass measurement (as defined in subsection (rr))."; and (2) by inserting after subsection (qq) the following new subsection:
(rr)(1) The term 'bone mass measurement' means a radiologic or radioisotopic procedure or other procedure approved by the Food and Drug Administration performed on a qualified individual (as defined in paragraph (2)) for the purpose of identifying bone mass or detecting bone loss or determining bone quality, and includes a physician's interpretation of the results of the procedure.
(2) For purposes of this subsection, the term 'qualified individual' means an individual who is (in accordance with regulations prescribed by the Secretary)-- (A) an estrogen-deficient woman at clinical risk for osteoporosis; (B) an individual with vertebral abnormalities; (C) an individual receiving long-term glucocorticoid steroid therapy; (D) an individual with primary hyperparathyroidism; or (E) an individual being monitored to assess the response to or efficacy of an approved osteoporosis drug therapy.
(3) The Secretary shall establish such standards regarding the frequency with which a qualified individual shall be eligible to be provided benefits for bone mass measurement under this title.".
(b) Payment under Physician Fee Schedule.--Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)), as amended by sections 4102, 4103, 4104 and 4105, is amended-- (1) by striking "(4) and (14)" and inserting "(4), (14)" and (2) by inserting "and (15)" after "1861(nn)(2))".
(c) Conforming Amendments.--Sections 1864(a), 1902(a)(9)(C), and 1915(a)(1)(B)(ii)(I) (42 U.S.C. 1395aa(a), 1396a(a)(9)(C), and 1396n(a)(1)(B)(ii)(I)) are amended by striking "paragraphs (15) and (16)" each place it appears and inserting "paragraphs (16) and (17)".
(d) Effective Date.--The amendments made by this section shall apply to bone mass measurements performed on or after July 1, 1998.
(a) Extension of Influenza and Pneumococcal Vaccination Campaign.-- In order to increase utilization of pneumococcal and influenza vaccines in medicare beneficiaries, the Influenza and Pneumococcal Vaccination Campaign carried out by the Health Care Financing Administration in conjunction with the Centers for Disease Control and Prevention and the National Coalition for Adult Immunization, is extended until the end of fiscal year 2002.
(b) Authorization of Appropriation.--There are hereby authorized to be appropriated for each of fiscal years 1998 through 2002, $8,000,000 for the Campaign described in subsection (a). Of the amount so authorized to be appropriated in each fiscal year, 60 percent of the amount so appropriated shall be payable from the Federal Hospital Insurance Trust Fund, and 40 percent shall be payable from the Federal Supplementary Medical Insurance Trust Fund.
(a) Study.--The Secretary of Health and Human Services shall request the National Academy of Sciences, and as appropriate in conjunction with the United States Preventive Services Task Force, to analyze the expansion or modification of preventive or other benefits provided to medicare beneficiaries under title XVIII of the Social Security Act. The analysis shall consider both the short term and long term benefits, and costs to the medicare program, of such expansion or modification.
(b) Report.-- (1) Initial report.--Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit a report on the findings of the analysis conducted under subsection (a) to the Committee on Ways and Means and the Committee on Commerce of the House of Representatives and the Committee on Finance of the Senate.
(2) Contents.--Such report shall include specific findings with respect to coverage of at least the following benefits: (A) Nutrition therapy services, including parenteral and enteral nutrition and including the provision of such services by a registered dietitian.
(B) Skin cancer screening.
(C) Medically necessary dental care.
(D) Routine patient care costs for beneficiaries enrolled in approved clinical trial programs.
(E) Elimination of time limitation for coverage of immunosuppressive drugs for transplant patients.
(3) Funding.--From funds appropriated to the Department of Health and Human Services for fiscal years 1998 and 1999, the Secretary shall provide for such funding as the Secretary determines necessary for the conduct of the study by the National Academy of Sciences under this section.