Medicare Preventive Services Coverage Act of 2004

Medicare Preventive Services Coverage Act of 2004 - Amends part B (Supplementary Medical Insurance Benefits for Aged and Disabled) of title XVIII (Medicare) of the Social Security Act to require the part B program to provide appropriate preventive benefits.

Amends part E (Miscellaneous), as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, to provide for additional preventive services (including mental health services) under Medicare.

Eliminates coinsurance in outpatient department (OPD) hospital settings and application of deductible with respect to additional preventive services.

[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2535 Introduced in Senate (IS)]






108th CONGRESS
  2d Session
                                S. 2535

   To amend title XVIII of the Social Security Act to modernize the 
 medicare program by ensuring that appropriate preventive services are 
                      covered under such program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 17, 2004

   Mr. Graham of Florida (for himself and Mr. Durbin) 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 modernize the 
 medicare program by ensuring that appropriate preventive services are 
                      covered under such 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 Preventive Services 
Coverage Act of 2004''.

SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE SERVICES DETERMINED 
              APPROPRIATE BY THE SECRETARY.

    (a) Coverage.--
            (1) Description of program.--Section 1831 of the Social 
        Security Act (42 U.S.C. 1395j) is amended by inserting 
        ``(including appropriate preventive benefits)'' after ``medical 
        insurance benefits''.
            (2) Medical and other health services.--Section 1861(s)(2) 
        of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended 
        by section 642(a) of the Medicare Prescription Drug, 
        Improvement, and Modernization Act of 2003 (Public Law 108-173; 
        117 Stat. 2322), is amended--
                    (A) in subparagraph (Y), by striking ``and'' after 
                the semicolon at the end;
                    (B) in subparagraph (Z), by adding ``and'' after 
                the semicolon at the end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(AA) additional preventive services (as defined in 
        subsection (bbb)(1));''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x), as amended by section 706(b) of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108-173; 117 Stat. 2339), is amended by adding at the end the 
following new subsection:

                    ``Additional Preventive Services

    ``(bbb)(1) The term `additional preventive services' means items 
and services, including mental health services, not otherwise covered 
under this title that the Secretary determines to be reasonable and 
necessary for the prevention or early detection of an illness or 
disability.
    ``(2) In making determinations under paragraph (1), the Secretary 
shall--
            ``(A) take into account evidence-based recommendations by 
        the United States Preventive Services Task Force and other 
        appropriate organizations; and
            ``(B) use the process for making national coverage 
        determinations (as defined in section 1869(f)(1)(B)) under this 
        title.''.
    (c) Payment and Elimination of Cost-Sharing.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)), as amended by section 302(b)(2) of 
        the Medicare Prescription Drug, Improvement, and Modernization 
        Act of 2003 (Public Law 108-173; 117 Stat. 2229), is amended--
                    (A) by striking ``and'' before ``(V)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (W) with respect to additional 
                preventive services (as defined in section 
                1861(bbb)(1)), the amount paid shall be 100 percent of 
                the lesser of the actual charge for the services or the 
                amount determined under a fee schedule established by 
                the Secretary for purposes of this subparagraph''.
            (2) Elimination of coinsurance in outpatient hospital 
        settings.--
                    (A) Exclusion from opd fee schedule.--Section 
                1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 
                1395l(t)(1)(B)(iv)), as amended by section 614 of the 
                Medicare Prescription Drug, Improvement, and 
                Modernization Act of 2003 (Public Law 108-173; 117 
                Stat. 2306), is amended by striking ``and diagnostic 
                mammography'' and inserting ``, diagnostic mammography, 
                or additional preventive services (as defined in 
                section 1861(bbb)(1))''.
                    (B) Conforming amendments.--Section 1833(a)(2) of 
                the Social Security Act (42 U.S.C. 1395l(a)(2)) is 
                amended--
                            (i) in subparagraph (F), by striking 
                        ``and'' after the semicolon at the end;
                            (ii) in subparagraph (G)(ii), by striking 
                        the comma at the end and inserting ``; and''; 
                        and
                            (iii) by inserting after subparagraph 
                        (G)(ii) the following new subparagraph:
                    ``(H) with respect to additional preventive 
                services (as defined in section 1861(bbb)(1)) furnished 
                by an outpatient department of a hospital, the amount 
                determined under paragraph (1)(W),''.
            (3) Waiver of application of deductible.--The first 
        sentence of section 1833(b) of the Social Security Act (42 
        U.S.C. 1395l(b)) is amended--
                    (A) by striking ``and'' before ``(6)''; and
                    (B) by inserting before the period the following: 
                ``, and (7) such deductible shall not apply with 
                respect to additional preventive services (as defined 
                in section 1861(bbb)(1))''.
    (d) Inclusion as Part of Initial Preventive Physical Examination.--
Section 1861(ww)(2) of the Social Security Act (42 U.S.C. 
1395x(ww)(2)), as added by section 611(b) of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173; 
117 Stat. 2303), is amended by adding at the end the following new 
subparagraph:
            ``(L) Additional preventive services (as defined in 
        subsection (bbb)(1)).''.
    (e) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the date of enactment of this 
Act.
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