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106th CONGRESS
1st Session
S. 1618
To promote primary and secondary health promotion and disease
prevention services and activities among the elderly, to amend title
XVIII of the Social Security Act to add preventive benefits, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 22, 1999
Mr. Graham (for himself, Mr. Jeffords, Mr. Chafee, Mr. Bryan, Mr.
Rockefeller, and Mr. Kerry) introduced the following bill; which was
read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To promote primary and secondary health promotion and disease
prevention services and activities among the elderly, to amend title
XVIII of the Social Security Act to add preventive benefits, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare Wellness
Act of 1999''.
(b) Table of Contents.--The table of contents is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Finding.
Sec. 3. Definitions.
TITLE I--HEALTHY SENIORS PROMOTION PROGRAM
Sec. 101. Healthy Seniors Promotion Program.
Sec. 102. Sense of Congress regarding the response of HCFA to
preventive health issues.
Sec. 103. Sense of Congress regarding the efforts of HCFA to study
health promotion and disease prevention for
medicare beneficiaries.
Sec. 104. Sense of Congress regarding the establishment of a medicare
health promotion and disease prevention
clearinghouse.
TITLE II--MEDICARE COVERAGE OF PREVENTIVE SERVICES
Sec. 201. Counseling for cessation of tobacco use.
Sec. 202. Screening for hypertension.
Sec. 203. Counseling for hormone replacement therapy.
Sec. 204. Screening for glaucoma.
Sec. 205. Screening for diminished visual acuity.
Sec. 206. Screening for hearing impairment.
Sec. 207. Screening and counseling for osteoporosis.
Sec. 208. Screening for cholesterol.
Sec. 209. Elimination of cost sharing for current preventive benefits.
Sec. 210. National falls prevention education and awareness campaign.
Sec. 211. Program integrity.
TITLE III--MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM
Sec. 301. Medicare Health Education and Risk Appraisal Program.
TITLE IV--DISEASE SELF-MANAGEMENT DEMONSTRATION PROJECTS
Sec. 401. Disease self-management demonstration projects.
TITLE V--STUDIES AND REPORTS ADVANCING ORIGINAL RESEARCH IN THE FIELD
OF DISEASE PREVENTION AND THE ELDERLY
Sec. 501. MedPAC biannual report.
Sec. 502. National Institute on Aging study and report.
Sec. 503. Institute of Medicine 5-year medicare prevention benefit
study and report.
Sec. 504. Fast-track consideration of prevention benefit legislation.
SEC. 2. FINDING.
Congress finds that despite significant advancements in general
research for health promotion and disease prevention among the elderly,
there has been a failure in translating that research into practical
intervention.
SEC. 3. DEFINITIONS.
As used in this Act:
(1) Cost-effective benefit.--The term ``cost-effective
benefit'' means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) demonstrated value as measured by unit costs
relative to health outcomes achieved.
(2) Cost-saving benefit.--The term ``cost-saving benefit''
means a benefit or technique that has--
(A) been subject to peer review;
(B) been described in scientific journals; and
(C) caused a net reduction in health care costs for
medicare beneficiaries.
(3) Medically effective.--The term ``medically effective''
means, with respect to a benefit or technique, that the benefit
or technique has been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under
normal, programmatic conditions.
(4) Medical efficacy; medically efficacious.--The terms
``medical efficacy'' and ``medically efficacious'' mean, with
respect to a benefit or technique, that the benefit or
technique has been--
(A) subject to peer review;
(B) described in scientific journals; and
(C) determined to achieve an intended goal under
controlled conditions.
(5) Medicare beneficiary.--The term ``medicare
beneficiary'' means any individual who is entitled to benefits
under part A or enrolled under part B of the medicare program,
including any individual enrolled in a Medicare+Choice plan
offered by a Medicare+Choice organization under part C of such
program.
(6) Medicare program.--The term ``medicare program'' means
the health care program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(7) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
TITLE I--HEALTHY SENIORS PROMOTION PROGRAM
SEC. 101. HEALTHY SENIORS PROMOTION PROGRAM.
(a) Definitions.--As used in this section:
(1) Eligible entity.--The term ``eligible entity'' means an
entity that the Working Group determines has demonstrated
expertise in research regarding health promotion and disease
prevention among the elderly.
(2) Working group.--The term ``Working Group'' means the
Healthy Seniors Working Group established under subsection (d).
(b) Program Authorized.--The Secretary, subject to the general
policies and criteria established by the Working Group and in
accordance with the provisions of this Act, is authorized to make
grants to eligible entities to pay for the costs of the activities
described in subsection (c).
(c) Use of Funds.--An eligible entity may use payments received
under this section in any fiscal year to study--
(1) whether using different types of providers of care who
are not physicians and alternative settings (including
community-based senior centers) for the implementation of a
successful health promotion and disease prevention strategy,
including the implications regarding the payment of such
providers, is medically efficacious or medically effective;
(2) the most medically effective means of educating
medicare beneficiaries and providers of services regarding the
importance of health promotion and disease prevention among the
elderly and identification of incentives that would increase
the use of new and existing preventive services and healthy
behaviors by medicare beneficiaries; and
(3) other topics designated by the Secretary.
(d) Healthy Seniors Working Group.--
(1) Establishment.--There is established within the
Department of Health and Human Services a Healthy Seniors
Working Group.
(2) Composition.--Subject to paragraph (3), the Working
Group established pursuant to subsection (b) shall be composed
of 5 members as follows:
(A) The Administrator of the Health Care Financing
Administration.
(B) The Director of the Centers for Disease Control
and Prevention.
(C) The Administrator of the Agency for Health Care
Policy and Research.
(D) The Assistant Secretary for Aging.
(E) The Director of the National Institute on
Aging.
(3) Alternative membership.--
(A) Appointment.--Any member of the Working Group
described in a subparagraph of paragraph (2) may
appoint an individual who is an officer or employee of
the Federal Government to serve as a member of the
Working Group instead of the member described in such
subparagraph.
(B) Deadline.--If a member described in
subparagraph (A) elects to appoint an individual under
such subparagraph, such individual shall be appointed
not later than December 31, 2000.
(4) General policies and criteria.--The Working Group shall
establish general policies and criteria with respect to the
functions of the Secretary under this section including--
(A) priorities for the approval of applications;
(B) procedures for developing, monitoring, and
evaluating research efforts conducted under this
section; and
(C) such other matters as are recommended by the
Working Group and approved by the Secretary.
(5) Chairperson.--The Chairperson of the Working Group
shall be the Administrator of the Agency for Health Care Policy
and Research.
(6) Quorum.--A majority of the members of the Working Group
shall constitute a quorum, but a lesser number of members may
hold hearings.
(7) Meetings.--The Working Group shall meet at the call of
the Chairperson, except that--
(A) it shall meet not less than 4 times each year;
and
(B) it shall meet whenever a majority of the
appointed members request a meeting in writing.
(8) Compensation of members.--Each member of the Working
Group shall be an officer or employee of the Federal Government
and shall serve without compensation in addition to that
received for their service as an officer or employee of the
Federal Government.
(e) Application.--
(1) In general.--Each eligible entity which desires to
receive a grant under this section shall submit an application
to the Secretary, at such time, in such manner, and accompanied
by such additional information as the Secretary may reasonably
require.
(2) Contents.--Each application submitted pursuant to
paragraph (1) shall--
(A) describe the activities for which assistance
under this section is sought;
(B) describe how the research effort proposed to be
conducted will reflect the medical, behavioral, and
social aspects of care for the elderly, lead to the
development of cost-effective benefits and cost-saving
benefits, and impact the quality of life of medicare
beneficiaries;
(C) provide evidence that the eligible entity meets
the general policies established by the Working Group
pursuant to subsection (d)(4);
(D) provide assurances that the eligible entity
will take such steps as may be available to it to
continue the activities for which the eligible entity
is making application after the period for which
assistance is sought; and
(E) provide such additional assurances as the
Secretary determines to be essential to ensure
compliance with the requirements of this Act.
(3) Joint application.--A consortium of eligible entities
may file a joint application under the provisions of paragraph
(1) of this subsection.
(f) Approval of Application.--The Secretary shall approve
applications in accordance with the general policies established by the
Working Group under subsection (d).
(g) Payments.--The Secretary shall pay to each eligible entity
having an application approved under subsection (f) the cost of the
activities described in the application.
(h) Evaluation and Report.--
(1) Evaluation.--The Secretary shall conduct an annual
evaluation of grants made under this section to determine--
(A) the results of the overall applied research
conducted under this Act;
(B) the extent to which research assisted under
this section has improved or expanded the general
research for health promotion and disease prevention
among the elderly and identified practical
interventions based upon such research;
(C) a list of specific recommendations based upon
research conducted under this section which show
promise as practical interventions for health promotion
and disease prevention among the elderly;
(D) whether or not as a result of the applied
research effort certain health promotion and disease
prevention benefits or education efforts should be
added to the medicare program, including discussions of
quality of life, translating the applied research
results into a benefit under the medicare program, and
whether each additional benefit would be a cost-
effective benefit or cost-saving benefit for each
proposed addition;
(E) the utility of, potential for, and issues
surrounding health risk appraisals sponsored under the
medicare program and targeted followup; and
(F) how best to increase utilization of existing
and recommended health promotion and disease prevention
services, including an education and public awareness
component discussion of financial incentives for
providers of services and medicare beneficiaries to
improve utilization and other administrative means of
increasing utilization.
(2) Annual report.--Not later than December 31, 2002, and
each year thereafter through 2005, the Secretary shall submit a
report to Congress based on the annual studies made under
paragraph (1), which shall contain a detailed statement of the
findings and conclusions of the Working Group together with its
recommendations for such legislation and administrative actions
as it considers appropriate.
(i) Authorization of Appropriations.--There are authorized to be
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