Requiring coverage of annual glaucoma screenings for certain individuals

(a) Private insurance (1) In general Section 2713 of the Public Health Service Act (42 U.S.C. 300gg–13) is amended— (A) in subsection (a)— (i) in paragraph (2), by striking and at the end; (ii) in paragraph (3), by striking the period and inserting a semicolon; (iii) in paragraph (4), by striking the period at the end and inserting; and; (iv) by redesignating paragraph (5) as paragraph (6); and (v) by inserting after paragraph (4) the following new paragraph: (5) with respect to specified individuals (as defined in subsection (d)), screening for glaucoma (as defined in section 1861(uu) of the Social Security Act).; and (B) by adding at the end the following new subsection: (d) Specified individual defined For purposes of subsection (a)(5), the term specified individual means any of the following individuals: (1) An individual 40 years of age or older who— (A) identifies as having African, Hispanic/Latino, or Asian ancestry; or (B) has a clinical risk factor for glaucoma (including diabetes, a family history of glaucoma, elevated intraocular pressure, very low or very high blood pressure, myopia, a history of corneal refractive surgery or other causes of reduced central corneal thickness, or a history of chronic corticosteroid use). (2) An individual 60 years of age or older.. (2) Effective date The amendments made by this subsection shall apply with respect to plan years beginning on or after January 1, 2027. (b) Medicare (1) In general Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended— (A) in subsection (a)(1)(Y), by inserting (other than screening for glaucoma furnished to a specified individual (as defined in section 2713(d) of the Public Health Service Act)) after subparagraph (A); and (B) in subsection (b)(1), by striking the period and inserting or that are screenings for glaucoma furnished to specified individuals (as defined in section 2713(d) of the Public Health Service Act) and are appropriate for such individuals,. (2) Effective date The amendments made by this subsection shall apply with respect to items and services furnished on or after January 1, 2027. (c) Medicaid (1) In general Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended— (A) in paragraph (31), by striking and at the end; (B) by redesignating paragraph (32) as paragraph (33); and (C) by inserting after paragraph (31) the following new paragraph: (32) screening for glaucoma (as defined in section 1861(uu)) furnished to specified individuals (as defined in section 2713(d) of the Public Health Service Act); and. (2) Mandatory benefit Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking and (30) and inserting (30), and (32). (3) Alternative benefit plans Section 1937(b) of the Social Security Act (42 U.S.C. 1396u–7(b)) is amended by adding at the end the following new paragraph: (9) Screening for glaucoma for specified individuals Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless such coverage includes (and does not impose any deduction, cost sharing, or similar charge for) screening for glaucoma (as defined in section 1861(uu)) furnished to specified individuals (as defined in section 2713(d) of the Public Health Service Act).. (4) Cost sharing (A) In general Section 1916(a)(2) of the Social Security Act (42 U.S.C. 1396o(a)(2)) is amended— (i) in subparagraph (I), by striking or at the end; (ii) in subparagraph (J), by striking; and and inserting, or; and (iii) by adding at the end the following new subparagraph: (K) screening for glaucoma (as defined in section 1861(uu)) furnished to specified individuals (as defined in section 2713(d) of the Public Health Service Act); and. (B) Alternative cost sharing Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by adding at the end the following new clause: (xv) Screening for glaucoma (as defined in section 1861(uu)) furnished to specified individuals (as defined in section 2713(d) of the Public Health Service Act).. (5) Effective date The amendments made by this subsection shall apply with respect to medical assistance furnished on or after January 1, 2027. (d) FEHB (1) In general Section 8902 of title 5, United States Code, is amended by adding at the end the following new subsection: (q) Each contract under this chapter shall require the carrier to provide benefits for screening for glaucoma (as defined in section 1861(uu) of the Social Security Act) furnished to specified individuals (as defined in section 2713(d) of the Public Health Service Act) without imposition of any cost sharing (including coinsurance, copayments, and deductibles).. (2) Effective date The amendment made by this subsection shall apply with respect to contracts entered into for plan years beginning on or after January 1, 2027.