Vision services under Medicare

(a) Coverage Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 2(a), is amended— (1) in subparagraph (JJ), by striking and after the semicolon at the end; (2) in subparagraph (KK), by inserting and after the semicolon at the end; and (3) by adding at the end the following new subparagraph: (LL) vision services (as defined in subsection (mmm));. (b) Vision services defined Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 2(b), is amended by adding at the end the following new subsection: (ooo) Vision Services The term vision services means— (1) routine eye examinations and procedures performed (during the course of any eye examination) to determine the refractive state of the eyes; and (2) other necessary services related to eye and vision health (as defined by the Secretary).. (c) Payment; coinsurance; and limitations (1) In general Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by section 2(c)(1), is amended— (A) by striking and before (II); and (B) by inserting before the semicolon at the end the following:, and (JJ) with respect to vision services (as defined in section 1861(mmm)), the amount paid shall be the payment amount specified under section 1834(bb). (2) Payment and limits specified Section 1834 of the Social Security Act (42 U.S.C. 1395m), as amended by section 2(c)(2), is amended by adding at the end the following new subsection: (bb) Payment and limits for vision services (1) In general The payment amount under this part for vision services (as defined in section 1861(mmm)) shall be, subject to paragraph (3), the applicable percent (specified in paragraph (2)) of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848. (2) Applicable percent For purposes of paragraph (1), the applicable percent specified in this paragraph is— (A) for the first year beginning at least 6 months after the date of the enactment of this subsection, 0 percent; (B) for the year following the year specified in subparagraph (A) and each subsequent year through the seventh year following the year specified in subparagraph (A), the applicable percent specified in this paragraph for the previous year increased by 10 percentage points; and (C) for the eighth year following the year specified in subparagraph (A) and each subsequent year, 80 percent. (3) Limitations and Secretarial authority (A) Frequency With respect to routine eye exams, payment may be made under this part for only one such exam during a 12-month period. (B) Secretarial authority (i) Authority to apply additional limitations The Secretary may apply other reasonable limitations on the extent to which vision services are covered under this part, including through application of a prior authorization requirement. (ii) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of vision services to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force.. (d) Payment under physician fee schedule Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)), as amended by section 2(d), is amended by inserting (2)(LL), after (2)(KK),. (e) Special payment rules for eyeglasses, contact lenses, and low vision devices Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), as amended by section 2(e)(2), is amended by adding at the end the following new paragraphs: (24) Payment and limits for eyeglasses and contact lenses (A) In general The payment amount under this part for eyeglass lenses, eyeglass frames, and contact lenses shall be, subject to subparagraph (C), the applicable percent (specified in subparagraph (B)) of the amount otherwise payable for such eyeglass lenses, eyeglass frames, and contact lenses, respectively, under this section. (B) Applicable percent For purposes of subparagraph (A), the applicable percent specified in this subparagraph is— (i) for the first year beginning at least 6 months after the date of the enactment of this paragraph, 0 percent; (ii) for the year following the year specified in clause (i) and each subsequent year through the seventh year following the year specified in clause (i), the applicable percent specified in this subparagraph for the previous year increased by 10 percentage points; and (iii) for the eighth year following the year specified in clause (i) and each subsequent year, 80 percent. (C) Limitations and Secretarial authority (i) In general Payment may be made under this part (other than for eyewear described in section 1861(s)(8)) for an individual for— (I) not more than one pair of eyeglass lenses during any 12-month period; (II) not more than one set of eyeglass frames during any 24-month period; and (III) contact lenses, only to the extent that the sum of such payments for contact lenses does not exceed a limitation of $200 during any 24-month period beginning during the first year beginning at least six months after the date of the enactment of this paragraph (or, beginning during a subsequent year, such limitation for a 24-month period beginning in the previous year increase by an appropriate inflation adjustment specified by the Secretary). (ii) Secretarial authority (I) Authority to apply additional limitations The Secretary may apply such other reasonable limitations on the extent to which eyeglass lenses, eyeglass frames, and contact lenses are covered under this part, including through application of a prior authorization requirement. (II) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of eyeglass lenses, eyeglass frames, and contact lenses to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. (25) Payment and limits for low vision devices (A) In general The payment amount under this part for low vision devices shall be, subject to subparagraph (C), the applicable percent (specified in subparagraph (B)) of the amount otherwise payable for low vision devices under this section. (B) Applicable percent For purposes of subparagraph (A), the applicable percent specified in this subparagraph is— (i) for the first year beginning at least 6 months after the date of the enactment of this paragraph, 0 percent; (ii) for the year following the year specified in clause (i) and each subsequent year through the seventh year following the year specified in clause (i), the applicable percent specified in this subparagraph for the previous year increased by 10 percentage points; and (iii) for the eighth year following the year specified in clause (i) and each subsequent year, 80 percent. (C) Secretarial authority (i) Authority to apply limitations The Secretary may apply reasonable limitations on the extent to which low vision devices are covered under this part, including through application of a prior authorization requirement. (ii) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of low vision devices to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. (D) Low vision device defined In this paragraph, the term low vision device means a device, prescribed by a physician, that magnifies, enhances, or otherwise augments or interprets visual images irrespective of the size, form, or technological features of such device and does not include ordinary eyeglasses or contact lenses. In the previous sentence, the term ordinary eyeglasses or contact lenses means lenses that are intended to fully correct visual acuity or fully eliminate refractive error.. (f) Definition of durable medical equipment To include eyeglasses, contact lenses, and low vision devices Section 1861(n) of the Social Security Act (42 U.S.C. 1395x(n)) is amended— (1) by striking and before eye tracking and inserting a comma; and (2) by inserting, and eyeglass lenses, low vision devices (as defined in section 1834(a)(25)), eyeglass frames, and contact lenses before; except. (g) Repeal of ground for exclusion Section 1862(a)(7) of the Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by striking, eyeglasses (other than eyewear described in section 1861(s)(8)) or eye examinations for the purpose of prescribing, fitting, or changing eyeglasses, procedures performed (during the course of any eye examination) to determine the refractive state of the eyes. (h) Effective date The amendments made by this section shall apply to services furnished on or after January 1 of the first year beginning at least 6 months after the date of the enactment of this Act.