Providing coverage for vision care under the Medicare program

(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 striking the period at the end and adding; and; and (3) by adding at the end the following new subparagraph: (LL) vision services (as defined in subsection (ooo));. (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 routine eye examinations to determine the refractive state of the eyes, including procedures performed during the course of such examination, furnished on or after January 1, 2027, by or under the direct supervision of an ophthalmologist or optometrist who is legally authorized to furnish such examinations or procedures (as applicable) under State law (or the State regulatory mechanism provided by State law) of the State in which the examinations or procedures are furnished.. (c) Payment limitations 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) Limitation for vision services With respect to vision services (as defined in section 1861(ooo)) and an individual, payment shall be made under this part for only 1 routine eye examination described in such subsection during a 2-year period.. (d) Payment under physician fee schedule Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting (2)(LL), before (3). (e) Coverage of conventional eyeglasses Section 1861(s)(8) of the Social Security Act (42 U.S.C. 1395x(s)(8)), as amended by section 3(b)(1), is amended by striking, and including one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens and inserting, including 1 pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens, if furnished before January 1, 2027, and including conventional eyeglasses (as described in section 1834(h)(8)), whether or not furnished subsequent to such a surgery, if furnished on or after January 1, 2027. (f) Special payment rules for eyeglasses (1) Limitations Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)), as amended by section 3(b)(2), is amended by adding at the end the following new paragraph: (8) Payment limitations for eyeglasses (A) In general With respect to conventional eyeglasses furnished to an individual on or after January 1, 2027, subject to subparagraph (B), payment shall be made under this part only during a 2-year period, for 1 pair of eyeglasses (including lenses and the frame). (B) Exception With respect to a 2-year period described in subparagraph (A), in the case of an individual who receives cataract surgery with insertion of an intraocular lens, payment shall be made under this part for 1 pair of conventional eyeglasses furnished subsequent to such cataract surgery during such period. (C) Special rule The payment basis determined under this subsection (including after application of paragraph (1)(H), relating to application of competitive acquisition) for conventional eyeglasses furnished to an individual on or after January 1, 2027, shall not exceed the rate determined for such eyeglasses under the Federal Supply Schedule of the General Services Administration, as published by such Administration in 2021, updated to the year involved using the applicable percent increase for the year. (D) No coverage of certain items Payment shall not be made under this part for deluxe eyeglasses or conventional reading glasses.. (2) Application of competitive acquisition (A) In general Section 1834(h)(1)(H) of the Social Security Act (42 U.S.C. 1395m(h)(1)(H)), as amended by section 3(b)(3)(A), is amended— (i) in the heading, by striking and hearing aids and inserting hearing aids, and eyeglasses; (ii) in the matter preceding clause (i)— (I) by striking or of hearing aids and inserting of hearing aids; and (II) by inserting or of eyeglasses described in paragraph (2)(E) of such section, after paragraph (2)(D) of such section,; and (iii) in clause (i), by striking or such hearing aids and inserting, such hearing aids, or such eyeglasses. (B) Conforming amendment Section 1847(a)(2) of the Social Security Act (42 U.S.C. 1395w–3(a)(2)), as amended by section 3(b)(3)(B)(i), is amended by adding at the end the following new subparagraph: (F) Eyeglasses Eyeglasses described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h).. (C) Implementation Section 1847(a) of the Social Security Act (42 U.S.C. 1395w–3(a)), as amended by section 3(b)(3)(B)(iii), is amended by adding at the end the following new paragraph: (9) Competition with respect to eyeglasses Not later than January 1, 2030, the Secretary shall begin the competition with respect to the items and services described in paragraph (2)(F).. (g) Exclusion modifications Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)), as amended by section 2(e), is amended— (1) in paragraph (1)— (A) in subparagraph (P), by striking and at the end; (B) in subparagraph (Q), by striking the semicolon at the end and inserting, and; and (C) by adding at the end the following new subparagraph: (R) in the case of vision services (as defined in section 1861(ooo)) that are routine eye examinations as described in such section, which are furnished more frequently than once during a 2-year period;; and (2) in paragraph (7)— (A) by inserting (other than such an examination that is a vision service that is covered under section 1861(s)(2)(LL)) after eye examinations; and (B) by inserting (other than such a procedure that is a vision service that is covered under section 1861(s)(2)(LL)) after refractive state of the eyes. (h) Inclusion as excepted medical treatment Section 1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C. 1395i–5(b)(5)(A)(iv)), as added by section 2(f) and amended by section 3(d), is amended— (1) by striking or hearing aids and inserting hearing aids; and (2) by inserting, or vision services (as defined in subsection (ooo) of such section) after subsection (s)(8) of such section. (i) Rural Health Clinics and Federally Qualified Health Centers (1) Clarifying coverage of vision services as physicians' services Section 1861(aa)(1)(A) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(A)), as amended by section 3(e)(1), is amended by inserting and vision services (as defined in subsection (ooo)) after (as defined in subsection (ll)(3)). (2) Temporary payment rates for certain services under the RHC AIR and FQHC PPS (A) AIR Section 1833 of the Social Security Act (42 U.S.C. 1395l), as amended by sections 2(g)(2)(A) and 3(e)(3)(A), is amended— (i) in subsection (a)(3)(A)— (I) by striking or audiology and inserting, audiology; and (II) by inserting, or vision services (as defined in section 1861(ooo)) after (as defined in section 1861(ll)(3)); and (ii) in subsection (ee)— (I) by striking or audiology and inserting, audiology; and (II) by inserting, or vision services (as defined in section 1861(ooo)) after (as defined in section 1861(ll)(3)). (B) PPS Section 1834(o)(6) of the Social Security Act (42 U.S.C. 1395m(o)(6)), as added by section 2(g)(2)(B) and amended by section 3(e)(3)(B), is amended— (i) in the first sentence— (I) by striking or audiology and inserting, audiology; and (II) by inserting, or vision services (as defined in section 1861(ooo)) after (as defined in section 1861(ll)(3)); and (ii) in the second sentence, by striking or such audiology services and inserting, such audiology services, or such vision services. (j) Expediting implementation The Secretary of Health and Human Services shall implement this section for 2027 and 2028 through program instruction or other forms of program guidance. (k) Funding In addition to amounts otherwise available, there is appropriated to the Secretary of Health and Human Services for fiscal year 2025, out of any money in the Treasury not otherwise appropriated, $500,000,000, to remain available until expended, for purposes of implementing the amendments made by this section during the period beginning on January 1, 2026, and ending on September 30, 2034.