Sec. 404. Providing coverage for vision care under the Medicare program

1,218 words·~6 min read·/bill/119/s/3956/is/section-404·

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) ), as amended by section 402(a), is amended— in subparagraph (KK), by striking and at the end; in subparagraph (LL), by inserting and after the semicolon; and by adding at the end the following new subparagraph: vision services (as defined in subsection (ppp)); . Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ), as amended by section 402(b), is amended by adding at the end the following new subsection:

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, 2028, 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. .

Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ), as amended by section 402(c)(2), is amended by adding at the end the following new subsection: With respect to vision services (as defined in section 1861(ppp)) 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. . Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) ) is amended by inserting (2)(MM), before

(3). Section 1861(s)(8) of the Social Security Act ( 42 U.S.C. 1395x(s)(8) ), as amended by section 403(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, 2028, 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, 2028 . Section 1834(h) of the Social Security Act ( 42 U.S.C. 1395m(h) ), as amended by section 403(b)(2), is amended by adding at the end the following new paragraph: With respect to conventional eyeglasses furnished to an individual on or after January 1, 2028, 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). 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. 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, 2028, 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. Payment shall not be made under this part for deluxe eyeglasses or conventional reading glasses. . Section 1834(h)(1)(H) of the Social Security Act ( 42 U.S.C. 1395m(h)(1)(H) ), as amended by section 403(b)(3)(A), is amended— in the heading, by striking and inserting and hearing aids ; hearing aids, and eyeglasses in the matter preceding clause (i)— by striking or of hearing aids and inserting of hearing aids ; and by inserting or of eyeglasses described in paragraph (2)(F) of such section, after paragraph (2)(E) of such section, ; and in clause (i), by striking or such hearing aids and inserting , such hearing aids, or such eyeglasses . Section 1847(a)(2) of the Social Security Act ( 42 U.S.C. 1395w–3(a)(2) ), as amended by section 403(b)(3)(B)(i), is amended by adding at the end the following new subparagraph: Eyeglasses described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h). . Section 1847(a) of the Social Security Act ( 42 U.S.C. 1395w–3(a) ), as amended by section 403(b)(3)(B)(iii), is amended by adding at the end the following new paragraph: Not later than January 1, 2030, the Secretary shall begin the competition with respect to the items and services described in paragraph (2)(F). . Section 1862(a) of the Social Security Act ( 42 U.S.C. 1395y(a) ), as amended by section 402(e), is amended— in paragraph (1)— in subparagraph (P), by striking and at the end; in subparagraph (Q), by striking the semicolon at the end and inserting , and ; and by adding at the end the following new subparagraph: in the case of vision services (as defined in section 1861(ppp)) that are routine eye examinations as described in such section, which are furnished more frequently than once during a 2-year period; ; and in paragraph (7)— by inserting (other than such an examination that is a vision service that is covered under section 1861(s)(2)(MM)) after eye examinations ; and by inserting (other than such a procedure that is a vision service that is covered under section 1861(s)(2)(MM)) after refractive state of the eyes . 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 402(f) and amended by section 403(d), is amended— by striking or hearing aids and inserting hearing aids ; and by inserting , or vision services (as defined in subsection

(ppp)of such section) after subsection (s)(8) of such section . Section 1861(aa)(1)(A) of the Social Security Act ( 42 U.S.C. 1395x(aa)(1)(A) ), as amended by section 403(e)(1), is amended by inserting and vision services (as defined in subsection (ppp)) after (as defined in subsection (ll)(3)) . Section 1833 of the Social Security Act ( 42 U.S.C. 1395l ), as amended by sections 402(g)(2)(A) and 403(e)(3)(A), is amended— in subsection (a)(3)(A)— by striking or audiology and inserting , audiology ; and by inserting , or vision services (as defined in section 1861(ppp)) after (as defined in section 1861(ll)(3)) ; and in subsection (ee)— by striking or audiology and inserting , audiology ; and by inserting , or vision services (as defined in section 1861(ppp)) after (as defined in section 1861(ll)(3)) . Section 1834(o)(6) of the Social Security Act ( 42 U.S.C. 1395m(o)(6) ), as added by section 402(g)(2)(B) and amended by section 403(e)(3)(B), is amended— in the first sentence— by striking or audiology and inserting , audiology ; and by inserting , or vision services (as defined in section 1861(ppp)) after (as defined in section 1861(ll)(3)) ; and in the second sentence, by striking or such audiology services and inserting , such audiology services, or such vision services . The Secretary of Health and Human Services shall implement this section for 2028 and 2029 through program instruction or other forms of program guidance. In addition to amounts otherwise available, there is appropriated to the Secretary of Health and Human Services for fiscal year 2026, 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, 2027, and ending on September 30, 2035.

Connectionstraces to 4

Traces to 4 documents

U.S. Code

4 references not yet in our index