Sec. 4104. REMOVAL OF BARRIERS TO PREVENTIVE SERVICES IN MEDICARE
600 words·~3 min read·
/statute-compilations/comps-9307/sec-4104A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
## SEC. 4104 REMOVAL OF BARRIERS TO PREVENTIVE SERVICES IN MEDICARE ###
(a)Definition of Preventive Services Section 1861(ddd) of the Social Security Act (42 U.S.C. 1395x(ddd)) is amended— ####
(1)in the heading, by inserting “; preventive services” after “services”; ####
(2)in paragraph (1), by striking “not otherwise described in this title” and inserting “not described in subparagraph
(A)or
(C)of paragraph (3)”; and ####
(3)by adding at the end the following new paragraph: > > #### “(3) > > The term ‘**preventive services**’ means the following: > > > ##### “(A) > > The screening and preventive services described in subsection (ww)(2) (other than the service described in subparagraph
(M)of such subsection). > > > ##### “(B) > > An initial preventive physical examination (as defined in subsection (ww)). > > > ##### “(C) > > Personalized prevention plan services (as defined in subsection (hhh)(1)).” > . ###
(b)Payment and Elimination of Coinsurance in All Settings Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by section 4103(c)(1), is amended— ####
(1)in subparagraph (T), by inserting “(or 100 percent if such services are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population and are appropriate for the individual)” after “80 percent”; ####
(2)in subparagraph (W)— #####
(A)in clause (i), by inserting “(if such subparagraph were applied, by substituting ‘100 percent’ for ‘80 percent’)” after “subparagraph (D)”; and #####
(B)in clause (ii), by striking “80 percent” and inserting “100 percent”; ####
(3)by striking “and” before “(X)”; and ####
(4)by inserting before the semicolon at the end the following: “, and
(Y)with respect to preventive services described in subparagraphs
(A)and
(B)of section 1861(ddd)(3) that are appropriate for the individual and, in the case of such services described in subparagraph (A), are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population, the amount paid shall be 100 percent of
(i)except as provided in clause (ii), the lesser of the actual charge for the services or the amount determined under the fee schedule that applies to such services under this part, and
(ii)in the case of such services that are covered OPD services (as defined in subsection (t)(1)(B)), the amount determined under subsection (t)”. ###
(c)Waiver of Application of Deductible for Preventive Services and Colorectal Cancer Screening Tests Section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as amended by section 4103(c)(4), is amended— ####
(1)in paragraph (1), by striking “items and services described in section 1861(s)(10)(A)” and inserting “preventive services described in subparagraph
(A)of section 1861(ddd)(3) that are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population and are appropriate for the individual.”; and ####
(2)by adding at the end the following new sentence: “Paragraph
(1)of the first sentence of this subsection shall apply with respect to a colorectal cancer screening test regardless of the code that is billed for the establishment of a diagnosis as a result of the test, or for the removal of tissue or other matter or other procedure that is furnished in connection with, as a result of, and in the same clinical encounter as the screening test.”. ###
(d)Effective Date **[**[42 U.S.C. 1395l note](/us/usc/t42/s1395l)**]** The amendments made by this section shall apply to items and services furnished on or after January 1, 2011.
Connectionstraces to 2
Traces to 2 documents
Citation graph
cites case law
Cites 2Cited by 0 across 0 sources