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<PRE>[DOCID: f:s982is.txt]






107th CONGRESS
  1st Session
                                 S. 982

     To promote primary and secondary health promotion and disease 
 prevention services and activities among the elderly, to amend title 
XVIII of the Social Security Act to add preventive health benefits, and 
                          for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 5, 2001

  Mr. Graham (for himself, Mr. Jeffords, Mr. Kennedy, Mr. Lugar, Mr. 
 Bingaman, Mr. Chafee, Mr. Rockefeller, Mrs. Murray, Mr. Hollings, Mr. 
 Levin, Mr. Corzine, and Mrs. Lincoln) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
     To promote primary and secondary health promotion and disease 
 prevention services and activities among the elderly, to amend title 
XVIII of the Social Security Act to add preventive health benefits, and 
                          for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Wellness 
Act of 2001''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
               TITLE I--HEALTHY SENIORS PROMOTION PROGRAM

Sec. 101. Definitions.
Sec. 102. Working Group on Disease Self-Management and Health 
                            Promotion.
Sec. 103. Healthy seniors promotion grants.
Sec. 104. Disease self-management demonstration projects.
       TITLE II--MEDICARE COVERAGE OF PREVENTIVE HEALTH BENEFITS

Sec. 201. Therapy and counseling for cessation of tobacco use.
Sec. 202. Counseling for post-menopausal women.
Sec. 203. Screening for diminished visual acuity.
Sec. 204. Screening for hearing impairment.
Sec. 205. Screening for cholesterol.
Sec. 206. Screening for hypertension.
Sec. 207. Expansion of eligibility for bone mass measurement.
Sec. 208. Coverage of medical nutrition therapy services for 
                            beneficiaries with cardiovascular diseases.
Sec. 209. Elimination of deductibles and coinsurance for existing 
                            preventive health benefits.
Sec. 210. Program integrity.
Sec. 211. Promotion of preventive health benefits.
 TITLE III--NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN

Sec. 301. National falls prevention education and awareness campaign.
     TITLE IV--CLINICAL DEPRESSION SCREENING DEMONSTRATION PROJECTS

Sec. 401. Clinical depression screening demonstration projects.
     TITLE V--MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM

Sec. 501. Medicare health education and risk appraisal program.
  TITLE VI--STUDIES, EVALUATIONS, AND REPORTS IN THE FIELD OF DISEASE 
                       PREVENTION AND THE ELDERLY

Sec. 601. MedPAC evaluation and report on medicare benefit package in 
                            relation to private sector benefit 
                            packages.
Sec. 602. National Institute on Aging study and report on ways to 
                            improve the quality of life of elderly.
Sec. 603. Institute of Medicine medicare prevention benefit study and 
                            report.
Sec. 604. Fast-track consideration of prevention benefit legislation.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Medicare beneficiary.--The term ``medicare 
        beneficiary'' means any individual who is entitled to benefits 
        under part A or enrolled under part B of the medicare program, 
        including any individual enrolled in a Medicare+Choice plan 
        offered by a Medicare+Choice organization under part C of such 
        program.
            (2) Medicare program.--The term ``medicare program'' means 
        the health benefits program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

               TITLE I--HEALTHY SENIORS PROMOTION PROGRAM

SEC. 101. DEFINITIONS.

    In this title:
            (1) Cost-effective benefit.--The term ``cost-effective 
        benefit'' means a benefit or technique that has--
                    (A) been subject to peer review;
                    (B) been described in scientific journals; and
                    (C) demonstrated value as measured by unit costs 
                relative to health outcomes achieved.
            (2) Cost-saving benefit.--The term ``cost-saving benefit'' 
        means a benefit or technique that has--
                    (A) been subject to peer review;
                    (B) been described in scientific journals; and
                    (C) caused a net reduction in health care costs for 
                medicare beneficiaries.
            (3) Eligible entity.--The term ``eligible entity'' means an 
        entity that the Working Group (as defined in paragraph (6)) 
        determines has demonstrated expertise regarding health 
        promotion and disease prevention among medicare beneficiaries.
            (4) Medically effective.--The term ``medically effective'' 
        means, with respect to a benefit or technique, that the benefit 
        or technique has been--
                    (A) subject to peer review;
                    (B) described in scientific journals; and
                    (C) determined to achieve an intended goal under 
                normal programmatic conditions.
            (5) Medically efficacious.--The term ``medically 
        efficacious'' means, with respect to a benefit or technique, 
        that the benefit or technique has been--
                    (A) subject to peer review;
                    (B) described in scientific journals; and
                    (C) determined to achieve an intended goal under 
                controlled conditions.
            (6) Working group.--The term ``Working Group'' means the 
        Working Group on Disease Self-Management and Health Promotion 
        established under section 102.

SEC. 102. WORKING GROUP ON DISEASE SELF-MANAGEMENT AND HEALTH 
              PROMOTION.

    (a) Establishment.--There is established within the Department of 
Health and Human Services a Working Group on Disease Self-Management 
and Health Promotion.
    (b) Composition.--
            (1) In general.--Subject to paragraph (2), the Working 
        Group shall be composed of 5 members as follows:
                    (A) The Administrator of the Health Care Financing 
                Administration.
                    (B) The Director of the Centers for Disease Control 
                and Prevention.
                    (C) The Director of the Agency for Healthcare 
                Research and Quality.
                    (D) The Assistant Secretary for Aging.
                    (E) The Director of the National Institutes of 
                Health.
            (2) Alternative membership.--Any member of the Working 
        Group described in a subparagraph of paragraph (1) may appoint 
        an individual who is an officer or employee of the Federal 
        Government to serve as a member of the Working Group instead of 
        the member described in such subparagraph.
    (c) Duties.--The duties of the Working Group are as follows:
            (1) Healthy seniors promotion grants.--The Working Group 
        shall establish general policies and criteria with respect to 
        the functions of the Secretary under section 103, including--
                    (A) priorities for the approval of applications 
                submitted under subsection (c) of such section;
                    (B) procedures for monitoring and evaluating 
                research efforts conducted under such section; and
                    (C) such other ma
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tters relating to the grant 
                program established under such section as are 
                recommended by the Working Group and approved by the 
                Secretary.
            (2) Disease self-management demonstration projects.--The 
        Working Group shall establish general policies and criteria 
        with respect to the functions of the Secretary under section 
        104, including--
                    (A) the identification of medical conditions for 
                which a demonstration project under such section may be 
                implemented;
                    (B) the prioritization of the conditions identified 
                under subparagraph (A) based on the potential for the 
                self-management of such condition to be medically 
                effective and for such self-management to be a cost-
                effective benefit or cost-saving benefit;
                    (C) the identification of target individuals (as 
                defined in section 104(a)(2));
                    (D) the development of procedures for selecting 
                areas in which such a demonstration project may be 
                implemented; and
                    (E) such other matters relating to such 
                demonstration projects as are recommended by the 
                Working Group and approved by the Secretary.
    (d) Chairperson.--The Secretary shall designate 1 of the members of 
the Working Group to be the chairperson of the Group.
    (e) Quorum.--A majority of the members of the Working Group shall 
constitute a quorum, but, subject to subsection (f), a lesser number of 
members may hold meetings.
    (f) Meetings.--The Working Group shall meet at the call of the 
chairperson, except that--
            (1) it shall meet not less than 4 times each year; and
            (2) it shall meet upon the written request of a majority of 
        the members.
    (g) Compensation of Members.--Each member of the Working Group 
shall serve without compensation in addition to that received for their 
service as an officer or employee of the Federal Government.
    (h) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for the purpose of carrying 
out this section.

SEC. 103. HEALTHY SENIORS PROMOTION GRANTS.

    (a) Program Authorized.--The Secretary, using the general policies 
and criteria established by the Working Group under section 102(c)(1) 
and in accordance with the provisions of this section, is authorized to 
make grants to eligible entities (as defined in section 101(3)) to pay 
for the costs of the activities described in subsection (b).
    (b) Use of Funds.--An eligible entity may use payments received 
under this section in any fiscal year to conduct a program to--
            (1) study whether using different types of providers of 
        care and alternative settings (including community-based senior 
        centers) for the implementation of a successful health 
        promotion and disease prevention strategy, including the 
        implications regarding the payment of such providers, is 
        medically efficacious or medically effective;
            (2) determine the most effective means of educating 
        medicare beneficiaries, either directly or through providers of 
        care, regarding the importance of health promotion and disease 
        prevention among such beneficiaries;
            (3) identify incentives that would increase the use of new 
        and existing preventive health benefits and healthy behaviors 
        by medicare beneficiaries;
            (4) promote--
                    (A) the use of preventive health benefits by 
                medicare beneficiaries, including such services that 
                are covered under the medicare program;
                    (B) the proper use by medicare beneficiaries of 
                prescription and over-the-counter drugs in order to 
                reduce the number of hospital stays and physician 
                visits that are a result of improper use of such drugs; 
                and
                    (C) the utilization by medicare beneficiaries of 
                the steps (including exercise, maintenance of a proper 
                diet, and the utilization of accident prevention 
                techniques) that research has shown to promote and 
                safeguard individual health; and
            (5) address other topics designated by the Secretary.
    (c) Application.--
            (1) In general.--Each eligible entity that desires to 
        receive a grant under this section shall submit an application 
        to the Secretary, at such time, in such manner, and accompanied 
        by such additional information as the Secretary may reasonably 
        require.
            (2) Contents.--Each application submitted under paragraph 
        (1) shall--
                    (A) describe the activities for which assistance 
                under this section is sought;
                    (B) describe how such activities will--
                            (i) reflect the medical, behavioral, and 
                        social aspects of care for medicare 
                        beneficiaries;
                            (ii) lead to the development of cost-
                        effective benefits and cost-saving benefits; 
                        and
                            (iii) impact the quality of life of 
                        medicare beneficiaries;
                    (C) provide assurances that such activities will 
                focus on broad medicare populations rather than unique 
                local medicare populations;
                    (D) provide evidence that the eligible entity meets 
                the general policies and criteria established by the 
                Working Group under section 102(c)(1);
                    (E) provide assurances that the eligible entity 
                will take such steps as may be available to the entity 
                in order to continue the activities for which the 
                entity is making application after the period for which 
                assistance is sought; and
                    (F) provide such additional assurances as the 
                Secretary determines to be essential to ensure 
                compliance with the requirements of this title.
            (3) Joint application.--A consortium of eligible entities 
        may file a joint application under the provisions of paragraph 
        (1).
    (d) Approval of Application.--The Secretary shall approve 
applications in accordance with the general policies and criteria 
established by the Working Group under section 102(c)(1).
    (e) Payments.--Subject to amounts appropriated under subsection 
(g), the Secretary shall pay to each eligible entity having an 
application approved under subsection (d) the cost of the activities 
described in the application.
    (f) Evaluation and Report.--
            (1) Evaluation.--The Secretary shall conduct an annual 
        evaluation of grants made under this section to determine--
                    (A) the results of the activities conducted under 
                the programs for which grants were made under this 
                section;
                    (B) the extent to which research assisted under 
                this section has improved or expanded the general 
                research for health promotion and disease prevention 
                among medicare beneficiaries and identified practical 
                interventions based upon such research;
                    (C) a list of specific recommendations based upon 
                the activities conducted under the programs for which 
                grants were made under this section which show promise 
                as practical interventions for health promotion and 
                disease prevention among medicare beneficiaries;
                    (D) whether or not, as a result of the activities 
      
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          conducted under the programs for which grants were made 
                under this section, certain health promotion and 
                disease prevention benefits or education efforts should 
                be added to the medicare program, including discussions 
                of quality of life, translating the applied research 
                results into a benefit under the medicare program, and 
                whether each additional benefit would be a cost-
                effective benefit or a cost-saving benefit for each 
                proposed addition; and
                    (E) how best to increase utilization of existing 
                and recommended health promotion and disease prevention 
                services, such as an education and public awareness 
                campaign, providing financial incentives for providers 
                of care and medicare beneficiaries, or utilizing other 
                administrative means.
            (2) Annual report.--Not later than December 31, 2003, and 
        annually thereafter through 2005, the Secretary, in 
        consultation with the Working Group, shall submit a report to 
        Congress on the evaluation conducted under paragraph (1), 
        together with such recommendations for such legislation and 
        administrative actions as the Secretary considers appropriate.
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated for the purpose of carrying out this section $50,000,000 
for each of fiscal years 2002, 2003, 2004, and 2005.

SEC. 104. DISEASE SELF-MANAGEMENT DEMONSTRATION PROJECTS.

    (a) Demonstration Projects.--
            (1) In general.--The Secretary shall conduct demonstration 
        projects for the purpose of promoting disease self-management 
        for conditions identified by the Working Group under section 
        102(c)(2) for target individuals (as defined in paragraph (2)).
            (2) Target individual defined.--In this section, the term 
        ``target individual'' means an individual who--
                    (A) is at risk for, or has, 1 or more of the 
                conditions identified by the Working Group under 
                section 102(c)(2); and
                    (B) is enrolled under the original medicare fee-
                for-service program under parts A and B of title XVIII 
                of the Social Security Act (42 U.S.C. 1395c et seq.; 
                1395j et seq.) or is enrolled under the Medicare+Choice 
                program under part C of title XVIII of such Act (42 
                U.S.C. 1395w-21 et seq.).
    (b) Number; Project Areas; Duration.--
            (1) Number.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall implement a series 
        of demonstration projects to carry out the purpose described in 
        subsection (a)(1).
            (2) Project areas.--The Secretary shall implement the 
        demonstration projects described in paragraph (1) in urban, 
        suburban, and rural areas.
            (3) Duration.--The demonstration projects under this 
        section shall be conducted during the 3-year period beginning 
        on the date on which the initial demonstration project is 
        implemented.
    (c) Report to Congress.--
            (1) In general.--Not later than 18 months after the 
        conclusion of the demonstration projects under this section, 
the Secretary shall submit a report to Congress on such projects.
            (2) Contents of report.--The report required under 
        paragraph (1) shall include the following:
                    (A) A description of the demonstration projects.
                    (B) An evaluation of--
                            (i) whether each benefit provided under the 
                        demonstration projects is a cost-effective 
                        benefit or a cost-saving benefit;
                            (ii) the level of the disease self-
                        management attained by target individuals under 
                        the demonstration projects; and
                            (iii) the satisfaction of target 
                        individuals under the demonstration projects.
                    (C) Recommendations of the Secretary regarding 
                whether to conduct the demonstration projects on a 
                permanent basis.
                    (D) Such recommendations for legislation and 
                administrative action as the Secretary determines to be 
                appropriate.
                    (E) Any other information regarding the 
                demonstration projects that the Secretary determines to 
                be appropriate.
    (d) Funding.--The Secretary shall provide for the transfer from the 
Federal Hospital Insurance Trust Fund under section 1817 of the Social 
Security Act (42 U.S.C. 1395i) an amount not to exceed $30,000,000 for 
the costs of carrying out this section.

       TITLE II--MEDICARE COVERAGE OF PREVENTIVE HEALTH BENEFITS

SEC. 201. THERAPY AND COUNSELING FOR CESSATION OF TOBACCO USE.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 105(a) of the Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 
(114 Stat. 2763A-471), as enacted into law by section 1(a)(6) of Public 
Law 106-554, is amended--
            (1) in subparagraph (U), by striking ``and'' at the end;
            (2) in subparagraph (V), by inserting ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
            ``(W) supplemental preventive health services (as defined 
        in subsection (ww));''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x), as amended by section 105(b) of the Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 
(114 Stat. 2763A-471), as enacted into law by section 1(a)(6) of Public 
Law 106-554, is amended by adding at the end the following new 
subsection:

               ``Supplemental Preventive Health Services

    ``(ww) The term `supplemental preventive health services' means the 
following:
            ``(1)(A) Therapy and counseling for cessation of tobacco 
        use for individuals who use tobacco products or who are being 
        treated for tobacco use that is furnished--
                    ``(i) by or under the supervision of a physician; 
                or
                    ``(ii) by any other health care professional who--
                            ``(I) is legally authorized to furnish such 
                        services under State law (or the State 
                        regulatory mechanism provided by State law) of 
                        the State in which the services are furnished; 
                        and
                            ``(II) is authorized to receive payment for 
                        other services under this title or is 
                        designated by the Secretary for this purpose.
            ``(B) Subject to subparagraph (C), such term is limited 
        to--
                    ``(i) therapy and counseling services recommended 
                in `Treating Tobacco Use and Dependence: A Clinical 
                Practice Guideline', published by the Public Health 
                Service in June 2000, or any subsequent modification of 
                such Guideline; and
                    ``(ii) such other therapy and counseling services 
                that the Secretary recognizes to be effective.
            ``(C) Such term shall not include coverage for drugs or 
        biologicals that are not otherwise covered under this title.''.
    (c) Payment and Elimination of Cost-Sharing for All Supplemental 
Preventive Health Services.--
            (1) Payment and elimination of coinsurance.--Section 
        1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), 
        as amended by section 223(c) of the Medicare, Medicaid, and 

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        SCHIP Benefits Improvement and Protection Act of 2000 
(114 Stat. 2763A-489), as enacted into law by section 1(a)(6) of Public 
Law 106-554, is amended--
                    (A) in subparagraph (N), by inserting ``other than 
                supplemental preventive health services (as defined in 
                section 1861(ww))'' after ``(as defined in section 
                1848(j)(3))''
                    (B) by striking ``and'' before ``(U)''; and
                    (C) by inserting before the semicolon at the end 
                the following: ``, and (V) with respect to supplemental 
                preventive health services (as defined in section 
                1861(ww)), the amount paid shall be 100 percent of the 
                lesser of the actual charge for the services or the 
                amount determined under the payment basis determined 
                under section 1848 by the Secretary for the particular 
                supplemental preventive health service involved''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by inserting 
        ``(2)(W),'' after ``(2)(S),''.
            (3) Elimination of coinsurance in outpatient hospital 
        settings.--The third sentence of section 1866(a)(2)(A) of the 
        Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by 
        inserting after ``1861(s)(10)(A)'' the following: ``, with 
        respect to supplemental preventive health services (as defined 
        in section 1861(ww)),''.
            (4) Elimination of deductible.--The first sentence of 
        section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) 
        is amended--
                    (A) by striking ``and'' before ``(6)''; and
                    (B) by inserting before the period the following: 
                ``, and (7) such deductible shall not apply with 
                respect to supplemental preventive health services (as 
                defined in section 1861(ww))''.
    (d) Application of Limits on Billing.--Section 1842(b)(18)(C) of 
the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), as amended by 
section 105(d) of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (114 Stat. 2763A-472), as 
enacted into law by section 1(a)(6) of Public Law 106-554, is amended 
by adding at the end the following new clause:
            ``(vii) Any health care professional designated under 
        section 1861(ww)(1)(A)(ii)(II) to perform therapy and 
        counseling for cessation of tobacco use.''.
    (e) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the day that is 1 year after 
the date of enactment of this Act.

SEC. 202. COUNSELING FOR POST-MENOPAUSAL WOMEN.

    (a) Coverage.--Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as added by section 201(b), is amended by adding 
at the end the following new paragraph:
            ``(2)(A) Counseling for post-menopausal women.
            ``(B) For purposes of subparagraph (A), the term 
        `counseling for post-menopausal women' means counseling 
        provided to a post-menopausal woman regarding--
                    ``(i) the symptoms, risk factors, and conditions 
                associated with menopause;
                    ``(ii) appropriate treatment options for post-
                menopausal women, including hormone replacement 
                therapy; and
                    ``(iii) other interventions that can be implemented 
                to prevent or delay the onset of health risks 
                associated with menopause.
            ``(C) Such term does not include coverage for drugs or 
        biologicals that are not otherwise covered under this title.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to services furnished on or after the day that is 1 year after the date 
of enactment of this Act.

SEC. 203. SCREENING FOR DIMINISHED VISUAL ACUITY.

    (a) Coverage.--Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 202(a), is amended by adding 
at the end the following new paragraph:
            ``(3)(A) Screening for diminished visual acuity.
            ``(B) For purposes of subparagraph (A), the term `screening 
        for diminished visual acuity' means a screening for diminished 
        visual acuity that is furnished by or under the supervision of 
        an optometrist or ophthalmologist who is legally authorized to 
        furnish such services under State law (or the State regulatory 
        mechanism provided by State law) of the State in which the 
        services are furnished.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to services furnished on or after the day that is 1 year after the date 
of enactment of this Act.

SEC. 204. SCREENING FOR HEARING IMPAIRMENT.

    (a) Coverage.--Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 203(a), is amended by adding 
at the end the following new paragraph:
            ``(4)(A) Screening for hearing impairment.
            ``(B) For purposes of subparagraph (A), the term `screening 
        for hearing impairment' means the following services:
                    ``(i) A screening for hearing impairment using 
                periodic questions that is furnished by--
                            ``(I) a physician, including an 
                        otolaryngologist;
                            ``(II) a qualified audiologist (as defined 
                        in subsection (ll)(3)(B)); or
                            ``(III) any other health care professional 
                        who is legally authorized to furnish such 
                        screening under State law (or the State 
                        regulatory mechanism provided by State law) of 
                        the State in which the screening is furnished.
                    ``(ii) If the answers to such questions indicate 
                potential hearing impairment, an otoscopic examination 
                and an audiometric screening test that are furnished by 
                an otolaryngologist or a qualified audiologist (as so 
                defined).
                    ``(iii) If the results of such examination or test 
                indicate a need for assistive listening devices 
                (whether or not such examination or test was based on a 
                screening or was diagnostic), counseling about such 
                devices that is furnished by an otolaryngologist or a 
                qualified audiologist (as so defined).''.
    (b) Effective Date.--The amendment made by this section shall apply 
to services furnished on or after the day that is 1 year after the date 
of enactment of this Act.

SEC. 205. SCREENING FOR CHOLESTEROL.

    (a) Coverage.--Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 204(a), is amended by adding 
at the end the following new paragraph:
            ``(5)(A) Screening for cholesterol if the individual 
        involved has not had such a screening during the preceding 5 
        years.
            ``(B) Notwithstanding subparagraph (A), payment may be made 
        under this part for a screening for cholesterol with respect to 
        an individual even if the individual has had such a screening 
        during the preceding 5 years if the individual exhibits major 
        risk factors for coronary heart disease or a stroke, including, 
        but not limited to, smoking, hypertension, and diabetes.''.
    (b) Conforming Amendment.--Section 1862(a)(1) of the Social 
Security Act (42 U.S.C. 1395y(a)(1)) is amended--
            (1) in subparagraph (H), by striking ``and'' at the end;
            (2) in subparagraph (I), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(J) in the case of a scr
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eening for cholesterol, 
                which is performed more frequently than is covered 
                under section 1861(ww)(5);''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the day that is 1 year after 
the date of enactment of this Act.

SEC. 206. SCREENING FOR HYPERTENSION.

    (a) Coverage.--Section 1861(ww) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 205(a), is amended by adding 
at the end the following new paragraph:
            ``(6)(A) Screening for hypertension if the individual 
        involved has not had such a screening during the preceding 2 
        years.
            ``(B) Notwithstanding subparagraph (A), payment may be made 
        under this part for a screening for hypertension with respect 
        to an individual even if the individual has had such a 
        screening during the preceding 2 years if the individual has a 
        history of, or is at risk for, hypertension.''.
    (b) Conforming Amendment.--Section 1862(a)(1) of the Social 
Security Act (42 U.S.C. 1395y(a)(1)), as amended by section 205(b), is 
amended--
            (1) in subparagraph (I), by striking ``and'' at the end;
            (2) in subparagraph (J), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(K) in the case of a screening for hypertension, 
                which is performed more frequently than is covered 
                under section 1861(ww)(6);''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the day that is 1 year after 
the date of enactment of this Act.

SEC. 207. EXPANSION OF ELIGIBILITY FOR BONE MASS MEASUREMENT.

    (a) Expansion.--Section 1861(rr)(2) of the Social Security Act (42 
U.S.C. 1395x(rr)(2)) is amended to read as follows:
    ``(2) For purposes of this subsection, the term `qualified 
individual' means an individual who is (in accordance with regulations 
prescribed by the Secretary)--
            ``(A) an estrogen-deficient woman (including those 
        receiving hormone replacement therapy);
            ``(B) an individual with low trauma or fragility fractures 
        (including vertebral abnormalities and hip, rib, wrist, pelvic, 
        or proximal humeral fractures);
            ``(C) an individual receiving long-term medications that 
        have associations to bone loss or osteoporosis (including 
        glucocorticoid therapy and androgen deprivation therapy);
            ``(D) an individual with a long-term medical condition that 
        has association to osteoporosis (including primary 
        hyperparathyroidism);
            ``(E) a man with risk factors for osteoporosis such as 
        hypogonadism; and
            ``(F) an individual being monitored to assess the response 
        to, or efficacy of, an approved osteoporosis therapy.''.
    (b) Reference to Elimination of Coinsurance and Waiver of 
Application of Deductible.--For the elimination of the coinsurance for 
bone mass measurement and for the waiver of the application of the part 
B deductible for such measurement, see section 209.
    (c) Effective Date.--The amendment made by subsection (a) shall 
apply to services furnished on or after the day that is 1 year after 
the date of enactment of this Act.

SEC. 208. COVERAGE OF MEDICAL NUTRITION THERAPY SERVICES FOR 
              BENEFICIARIES WITH CARDIOVASCULAR DISEASES.

    (a) In General.--Section 1861(s)(2)(V) of the Social Security Act 
(42 U.S.C. 1395x(s)(2)(V)), as added by subsection (a) of section 105 
of the Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act of 2000 (114 Stat. 2763A-471), as enacted into law by 
section 1(a)(6) of Public Law 106-554, is amended to read as follows:
            ``(V) medical nutrition therapy services (as defined in 
        subsection (vv)(1)) in the case of a beneficiary--
                    ``(i) with a cardiovascular disease (including 
                congestive heart failure, arteriosclerosis, 
                hyperlipidemia, hypertension, 
and hypercholesterolemia), diabetes, or a renal disease (or a 
combination of such conditions) who--
                            ``(I) has not received diabetes outpatient 
                        self-management training services within a time 
                        period determined by the Secretary;
                            ``(II) is not receiving maintenance 
                        dialysis for which payment is made under 
                        section 1881; and
                            ``(III) meets such other criteria 
                        determined by the Secretary after consideration 
                        of protocols established by dietitian or 
                        nutrition professional organizations; or
                    ``(ii) with a combination of such conditions who--
                            ``(I) is not described in clause (i) 
                        because of the application of subclause (I) or 
                        (II) of such clause;
                            ``(II) receives such medical nutrition 
                        therapy services in a coordinated manner (as 
                        determined appropriate by the Secretary) with 
                        any services described in such subclauses that 
                        the beneficiary is receiving; and
                            ``(III) meets such other criteria 
                        determined by the Secretary after consideration 
                        of protocols established by dietitian or 
                        nutrition professional organizations;''.
    (b) Elimination of Coinsurance.--Section 1833(a)(1)(T) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)(T)), as added by section 
105(c)(2) of the Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act of 2000 (114 Stat. 2763A-472), as enacted into law by 
section 1(a)(6) of Public Law 106-554, is amended by striking ``80 
percent'' and inserting ``100 percent''.
    (c) Reference to Waiver of Application of Deductible.--For the 
waiver of the application of the part B deductible for medical 
nutrition therapy services, see section 209.
    (d) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 105 of the Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 
(114 Stat. 2763A-471), as enacted into law by section 1(a)(6) of Public 
Law 106-554.

SEC. 209. ELIMINATION OF DEDUCTIBLES AND COINSURANCE FOR EXISTING 
              PREVENTIVE HEALTH BENEFITS.

    (a) In General.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by inserting after subsection (o) the following new 
subsection:
    ``(p) Deductibles and Coinsurance Waived for Preventive Health 
Items and Services.--The Secretary may not require the payment of any 
deductible or coinsurance under subsection (a) or (b), respectively, of 
any individual enrolled for coverage under this part for any of the 
following preventive health items and services:
            ``(1) Blood-testing strips, lancets, and blood glucose 
        monitors for individuals with diabetes described in section 
        1861(n).
            ``(2) Diabetes outpatient self-management training services 
        (as defined in section 1861(qq)(1)).
            ``(3) Pneumococcal, influenza, and hepatitis B vaccines and 
        administration described in section 1861(s)(10).
            ``(4) Screening mammography (as defined in section 
        1861(jj)).
            ``(5) Screening pap smear and screening pelvic exam (as 
        defined in paragraphs (1) and (2) of section 1861(nn), 
        respectively).
            ``(6) Bone mass measurement (as defined in section 
        1861(rr)(1)).
            ``(7) Prostate cancer screening test (as defined in section 
        1861(oo)(1)).
            ``(8) Colorectal cancer screening test (as defined in 
     
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   section 1861(pp)(1)).
            ``(9) Screening for glaucoma (as defined in section 
        1861(uu)).
            ``(10) Medical nutrition therapy services (as defined in 
        section 1861(vv)(1)).''.
    (b) Waiver of Coinsurance.--
            (1) In general.--Section 1833(a)(1)(B) of the Social 
        Security Act (42 U.S.C. 1395l(a)(1)(B)) is amended to read as 
        follows: ``(B) with respect to preventive health items and 
        services described in subsection (p), the amounts paid shall be 
        100 percent of the fee schedule or other basis of payment under 
        this title for the particular item or service,''.
            (2) Elimination of coinsurance in outpatient hospital 
        settings.--The third sentence of section 1866(a)(2)(A) of the 
        Social Security Act (42 U.S.C. 1395cc(a)(2)(A)), as amended by 
        section 201(c)(3), is amended by inserting after ``section 
        1861(ww)'' the following: ``and preventive health items and 
        services described in section 1833(p)''.
    (c) Waiver of Application of Deductible.--Section 1833(b)(1) of the 
Social Security Act (42 U.S.C. 1395l(b)(1)) is amended to read as 
follows: ``(1) such deductible shall not apply with respect to 
preventive health items and services described in subsection (p),''.
    (d) Adding ``Lancet'' to Definition of DME.--Section 1861(n) of the 
Social Security Act (42 U.S.C. 1395x(n)) is amended by striking 
``blood-testing strips and blood glucose monitors'' and inserting 
``blood-testing strips, lancets, and blood glucose monitors''.
    (e) Conforming Amendments.--
            (1) Elimination of coinsurance for clinical diagnostic 
        laboratory tests.--Paragraphs (1)(D)(i) and (2)(D)(i) of 
        section 1833(a) of the Social Security Act (42 U.S.C. 
        1395l(a)), as amended by section 201(b)(1) of the Medicare, 
        Medicaid, and SCHIP Benefits Improvement and Protection Act of 
        2000 (114 Stat. 2763A-481), as enacted into law by section 
        1(a)(6) of Public Law 106-554, are each amended by inserting 
        ``or which are described in subsection (p)'' after 
        ``assignment-related basis''.
            (2) Elimination of coinsurance for certain dme.--Section 
        1834(a)(1)(A) of the Social Security Act (42 U.S.C. 
        1395m(a)(1)(A)) is amended by inserting ``(or 100 percent, in 
        the case of such an item described in section 1833(p))'' after 
``80 percent''.
            (3) Elimination of deductibles and coinsurance for 
        colorectal cancer screening tests.--Section 1834(d) of the 
        Social Security Act (42 U.S.C. 1395m(d)) is amended--
                    (A) in paragraph (2)(C)--
                            (i) by striking ``(C) Facility payment 
                        limit.--'' and all that follows through 
                        ``Notwithstanding subsections'' and inserting 
                        the following:
                    ``(C) Facility payment limit.--Notwithstanding 
                subsections'';
                            (ii) by striking ``(I) in accordance'' and 
                        inserting the following:
                            ``(i) in accordance'';
                            (iii) by striking ``(II) are performed'' 
                        and all that follows through ``payment under'' 
                        and inserting the following:
                            ``(ii) are performed in an ambulatory 
                        surgical center or hospital outpatient 
                        department,
                payment under''; and
                            (iv) by striking clause (ii); and
                    (B) in paragraph (3)(C)--
                            (i) by striking ``(C) Facility payment 
                        limit.--'' and all that follows through 
                        ``Notwithstanding subsections'' and inserting 
                        the following:
                    ``(C) Facility payment limit.--Notwithstanding 
                subsections''; and
                            (ii) by striking clause (ii).
    (f) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the day that is 1 year after 
the date of enactment of this Act.

SEC. 210. PROGRAM INTEGRITY.

    The Secretary, in consultation with the Inspector General of the 
Department of Health and Human Services, shall integrate supplemental 
preventive health services (as defined in section 1861(ww) of the 
Social Security Act (as added by the preceding provisions of this 
title)) with existing program integrity measures.

SEC. 211. PROMOTION OF PREVENTIVE HEALTH BENEFITS.

    In order to promote the use by medicare beneficiaries of preventive 
health benefits, including preventive health services (as defined in 
section 1861(ww) of the Social Security Act (as added by the preceding 
provisions of this title)) and preventive health items and services 
described in section 1833(p) of such Act (as added by section 209), the 
Secretary shall do the following:
            (1) Medicare handbook and other annual notices.--Include in 
        any medicare handbook and any other annual notice provided to 
        medicare beneficiaries a detailed description of--
                    (A) the preventive health benefits that are covered 
                under the medicare program; and
                    (B) the importance of using such benefits.
            (2) Fiscal intermediaries and carriers.--Require that 
        fiscal intermediaries with a contract under section 1816 of the 
        Social Security Act (42 U.S.C. 1395h) and carriers with a 
        contract under section 1842 of such Act (42 U.S.C. 1395u) 
        include preventive health benefits messages on Medicare Summary 
        Notice Statements and Explanations of Medicare Benefits 
        distributed by such entities.
            (3) Medicare part b statement.--Regularly include 
        preventive health benefits messages on the medicare part B 
        statement.
            (4) Medicare+choice plans.--Require that Medicare+Choice 
        organizations offering a Medicare+Choice plan disclose under 
        section 1852(c)(1)(B) of the Social Security Act (42 U.S.C. 
        1395w-22(c)(1)(B)) information regarding the preventive health 
        benefits that are covered under the plan.
            (5) Other activities.--Conduct activities in addition to 
        those described in paragraphs (1) through (4) that the 
        Secretary determines to be useful in disseminating information 
        to medicare beneficiaries regarding--
                    (A) the preventive health benefits that are covered 
                under the medicare program;
                    (B) the importance of using such benefits; and
                    (C) general health promotion.

 TITLE III--NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN

SEC. 301. NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN.

    (a) In General.--The Director of the Centers for Disease Control 
and Prevention, in consultation with the Administrator of the Health 
Care Financing Administration, shall conduct a national falls 
prevention and awareness campaign to reduce fall-related injuries among 
medicare beneficiaries.
    (b) Report to Congress.--
            (1) In general.--The Director of the Centers for Disease 
        Control and Prevention, in consultation with the Administrator 
        of the Health Care Financing Administration, shall submit to 
        Congress a report on the campaign conducted under this section.
            (2) Deadline for report.--The report required under 
        paragraph (1) shall be submitted not later than the earlier 
        of--
                    (A) 6 months after the campaign is completed; or
                    (B) 3 years after the campaign is implemented.
            (3) Contents of report.--The report required under 
        paragraph (1) shall include the following:
                    (A) A description of the campaign.
                    (B) An evaluation of--
        
2000
                    (i) whether the campaign has effectively 
                        reached its target population; and
                            (ii) the cost-effectiveness of the 
                        campaign.
                    (C) An assessment of whether the campaign has been 
                effective, as measured by whether--
                            (i) the target population has adopted the 
                        interventions suggested in the campaign, and if 
                        not, the reasons why such interventions have 
                        not been adopted; and
                            (ii) the fall rates among the target 
                        population have decreased since the campaign 
                        was implemented, and if not, the reasons why 
                        such fall rates have not decreased.
                    (D) Any other information regarding the campaign 
                that the Director of the Centers for Disease Control 
                and Prevention determines to be appropriate.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for the purpose of carrying 
out this section.

     TITLE IV--CLINICAL DEPRESSION SCREENING DEMONSTRATION PROJECTS

SEC. 401. CLINICAL DEPRESSION SCREENING DEMONSTRATION PROJECTS.

    (a) Definitions.--In this section:
            (1) Demonstration project.--The term ``demonstration 
        project'' means a demonstration project established under 
        subsection (b)(1).
            (2) Eligible beneficiary.--The term ``eligible 
        beneficiary'' means an individual enrolled for benefits under 
        part B who is not enrolled in any of the following:
                    (A) A Medicare+Choice plan under part C of title 
                XVIII of the Social Security Act (42 U.S.C. 1395w-21 et 
                seq.).
                    (B) A plan offered by an eligible organization 
                under section 1876 of such Act (42 U.S.C. 1395mm).
                    (C) A program of all-inclusive care for the elderly 
                (PACE) under section 1894 of such Act (42 U.S.C. 
                1395eee).
                    (D) A social health maintenance organization (SHMO) 
                demonstration project established under section 4018(b) 
                of the Omnibus Budget Reconciliation Act of 1987 
                (Public Law 100-203).
                    (E) A health care prepayment plan under section 
                1833(a)(1)(A) of the Social Security Act (42 U.S.C. 
                1395l(a)(1)(A)).
            (3) Part b.--The term ``part B'' means part B of the 
        original medicare fee-for-service program under title XVIII of 
        the Social Security Act (42 U.S.C. 1395j et seq.).
            (4) Qualified health professional.--The term ``qualified 
        health professional'' means an individual that--
                    (A) is--
                            (i) a physician (as defined in section 
                        1861(r)(1) of the Social Security Act (42 
                        U.S.C. 1395x(r)(1)));
                            (ii) a nurse practitioner (as defined in 
                        section 1861(aa)(5) of such Act (42 U.S.C. 
                        1395x(aa)(5))); or
                            (iii) a mental health care professional 
                        (including a clinical social worker, as defined 
                        in section 1861(hh) of such Act (42 U.S.C. 
                        1395x(hh))) that is licensed to perform mental 
                        health services by the State in which a 
                        screening for clinical depression is furnished 
                        under a demonstration project; and
                    (B) has an agreement in effect with the Secretary 
                under which the professional agrees to accept the 
                amount determined by the Secretary under subsection 
                (b)(4) as full payment for such screening and to accept 
                an assignment described in section 1842(b)(3)(B)(ii) of 
                the Social Security Act (42 U.S.C. 1395u(b)(3)(B)(ii)) 
                with respect to payment for each screening furnished by 
                the professional to an eligible beneficiary 
                participating in a demonstration project.
            (5) Screening for clinical depression.--
                    (A) In general.--The term ``screening for clinical 
                depression'' means a consultation during which--
                            (i) a self-administered written screening 
                        test (or an alternative format for such test 
                        pursuant to subsection (b)(3)(B)) is made 
                        available to an eligible beneficiary; and
                            (ii) a qualified health professional--
                                    (I) interprets the results of such 
                                test;
                                    (II) discusses the beneficiary's 
                                responses to the questions on the test 
                                with the beneficiary;
                                    (III) assesses the beneficiary's 
                                risk of clinical depression; and
                                    (IV) if the qualified health 
                                professional determines that the 
                                beneficiary is at high risk for 
                                clinical depression, refers the 
                                eligible beneficiary for a full 
diagnostic evaluation and such additional treatment as may be required.
                    (B) Construction.--Nothing in subparagraph 
                (A)(ii)(IV) shall be construed as prohibiting a 
                qualified health professional performing the screening 
                for clinical depression with respect to an individual 
                from directly providing the diagnostic evaluation and 
                additional treatment described in such subparagraph to 
                such individual if legally authorized under State law 
                to do so.
            (6) Self-administered written screening test.--The term 
        ``self-administered written screening test'' means an 
        instrument on which an eligible beneficiary writes answers to 
        questions designed to enable a qualified health professional to 
        establish the level of risk of such eligible beneficiary for 
        clinical depression.
    (b) Demonstration Projects.--
            (1) In general.--The Secretary shall establish and conduct 
        demonstration projects for the purpose of evaluating the 
        efficacy of providing screenings for clinical depression as a 
        benefit under part B to eligible beneficiaries through 
        qualified health professionals in accordance with the 
        requirements of this section.
            (2) Number, project areas, duration.--
                    (A) Number.--The Secretary shall establish no fewer 
                than 6 and no more than 10 demonstration projects.
                    (B) Project areas.--
                            (i) In general.--The Secretary shall 
                        conduct demonstration projects in geographic 
                        areas that include urban, suburban, and rural 
                        areas.
                            (ii) Selection.--The Secretary shall select 
                        the geographic areas described in clause (i) in 
                        a manner that--
                                    (I) ensures geographic diversity 
                                and a mix of screening sites (including 
                                physicians' offices, hospital 
                                outpatient departments, community 
                                mental health centers, and skilled 
                                nursing facilities); and
                    
2000
                (II) gives preference to areas with 
                                a high concentration of eligible 
                                beneficiaries.
                    (C) Duration.--The demonstration projects under 
                this section shall be conducted during the 3-year 
                period beginning on the date on which the initial 
                demonstration project is implemented.
            (3) Identification and distribution of self-administered 
        tests.--
                    (A) In general.--The Secretary, in consultation 
                with professionals experienced in conducting large-
                scale depression screening projects, shall--
                            (i) establish or identify a self-
                        administered written screening test to be used 
                        in conducting the demonstration projects; and
                            (ii) not later than the date that is 3 
                        months before the date on which a demonstration 
                        project is implemented in a geographic area, 
                        distribute such test to each qualified health 
                        professional that provides services in such 
                        area in which the Secretary conducts a 
                        demonstration project, together with guidelines 
                        for making the test available to eligible 
                        beneficiaries.
                    (B) Alternative formats for test.--The Secretary 
                shall also establish and distribute alternative formats 
                for the self-administered written screening test under 
                subparagraph (A) which shall be available for use when 
                circumstances do not permit an individual to complete 
                the self-administered written screening test.
            (4) Payment for screenings for clinical depression.--
                    (A) In general.--Subject to subparagraph (C), the 
                Secretary shall provide for payment of the reasonable 
                charges for each screening for clinical depression 
                furnished to an eligible beneficiary by a qualified 
                health professional from the amounts transferred under 
                subsection (d).
                    (B) Waiver of coinsurance and deductibles.--The 
                Secretary may not require the payment of any deductible 
                or coinsurance by any eligible beneficiary for a 
                screening for clinical depression furnished under a 
                demonstration project.
                    (C) Frequency limitation.--No payment may be made 
                under this section for a screening for clinical 
                depression if such a screening is performed with 
                respect to an eligible beneficiary within the year 
                after a previous screening of such beneficiary.
            (5) Waiver authority.--The Secretary may waive such 
        requirements under title XVIII of the Social Security Act (42 
        U.S.C. 1395 et seq.) as the Secretary determines necessary to 
        carry out the demonstration projects under this section.
    (c) Reports to Congress.--
            (1) Interim report.--
                    (A) In general.--Not later than 2 years after the 
                Secretary implements the initial demonstration project, 
                the Secretary shall submit to Congress a report 
                regarding the demonstration projects conducted under 
                this section.
                    (B) Contents of report.--The report submitted under 
                subparagraph (A) shall contain--
                            (i) a description of the demonstration 
                        projects conducted under this section;
                            (ii) an evaluation of--
                                    (I) whether screening for clinical 
                                depression is a cost-effective benefit 
                                or a cost-saving benefit; and
                                    (II) the level of satisfaction of 
                                eligible beneficiaries to whom such a 
                                screening is furnished under the 
                                demonstration project; and
                            (iii) any other information regarding the 
                        demonstration projects that the Secretary 
                        determines to be appropriate.
            (2) Final report.--Not later than 1 year after the 
        conclusion of the demonstration projects, the Secretary shall 
        submit a final report to Congress on the demonstration projects 
        containing the recommendations of the Secretary regarding 
        whether to conduct the demonstration projects on a permanent 
        basis, together with such recommendations for legislation and 
        administrative action as the Secretary considers appropriate.
    (d) Funding.--The Secretary shall provide for the transfer from the 
Federal Hospital Insurance Trust Fund under section 1817 of the Social 
Security Act (42 U.S.C. 1395i) an amount not to exceed $30,000,000 for 
the costs of carrying out the demonstration projects under this 
section.

     TITLE V--MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM

SEC. 501. MEDICARE HEALTH EDUCATION AND RISK APPRAISAL PROGRAM.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by adding at the end the following new section:

         ``medicare health education and risk appraisal program

    ``Sec. 1897. (a) Establishment.--Not later than 18 months after the 
date of the conclusion of the demonstration projects conducted under 
subsection (b)(1), the Secretary shall implement the demonstration 
project that the Secretary identifies as being the most effective 
project under subsection (c)(2)(C) on a nationwide and permanent basis.
    ``(b) Demonstration Projects.--
            ``(1) Establishment.--Not later than 1 year after the date 
        of enactment of this Act, the Secretary, in consultation with 
        the Health Care Financing Administration, the Centers for 
        Disease Control and Prevention, and the Agency for Healthcare 
        Research and Quality, shall conduct a demonstration project for 
        the purpose of developing a comprehensive and systematic model 
        for delivering health promotion and disease prevention services 
        that--
                    ``(A) through self-assessment identifies--
                            ``(i) behavioral risk factors, such as 
                        tobacco use, physical inactivity, alcohol use, 
                        and depression, among target individuals;
                            ``(ii) needed medicare clinical preventive 
                        and screening health benefits among target 
                        individuals; and
                            ``(iii) functional and self-management 
                        information the Secretary determines to be 
                        appropriate;
                    ``(B) provides ongoing followup to reduce risk 
                factors and promote the appropriate use of preventive 
                and screening health benefits;
                    ``(C) improves clinical outcomes, satisfaction, 
                quality of life, and appropriate use by target 
                individuals of items and services covered under the 
                medicare program; and
                    ``(D) provides target individuals with information 
                regarding the adoption of healthy behaviors.
            ``(2) Self-assessment and provision of information.--The 
        Secretary shall conduct the demonstration projects established 
        under paragraph (1) in the following manner:
                    ``(A) Self-assessment.--
                            ``(i) In general.--The Secretary shall test 
                        different--
               
2000
                     ``(I) methods of making self-
                                assessments available to each target 
                                individual;
                                    ``(II) methods of encouraging each 
                                target individual to participate in the 
                                self-assessment; and
                                    ``(III) methods for processing 
                                responses to the self-assessment.
                            ``(ii) Contents.--A self-assessment made 
                        available under clause (i) shall include--
                                    ``(I) questions regarding 
                                behavioral risk factors;
                                    ``(II) questions regarding needed 
                                preventive screening health services;
                                    ``(III) questions regarding the 
                                target individual's preferences for 
                                receiving follow-up information; and
                                    ``(IV) other information that the 
                                Secretary determines appropriate.
                    ``(B) Provision of information.--After each target 
                individual completes the self-assessment, the Secretary 
                shall ensure that the target individual is provided 
                with such information as the Secretary determines 
                appropriate, which may include--
                            ``(i) information regarding the results of 
                        the self-assessment;
                            ``(ii) recommendations regarding any 
                        appropriate behavior modification based on the 
                        self-assessment;
                            ``(iii) information regarding how to access 
                        behavior modification assistance that promotes 
                        healthy behavior, including information on 
                        nurse hotlines, counseling services, provider 
                        services, and case-management services;
                            ``(iv) information, feedback, support, and 
                        recommendations regarding any need for clinical 
                        preventive and screening health services or 
                        treatment; and
                            ``(v) referrals to available community 
                        resources in order to assist the target 
                        individual in reducing health risks.
            ``(3) Project areas and duration.--
                    ``(A) Project areas.--The Secretary shall implement 
                the demonstration projects in geographic areas that 
                include urban, suburban, and rural areas.
                    ``(B) Duration.--The Secretary shall conduct the 
                demonstration projects during the 3-year period 
                beginning on the date on which the first demonstration 
                project is implemented.
    ``(c) Report to Congress.--
            ``(1) In general.--Not later than 1 year after the date on 
        which the demonstration projects conclude, the Secretary shall 
        submit to Congress a report on such projects.
            ``(2) Contents of report.--The report submitted under 
        paragraph (1) shall--
                    ``(A) describe the demonstration projects conducted 
                under this section;
                    ``(B) identify the demonstration project that is 
                the most effective; and
                    ``(C) contain such other information regarding the 
                demonstration projects as the Secretary determines 
                appropriate.
            ``(3) Measurement of effectiveness.--For purposes of 
        paragraph (2)(B), in identifying the demonstration project that 
        is the most effective, the Secretary shall consider--
                    ``(A) how successful the project was at--
                            ``(i) reaching target individuals and 
                        engaging them in an assessment of the risk 
                        factors of such individuals;
                            ``(ii) educating target individuals on 
                        healthy behaviors and getting such individuals 
                        to modify their behaviors in order to diminish 
                        the risk of chronic disease; and
                            ``(iii) ensuring that target individuals 
                        were provided with necessary information;
                    ``(B) the cost-effectiveness of the demonstration 
                project; and
                    ``(C) the degree of beneficiary satisfaction under 
                the demonstration projects.
    ``(d) Waiver Authority.--The Secretary may waive such requirements 
under this title as the Secretary determines necessary to carry out the 
demonstration projects under this section.
    ``(e) Funding.--There are authorized to be appropriated $25,000,000 
for carrying out the demonstration project under this section.
    ``(f) Definitions.--In this section:
            ``(1) Target individual.--The term `target individual' 
        means each individual that is--
                    ``(A) entitled to benefits under part A or enrolled 
                under part B, including an individual enrolled under 
                the Medicare+Choice program under part C; or
                    ``(B) between the ages of 50 and 64 who is not a 
                beneficiary under this title.
            ``(2) Major behavioral risk factor.--The term `major 
        behavioral risk factor' includes--
                    ``(A) the lack of proper nutrition;
                    ``(B) the use of alcohol;
                    ``(C) the lack of regular exercise;
                    ``(D) the use of tobacco;
                    ``(E) depression; and
                    ``(F) any other risk factor identified by the 
                Secretary.''.

  TITLE VI--STUDIES, EVALUATIONS, AND REPORTS IN THE FIELD OF DISEASE 
                       PREVENTION AND THE ELDERLY

SEC. 601. MEDPAC EVALUATION AND REPORT ON MEDICARE BENEFIT PACKAGE IN 
              RELATION TO PRIVATE SECTOR BENEFIT PACKAGES.

    (a) In General.--Section 1805(b) of the Social Security Act (42 
U.S.C. 1395b-6(b)), as amended by section 544(b) of the Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 
(114 Stat. 2763A-551), as enacted into law by section 1(a)(6) of Public 
Law 106-554, is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (C), by striking ``and'' at the 
                end;
                    (B) in subparagraph (D), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(E) on the date that is 3 years after the date of 
                enactment of the Medicare Wellness Act of 2001, and 
                each successive 3-year anniversary thereafter, submit 
                the report described in paragraph (8)(C) to 
                Congress.''; and
            (2) by adding at the end the following new paragraph:
            ``(8) Evaluation of medicare benefit package in relation to 
        private sector benefit packages.--
                    ``(A) Evaluation.--The Commission shall evaluate--
                            ``(i) the benefit package offered under the 
                        medicare program under this title; and
                            ``(ii) the degree to which such benefit 
                        package compares to the benefit packages 
                        offered by health benefit programs available in 
                        the private sector to individuals over age 55.
                    ``(B) Issues.--In conducting the evaluation under 
                subparagraph (A)(ii), the Commission shall addre
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ss the 
                following issues:
                            ``(i) Whether the benefit packages 
                        available under the programs are--
                                    ``(I) similar;
                                    ``(II) appropriate for the 
                                enrollees of the programs (based on 
                                what experts recommend for such 
                                enrollees);
                                    ``(III) actuarially equivalent; and
                                    ``(IV) comprehensive.
                            ``(ii) The financial liabilities of 
                        enrollees of the programs and whether such 
                        liabilities are appropriate.
                            ``(iii) The ability of enrollees of the 
                        programs to take advantage of benefits under 
                        the programs.
                    ``(C) Report.--The Commission shall submit a report 
                to Congress that shall contain--
                            ``(i) a detailed statement of the findings 
                        and conclusions of the Commission regarding the 
                        evaluation conducted under subparagraph (A);
                            ``(ii) the recommendations of the 
                        Commission regarding changes in the benefit 
                        package offered under the medicare program 
                        under this title that would keep the program 
                        modern and competitive in relation to health 
                        benefit packages offered by health benefit 
                        programs available in the private sector to 
                        individuals over age 55; and
                            ``(iii) the recommendations of the 
                        Commission for such legislation and 
                        administrative actions as it considers 
                        appropriate.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 602. NATIONAL INSTITUTE ON AGING STUDY AND REPORT ON WAYS TO 
              IMPROVE THE QUALITY OF LIFE OF ELDERLY.

    (a) Studies.--The Director of the National Institute on Aging, in 
consultation with the Working Group on Disease Self-Management and 
Health Promotion (established in section 102) and the United States 
Preventive Services Task Force, shall conduct 1 or more studies 
focusing on ways to--
            (1) improve quality of life for the elderly; and
            (2) develop better ways to prevent or delay the onset of 
        age-related functional decline and disease and disability among 
        the elderly.
    (b) Reports.--
            (1) Report for each study.--The Director of the National 
        Institute on Aging, in consultation with the Working Group on 
        Disease Self-Management and Health Promotion and the United 
        States Preventive Services Task Force, shall submit a report to 
        the Secretary regarding each study conducted under subsection 
        (a), together with a detailed statement of research findings 
        and conclusions that are scientifically valid and are 
        demonstrated to prevent or delay the onset of chronic illness 
        or disability among the elderly.
            (2) Timing for submitting reports.--Each report regarding a 
        study that is required to be submitted pursuant to paragraph 
        (1) shall be submitted by not later than the earlier of--
                    (A) the date that is 18 months after the completion 
                of the study involved; or
                    (B) January 1, 2008.
    (c) Transmission to Institute of Medicine.--Upon receipt of each 
report described in subsection (b), the Secretary shall transmit such 
report to the Institute of Medicine of the National Academy of Sciences 
for consideration in its effort to conduct the comprehensive study of 
current literature and best practices in the field of health promotion 
and disease prevention among the medicare beneficiaries described in 
section 603.
    (d) Authorization of Appropriations.--
            (1) In general.--There are authorized to be appropriated 
        for the purpose of carrying out this section such sums as may 
        be necessary for the period of fiscal years 2002 through 2008.
            (2) Availability.--Any sums appropriated under the 
        authorization contained in this subsection shall remain 
        available, without fiscal year limitation, until September 30, 
        2008.

SEC. 603. INSTITUTE OF MEDICINE MEDICARE PREVENTION BENEFIT STUDY AND 
              REPORT.

    (a) Study.--
            (1) In general.--The Secretary shall contract with the 
        Institute of Medicine of the National Academy of Sciences to--
                    (A) conduct a comprehensive study of current 
                literature and best practices in the field of health 
                promotion and disease prevention among medicare 
                beneficiaries, including the issues described in 
                paragraph (2); and
                    (B) submit the report described in subsection (b).
            (2) Issues studied.--The study required under paragraph (1) 
        shall include an assessment of--
                    (A) whether each health promotion and disease 
                prevention benefit covered under the medicare program 
                is--
                            (i) medically effective (as defined in 
                        section 101(4)); and
                            (ii) a cost-effective benefit (as defined 
                        in section 101(2)) or a cost-saving benefit (as 
                        defined in section 101(3));
                    (B) utilization by medicare beneficiaries of such 
                benefits (including any barriers to or incentives to 
                increase utilization);
                    (C) quality of life issues associated with such 
                benefits; and
                    (D) health promotion and disease prevention 
                benefits that are not covered under the medicare 
                program that would affect all medicare beneficiaries.
    (b) Reports.--
            (1) Three-year report.--On the date that is 3 years after 
        the date of enactment of this Act, and each successive 3-year 
        anniversary thereafter, the Institute of Medicine of the 
        National Academy of Sciences shall submit to the President a 
        report that contains--
                    (A) a detailed statement of the findings and 
                conclusions of the study conducted under subsection 
                (a); and
                    (B) the recommendations for legislation described 
                in paragraph (3).
            (2) Interim report based on new guidelines.--If the United 
        States Preventive Services Task Force or the Task Force on 
        Community Preventive Services establishes new guidelines 
        regarding preventive health benefits for medicare beneficiaries 
        more than 1 year prior to the date that a report described in 
        paragraph (1) is due to be submitted to the President, then not 
        later than 6 months after the date such new guidelines are 
        established, the Institute of Medicine of the National Academy 
        of Sciences shall submit to the President a report that 
        contains a detailed description of such new guidelines. Such 
        report may also contain recommendations for legislation 
        described in paragraph (3).
            (3) Recommendations for legislation.--The Institute of 
        Medicine of the National Academy of Sciences, in consultation 
        with the United States Preventive Services Task Force and the 
        Task Force on Community Preventive Services, shall develop 
        recommendations in legislative form that--
                    (A) prioritize the preventive health benefits under 
            
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    the medicare program; and
                    (B) modify such benefits, including adding new 
                benefits under such program, based on the study 
                conducted under subsection (a).
    (c) Transmission to Congress.--
            (1) In general.--On the day on which the report described 
        in paragraph (1) of subsection (b) (or paragraph (2) of such 
        subsection if the report contains recommendations in 
        legislative form described in subsection (b)(3)) is submitted 
        to the President, the President shall transmit the report and 
        recommendations to Congress.
            (2) Delivery.--Copies of the report and recommendations in 
        legislative form required to be transmitted to Congress under 
        paragraph (1) shall be delivered--
                    (A) to both Houses of Congress on the same day;
                    (B) to the Clerk of the House of Representatives if 
                the House is not in session; and
                    (C) to the Secretary of the Senate if the Senate is 
                not in session.

SEC. 604. FAST-TRACK CONSIDERATION OF PREVENTION BENEFIT LEGISLATION.

    (a) Rules of House of Representatives and Senate.--This section is 
enacted by Congress--
            (1) as an exercise of the rulemaking power of the House of 
        Representatives and the Senate, respectively, and is deemed a 
        part of the rules of each House of Congress, but--
                    (A) is applicable only with respect to the 
                procedure to be followed in that House of Congress in 
                the case of an implementing bill (as defined in 
                subsection (d)); and
                    (B) supersedes other rules only to the extent that 
                such rules are inconsistent with this section; and
            (2) with full recognition of the constitutional right of 
        either House of Congress to change the rules (so far as 
        relating to the procedure of that House of Congress) at any 
        time, in the same manner and to the same extent as in the case 
        of any other rule of that House of Congress.
    (b) Introduction and Referral.--
            (1) Introduction.--
                    (A) In general.--Subject to paragraph (2), on the 
                day on which the President transmits the report 
                pursuant to section 603(c) to the House of 
                Representatives and the Senate, the recommendations in 
                legislative form transmitted by the President with 
                respect to such report shall be introduced as a bill 
                (by request) in the following manner:
                            (i) House of representatives.--In the House 
                        of Representatives, by the Majority Leader, for 
                        himself and the Minority Leader, or by Members 
                        of the House of Representatives designated by 
                        the Majority Leader and Minority Leader.
                            (ii) Senate.--In the Senate, by the 
                        Majority Leader, for himself and the Minority 
                        Leader, or by Members of the Senate designated 
                        by the Majority Leader and Minority Leader.
                    (B) Special rule.--If either House of Congress is 
                not in session on the day on which such recommendations 
                in legislative form are transmitted, the 
                recommendations in legislative form shall be introduced 
                as a bill in that House of Congress, as provided in 
                subparagraph (A), on the first day thereafter on which 
                that House of Congress is in session.
            (2) Referral.--Such bills shall be referred by the 
        presiding officers of the respective Houses to the appropriate 
        committee, or, in the case of a bill containing provisions 
        within the jurisdiction of 2 or more committees, jointly to 
        such committees for consideration of those provisions within 
        their respective jurisdictions.
    (c) Consideration.--After the recommendations in legislative form 
have been introduced as a bill and referred under subsection (b), such 
implementing bill shall be considered in the same manner as an 
implementing bill is considered under subsections (d), (e), (f), and 
(g) of section 151 of the Trade Act of 1974 (19 U.S.C. 2191).
    (d) Implementing Bill Defined.--In this section, the term 
``implementing bill'' means only the recommendations in legislative 
form of the Institute of Medicine of the National Academy of Sciences 
described in section 603(b)(3), transmitted by the President to the 
House of Representatives and the Senate under subsection 603(c), and 
introduced and referred as provided in subsection (b) as a bill of 
either House of Congress.
    (e) Counting of Days.--For purposes of this section, any period of 
days referred to in section 151 of the Trade Act of 1974 shall be 
computed by excluding--
            (1) the days on which either House of Congress is not in 
        session because of an adjournment of more than 3 days to a day 
        certain or an adjournment of Congress sine die; and
            (2) any Saturday and Sunday, not excluded under paragraph 
        (1), when either House is not in session.
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