IMPROVEMENTS TO COVERAGE OF PREVENTIVE SERVICES.

SEC. 101. IMPROVEMENTS TO COVERAGE OF PREVENTIVE SERVICES.(a) Coverage of Additional Preventive Services.—(1) Coverage.—Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), is amended—(A) in subsection (s)(2)—(i) in subparagraph (Z), by striking “and” after the semicolon at the end;(ii) in subparagraph (AA), by adding “and” after the semicolon at the end; and(iii) by adding at the end the following new subparagraph:“(BB) additional preventive services (described in subsection (ddd)(1));”; and(B) by adding at the end the following new subsection:“Additional Preventive Services“(ddd)(1) The term ‘additional preventive services’ means services not otherwise described in this title that identify medical conditions or risk factors and that the Secretary determines are—“(A) reasonable and necessary for the prevention or early detection of an illness or disability;“(B) recommended with a grade of A or B by the United States Preventive Services Task Force; and122 STAT. 2497“(C) appropriate for individuals entitled to benefits under part A or enrolled under part B.“(2) In making determinations under paragraph (1) regarding the coverage of a new service, the Secretary shall use the process for making national coverage determinations (as defined in section 1869(f)(1)(B)) under this title. As part of the use of such process, the Secretary may conduct an assessment of the relation between predicted outcomes and the expenditures for such service and may take into account the results of such assessment in making such determination.”.(2) Payment and coinsurance for additional preventive services.—Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—(A) by striking “and” before “(V)”; and(B) by inserting before the semicolon at the end the following: “, and (W) with respect to additional preventive services (as defined in section 1861(ddd)(1)), the amount paid shall be (i) in the case of such services which are clinical diagnostic laboratory tests, the amount determined under subparagraph (D), and (ii) in the case of all other such services, 80 percent of the lesser of the actual charge for the service or the amount determined under a fee schedule established by the Secretary for purposes of this subparagraph”.(3) Conforming amendment regarding coverage.—Section 1862(a)(1)(A) of the Social Security Act (42 U.S.C. 1395y(a)(1)(A)) is amended by inserting “or additional preventive services (as described in section 1861(ddd)(1))” after “succeeding subparagraph”.(4) Rule of construction.—Nothing in the provisions of, or amendments made by, this subsection shall be construed to provide coverage under title XVIII of the Social Security Act of items and services for the treatment of a medical condition that is not otherwise covered under such title.(b) Revisions to Initial Preventive Physical Examination.—(1) In general.—Section 1861(ww) of the Social Security Act (42 U.S.C. 1395x(ww)) is amended—(A) in paragraph (1)—(i) by inserting “body mass index,” after “weight”;(ii) by striking “, and an electrocardiogram”; and(iii) by inserting “and end-of-life planning (as defined in paragraph (3)) upon the agreement with the individual” after “paragraph (2)”;(B) in paragraph (2), by adding at the end the following new subparagraphs:“(M) An electrocardiogram.“(N) Additional preventive services (as defined in subsection (ddd)(1)).”; and(C) by adding at the end the following new paragraph:“(3) For purposes of paragraph (1), the term ‘end-of-life planning’ means verbal or written information regarding—“(A) an individual’s ability to prepare an advance directive in the case that an injury or illness causes the individual to be unable to make health care decisions; and“(B) whether or not the physician is willing to follow the individual’s wishes as expressed in an advance directive.”.122 STAT. 2498(2) Waiver of application 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 “(8)”; and(B) by inserting “, and (9) such deductible shall not apply with respect to an initial preventive physical examination (as defined in section 1861(ww))” before the period at the end.(3) Extension of eligibility period from six months to one year.—Section 1862(a)(1)(K) of the Social Security Act (42 U.S.C. 1395y(a)(1)(K)) is amended by striking “6 months” and inserting “1 year”.(4) Technical correction.—Section 1862(a)(1)(K) of the Social Security Act (42 U.S.C. 1395y(a)(1)(K)) is amended by striking “not later” and inserting “more”.(c) Effective Date.—The amendments made by this section shall apply to services furnished on or after January 1, 2009.