Section 4104

SEC. 4104. REMOVAL OF BARRIERS TO PREVENTIVE SERVICES IN MEDICARE.

[a] Definition of Preventive Services- Section 1861[ddd] of the Social Security Act [42 U.S.C. 1395x[ddd]] is amended--

[1] in the heading, by inserting '; Preventive Services' after 'Services';

[2] in paragraph [1], by striking 'not otherwise described in this title' and inserting 'not described in subparagraph [A] or [C] of paragraph [3]'; and

[3] by adding at the end the following new paragraph:

'[3] The term 'preventive services' means the following:

'[A] The screening and preventive services described in subsection [ww][2] [other than the service described in subparagraph [M] of such subsection].

'[B] An initial preventive physical examination [as defined in subsection [ww]].

'[C] Personalized prevention plan services [as defined in subsection [hhh][1]].'.

[b] Coinsurance-

[1] GENERAL APPLICATION-

[A] IN GENERAL- Section 1833[a][1] of the Social Security Act [42 U.S.C. 1395l[a][1]], as amended by section 4103[c][1], is amended--

[i] in subparagraph [T], by inserting '[or 100 percent if such services are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population and are appropriate for the individual]' after '80 percent';

[ii] in subparagraph [W]--

[I] in clause [i], by inserting '[if such subparagraph were applied, by substituting '100 percent' for '80 percent']' after 'subparagraph [D]'; and

[II] in clause [ii], by striking '80 percent' and inserting '100 percent';

[iii] by striking 'and' before '[X]'; and

[iv] by inserting before the semicolon at the end the following: ', and [Y] with respect to preventive services described in subparagraphs [A] and [B] of section 1861[ddd][3] that are appropriate for the individual and, in the case of such services described in subparagraph [A], are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population, the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the fee schedule that applies to such services under this part'.

[2] ELIMINATION OF COINSURANCE IN OUTPATIENT HOSPITAL SETTINGS-

[A] EXCLUSION FROM OPD FEE SCHEDULE- Section 1833[t][1][B][iv] of the Social Security Act [42 U.S.C. 1395l[t][1][B][iv]], as amended by section 4103[c][3][A], is amended--

[i] by striking 'or' before 'personalized prevention plan services'; and

[ii] by inserting before the period the following: ', or preventive services described in subparagraphs [A] and [B] of section 1861[ddd][3] that are appropriate for the individual and, in the case of such services described in subparagraph [A], are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population'.

[B] CONFORMING AMENDMENTS- Section 1833[a][2] of the Social Security Act [42 U.S.C. 1395l[a][2]], as amended by section 4103[c][3][B], is amended--

[i] in subparagraph [G][ii], by striking 'and' after the semicolon at the end;

[ii] in subparagraph [H], by striking the comma at the end and inserting '; and'; and

[iii] by inserting after subparagraph [H] the following new subparagraph:

'[I] with respect to preventive services described in subparagraphs [A] and [B] of section 1861[ddd][3] that are appropriate for the individual and are furnished by an outpatient department of a hospital and, in the case of such services described in subparagraph [A], are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population, the amount determined under paragraph [1][W] or [1][Y],'.

[c] Waiver of Application of Deductible for Preventive Services and Colorectal Cancer Screening Tests- Section 1833[b] of the Social Security Act [42 U.S.C. 1395l[b]], as amended by section 4103[c][4], is amended--

[1] in paragraph [1], by striking 'items and services described in section 1861[s][10][A]' and inserting 'preventive services described in subparagraph [A] of section 1861[ddd][3] that are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population and are appropriate for the individual.'; and

[2] by adding at the end the following new sentence: 'Paragraph [1] of the first sentence of this subsection shall apply with respect to a colorectal cancer screening test regardless of the code that is billed for the establishment of a diagnosis as a result of the test, or for the removal of tissue or other matter or other procedure that is furnished in connection with, as a result of, and in the same clinical encounter as the screening test.'.

[d] Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2011.