Medicare Demonstration of Coverage for Low Vision Devices Act of 2013

A BILL

To evaluate, through a five-year national demonstration project administered by the Secretary of Health and Human Services, the fiscal impact of a permanent change to Title XVIII of the Social Security Act allowing reimbursement for certain low vision devices as durable medical equipment.

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

Sec. 1. Short Title

This Act may be cited as the Medicare Demonstration of Coverage for Low Vision Devices Act of 2012.

Sec. 2. Demonstration Project.

(a) Establishment of Demonstration Project.-Within one year of the date of enactment of this Act, the Secretary of Health and Human Services shall commence the demonstration project described in subsection (b) and shall administer such project for a period of no less than five years. Upon completion of the third year of such project, the Secretary shall, within 180 days, report to the Senate Committee on Finance and the House Committees on Ways and Means and Energy and Commerce the progress and preliminary findings from such project and, after solicitation and consideration of formal written input from organizations representing consumers with vision loss and other stakeholder organizations, shall, within 180 days of the conclusion of such project, report on final project findings and make such recommendations as the Secretary deems appropriate.

(b) Purposes, Structure and Scope of Demonstration Project.-The demonstration project established in subsection (a) shall evaluate the likely impact on the Medicare Trust Fund of a permanent establishment of payment under Title XVIII of the Social Security Act for certain low vision devices (including subsets of such devices) as defined in subsection (c). Such project shall be open to any Medicare beneficiary for whom, upon proper clinical evaluation, a physician deems prescription of an appropriate low vision device medically necessary. Such project shall be national in scope and, however the Secretary may administer such project (in the Secretary's discretion after consultation with organizations of consumers with vision loss and other stakeholder organizations), be designed to provide a rich, well structured and defined data set that can yield Medicare-program-wide evidence-based conclusions using appropriate statistical methods.

(c) Low Vision Devices Defined.-For the purposes of the demonstration project established by this Act, the term "low vision devices" means devices, prescribed by a physician, that magnify, enhance, or otherwise augment or interpret visual images irrespective of the size, form, or technological features of such devices and does not include ordinary eye glasses or contact lenses. The Secretary shall ensure that payment for low vision devices under the demonstration project is provided as though such devices are covered within the meaning of section 1861(n) of the Social Security Act (42 U.S.C. 1395x(n) (as amended), provided that payment for low vision devices shall not be made for a device that is otherwise available for non-prescription retail sale to the general public at a cost of less than five hundred dollars.

Sec. 3. Funding for Project Administration.-For fiscal year 2014 and for each of the four subsequent fiscal years, $2.5 million is appropriated to the Secretary to administer the demonstration project established pursuant to this Act.