119-s2830

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2830 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 2830

 To amend title XVIII of the Social Security Act to improve the annual 
 wellness visit under the Medicare program.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 September 17 (legislative day, September 16), 2025

 Mr. King introduced the following bill; which was read twice and 
 referred to the Committee on Finance

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to improve the annual 
 wellness visit under the Medicare program.

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

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Wellness and Education for Longer 
Lives for Seniors Act of 2025'' or the ``WELL Seniors Act of 2025''.

SEC. 2. IMPROVEMENTS TO THE MEDICARE ANNUAL WELLNESS VISIT.

    (a) Additional Elements.--

    (1) In general.--

Section 1861

    (hhh)

    (2) of the Social 
 Security Act (42 U.S.C. 1395x

    (hhh)

    (2) ) is amended--
        (A) in subparagraph
        (F) , by striking ``and 
 nutrition'' and inserting ``nutrition, mobility, food 
 security, housing security, transportation access, 
 social support, and other social determinants of health 
 as determined by the Secretary'';
        (B) by moving subparagraphs
        (G) and
        (H) 2 ems to 
 the left;
            (C) by redesignating subparagraph
            (I) as 
 subparagraph
        (J) ; and
            (D) by inserting after subparagraph
        (H) the 
 following new subparagraph:
 ``
            (I) Screening for balance to identify risk for falls and 
 referral for treatment as appropriate.''.

    (2) Effective date.--The amendments made by paragraph

    (1) shall apply to items and services furnished on or after January 
 1, 2026.

    (b) Incentive Payments.--

Section 1833 of the Social Security Act 
(42 U.S.C. 1395l) is amended by adding at the end the following new 
subsection:
 ``

    (ee) Incentive Payments for Annual Wellness Visits That Include 
Certain Elements.--
 ``

    (1) In general.--In the case of personalized prevention 
 plan services (as defined in paragraph

    (1) of 

section 1861

    (hhh) ) that are furnished on or after January 1, 2026, and 
 that include the element described in subparagraph
        (F) of 
 paragraph

    (2) of such 

section 1861

    (hhh) and at least 2 
 additional elements described in subparagraphs
        (A) through
        (E) and
        (G) through
        (J) of such paragraph

    (2) , in addition to the 
 amount of payment that would otherwise be made for such 
 personalized prevention plan services under this part, there 
 also shall be paid an amount equal to 10 percent of the payment 
 amount for the service under this part.
 ``

    (2) Coordination with other payments.--The amount of the 
 additional payment for a service under this subsection and 
 subsection
            (m) shall be determined without regard to any 
 additional payment for the service under subsection
            (m) and 
 this subsection, respectively. The amount of the additional 
 payment for a service under this subsection and subsection

    (z) shall be determined without regard to any additional payment 
 for the service under subsection

    (z) and this subsection, 
 respectively.''.
            (c) Education and Outreach.--

    (1) In general.--The Secretary of Health and Human Services 
 (in this section referred to as the ``Secretary'') shall 
 conduct education and outreach activities regarding the 
 coverage of annual wellness visits under the Medicare program, 
 including changes to such visits under the amendments made by 
 subsections

    (a) and

    (b) .

    (2) National outreach campaign.--Not later than 1 year 
 after the date of enactment of this Act, the Secretary shall 
 conduct a national outreach campaign to educate beneficiaries 
 on the annual wellness visit under the Medicare program. In 
 conducting such outreach campaign, the Secretary may prioritize 
 education and outreach to low-income beneficiaries, non-
 physician providers, and to providers working and beneficiaries 
 living in rural areas or health professional shortage areas.

    (3) Authorization of appropriations.--There is authorized 
 to be appropriated for fiscal years 2026 through 2030 such sums 
 as may be necessary to carry out this subsection.
            (d) Inclusion as Telehealth Service.--

Section 1834
            (m) (4)
        (F)
            (i) of 
the Social Security Act (42 U.S.C. 1395m
            (m) (4)
        (F)
            (i) ) is amended by 
adding at the end the following new sentence: ``Such term includes, 
with respect to telehealth services furnished on or after January 1, 
2026, an annual wellness visit (as defined in 

section 1861

    (hhh) ).''

    (e) Provider Eligibility.--

    (1) In general.--

Section 1861

    (hhh)

    (3) of the Social 
 Security Act (42 U.S.C. 1395x

    (hhh)

    (3) ) is amended:
        (A) by striking ``or'' at the end of subparagraph
        (B) ;
        (B) by redesignating subparagraph
            (C) as 
 subparagraph
            (D) ; and
            (C) by inserting after subparagraph
        (B) the 
 following new subparagraph:
 ``
            (C) a physical therapist, an occupational therapist, or a 
 pharmacist; or''.

    (2) Effective date.--The amendments made by paragraph

    (1) shall apply to items and services furnished on or after January 
 1, 2026.

    (f) Guidance Revision.--Not later than 1 year after the date of 
enactment of this Act, the Secretary shall issue guidance amending 

section 410.15 of title 42, Code of Federal Regulations (or any 
successor regulation), to include guidance on processes, oversight, and 
standards for the post-visit follow-up to ensure consistency and 
compliance with the Health Risk Assessment, personalized prevention 
plan, and referrals.

    (g) Research and Evaluation.--

    (1) Report.--
        (A) In general.--Not later than 1 year after the 
 date of enactment of this Act, the Secretary, acting 
 through the Administrator of the Centers for Medicare & 
 Medicaid Services (in this subsection referred to as 
 the ``Administrator''), shall analyze and publish a 
 report on the prevalence in use of the annual wellness 
 visit (as defined in 

section 1861

    (hhh) of the Social 
 Security Act (42 U.S.C. 1395x

    (hhh) )) by Medicare 
 beneficiaries, including current practices and 
 recommendations for increasing the use and 
 effectiveness of the annual wellness visit under the 
 Medicare program under title XVIII of the Social 
 Security Act (42 U.S.C. 1395 et seq.). Such report 
 shall include--
            (i) information regarding the interviews 
 conducted under subparagraph
        (B) ;
            (ii) data on the prevalence of annual 
 wellness visits furnished to Medicare 
 beneficiaries via telehealth during the COVID-
 19 public health emergency; and
            (iii) utilization and claims data for 
 annual wellness visits over the preceding 10 
 years broken down by State, demographic groups 
 (including age, race, ethnicity, income, and 
 education), the type of provider furnishing the 
 annual wellness visit, and whether the 
 beneficiary is enrolled for benefits under the 
 original Medicare-fee-for-service program under 
 parts A and B of title XVIII of the Social 
 Security Act or the Medicare Advantage program 
 under part C of title XVIII of the Social 
 Security Act.
        (B) Interviews with stakeholders.--The 
 Administrator shall conduct interviews with 
 stakeholders, including provider groups, on their 
 concerns regarding billing for and using the annual 
 wellness visit under the Medicare program, including 
 whether and to what extent personalized prevention plan 
 services and appropriate referrals and follow-up are 
 taking place for beneficiaries who are at particular 
 risk and which referral models are most effective.

    (2) Focus group study.--Not later than 6 months after the 
 date of enactment of this Act, the Secretary, acting through 
 the Administrator, shall conduct a focus group study among 
 providers, community-based organizations, and beneficiaries 
 towards increasing use of the annual wellness visit by Medicare 
 beneficiaries. The Secretary shall work with beneficiary and 
 stakeholder groups to develop the interview questions for such 
 focus group study, and shall include questions on--
        (A) improving referrals to community services;
        (B) barriers to utilization and recommendations to 
 increase uptake; and
            (C) the types of providers in practices that 
 furnish the visits.

    (3) Authorization of appropriations.--There is authorized 
 to be appropriated for fiscal years 2026 through 2030 such sums 
 as may be necessary to carry out this subsection.
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