	Introduction

The role of prevention in improving the quality of health care by preventing illness, disability, and death through expanded coverage or use of preventive services is a key topic of discussion among those seeking to reform the nation's health care delivery system. Some stakeholders have touted prevention as a means to contain health care costs. Whether expanding coverage or utilization of preventive services would actually save money for Medicare is, however, a matter of continuing debate. In general, Medicare law authorizes the Secretary to cover services for the diagnosis and treatment of illness, while coverage of preventive services (i.e., services provided in the absence of symptoms) has generally required legislation. Over the years, Congress has sought expert advice to determine, for the purposes of Medicare coverage, whether a given preventive service is effective, and whether its clinical use is likely to benefit the patient without posing potential risks from the procedure itself. Current Medicare coverage of preventive services does not always comport with evidence-based recommendations of expert panels such as the U.S. Preventive Services Task Force (USPSTF). A recent USPSTF recommendation regarding screening mammography has refocused congressional attention on the appropriate role of advisory panels with respect to Medicare coverage decisions. First, it provides a brief overview of the Medicare program and history of congressional actions that added coverage of various clinical preventive services under Medicare, including, most recently, a comprehensive health assessment for new Medicare beneficiaries, and a new administrative authority of the Secretary of HHS to expand Medicare coverage of preventive services. The report then discusses several advisory groups—in particular the USPSTF—and their recommendations regarding the effectiveness of clinical preventive services, Medicare coverage of these services, or related matters. This report will be updated as events warrant. "), if the Secretary determines that three conditions are met, namely that the proposed preventive service is 
reasonable and necessary for the prevention or early detection of an illness or disability; recommended with a grade of A or B by the USPSTF; and appropriate for individuals entitled to benefits under Medicare part A or enrolled under Medicare part B.
MIPPA also authorizes the Secretary to consider cost in determining whether to add coverage of a preventive service, saying: "As part of the use of such [NCD] 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." These panels have different mandates, and none is explicitly charged with evaluating preventive services for the purposes of Medicare coverage. Each panel is then discussed in more detail. Can Utilization of Medicare Preventive Services Be Improved? The House is preparing to vote on H.R. 3590 , as passed by the Senate, and on an accompanying reconciliation bill ( H.R. 4872 ). The reconciliation bill would change several controversial elements in H.R. 3590 and otherwise amend the underlying legislation so that its budgetary impact meets the reconciliation instructions in last year's budget resolution. If the House approves H.R. 3590 , it will be sent to the President to be signed into law. The reconciliation measure, if approved by the House, would then be taken up by the Senate. Senate-Passed H.R. 3590: The Patient Protection and Affordable Care Act

On December 24, 2009, the Senate passed an amended version of the Patient Protection and Affordable Care Act ( H.R. In addition, Section 4003, "Clinical and Community Preventive Services Task Forces," would reauthorize current authority for the USPSTF (calling it the "Preventive Services Task Force"), requiring the Task Force to review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community, and updating previous clinical preventive recommendations, to be published in the Guide to Clinical Preventive Services . House-Passed H.R. 3962 ). CBO has scored most of these proposals as incurring a net cost for the Medicare program. Appendix.
Congress established the Medicare program in 1965 in response to concerns that many seniors did not have health insurance, or had insurance that only covered hospital inpatient services. Historically, Medicare covered only diagnostic and treatment services, not preventive services provided in the absence of illness. Generally, adding coverage of a preventive service required statutory authority. Since 1980, Congress has established Medicare coverage for several preventive services in law. Recently, Congress gave the Secretary of HHS limited authority to cover new Medicare preventive services administratively.
While many view preventive services as a means to improve the quality of health care by preventing illness, disability, and death, some have also touted prevention as a means to contain health care costs. However, whether expanding coverage or utilization of preventive services would actually save money for Medicare is a matter of debate. While these screenings may be effective in preventing premature death or other unwanted outcomes in some beneficiaries, their broad use may incur a net cost for the Medicare program, rather than savings.
Efforts have also been made to determine whether specific preventive services are effective, and whether their use would be likely to benefit the patient without posing potential risks from the procedure itself. Congress has in the past sought the advice of expert panels to make these assessments. However, none of these panels is explicitly charged with evaluating preventive services for the purposes of Medicare coverage. For example, current Medicare coverage of preventive services does not always comport with evidence-based recommendations of a prominent expert panel, the U.S. Preventive Services Task Force (USPSTF). A recent USPSTF recommendation regarding screening mammography has refocused congressional attention on the appropriate role of advisory panels with respect to Medicare coverage decisions.
In November 2009, the House passed the Affordable Health Care for America Act (H.R. 3962). In December 2009, the Senate passed the Patient Protection and Affordable Care Act (an amendment to H.R. 3590). Each bill would, in general, expand Medicare coverage of preventive services, and reduce or eliminate most cost-sharing for these services. The Congressional Budget Office (CBO) has scored most of these proposals as incurring a net cost for Medicare. The House is preparing to vote on Senate-passed H.R. 3590 and on an accompanying reconciliation bill (H.R. 4872) that would change several controversial elements in the Senate-passed bill and otherwise amend it so that its budgetary impact meets the reconciliation instructions in last year's budget resolution. If the House approves H.R. 3590, it will be sent to the President to be signed into law. The reconciliation measure, if approved by the House, would then be taken up by the Senate.
This report first discusses the legislative and administrative history of Medicare coverage of preventive services. Then it discusses several advisory panels that have evaluated the effectiveness of preventive services, Medicare coverage of these services, or utilization of these services. Next, it discusses whether or not the use of preventive services would be cost-saving or cost-effective for Medicare, and whether utilization of preventive services can be improved. The report then presents relevant proposals in pending health reform legislation. Finally, the Appendix compares current Medicare coverage of preventive services with current USPSTF recommendations. This report will be updated to reflect legislative and other activity.