[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2194 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 2194

   To provide for cost savings in the medicare program through cost-
       effective coverage of positron emission tomography (PET).


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 4, 1995

  Mr. Duncan introduced the following bill; which was referred to the 
   Committee on Ways and Means, and in addition to the Committee on 
Commerce, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
   To provide for cost savings in the medicare program through cost-
       effective coverage of positron emission tomography (PET).
    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 ``Medicare PET Coverage Act of 1995''.

SEC. 2. CLARIFICATION OF MEDICARE COVERAGE OF, AND PAYMENT FOR, ITEMS 
              AND SERVICES ASSOCIATED WITH POSITRON EMISSION TOMOGRAPHY 
              (PET).

    (a) In General.--Nothing in title XVIII of the Social Security Act, 
or any other provision of law, regulation, policy, or interpretative 
statement, shall be construed to prohibit under parts A and B of such 
title coverage of, and payment for, items and services associated with 
the use of positron emission tomography (PET) for a covered medical 
indication (as defined in subsection (b)(1)) where the use meets the 
following conditions:
            (1) The PET is used as a substitute for other diagnostic 
        procedures or to assist a physician in assessing whether 
        exploratory surgery, surgical treatment, radiation, transplant, 
        or any other diagnostic or therapeutic procedure is medically 
        necessary.
            (2) The PET is performed at a facility that is licensed 
        under (or otherwise operating in compliance with) State law.
    (b) Covered Medical Indication Defined.--
            (1) In general.--For purposes of subsection (a), the term 
        ``covered medical indication'' means--
                    (A) any medical indication described in paragraph 
                (2), or
                    (B) any other medical indication where the carrier 
                involved (or the Secretary of Health and Human 
                Services) estimates that it will be less costly to the 
                medicare program under such title (on average) to use 
                the protocol using PET for the indication than to use 
                any alternative protocol which has similar diagnostic 
                accuracy and therapeutic outcome for that indication.
            (2) Specific medical indications covered.--The following 
        are the medical indications described in this paragraph:
                    (A) Localization of epileptogenic focus in patients 
                with complex partial seizure disorders.
                    (B) Differentiation of recurrent brain tumors from 
                radiation necrosis in patients who have previously 
                received radiation therapy treatment.
                    (C) Detection and assessment of tumors associated 
                with breast cancer, lung cancer, or colorectal cancer.
                    (D) Determination of cardiac perfusion and 
                viability in patients with left-ventricular dysfunction 
                or cardiomyopathy.
    (c) Definitions.--In this section:
            (1) The terms ``positron emission tomography'' and ``PET'' 
        mean a diagnostic imaging technology used, in a manner 
        generally accepted by the medical community and recognized in 
        the medical literature, to measure biochemical and physiologic 
        function in the human body.
            (2) The term ``diagnostic and therapeutic protocol'' means, 
        with respect to a specific medical indication, all of the 
        diagnostic procedures and resulting therapeutic procedures used 
        in diagnosing and treating the indication.
    (d) Effective Date.--This section shall apply to PET used on or 
after 30 days after the date of the enactment of this Act, without 
regard to whether or not regulations to carry out this section have 
been promulgated by such date.
    (e) Revision of National Coverage Determination.--The Secretary of 
Health and Human Services shall revise the medicare national coverage 
decision relating to coverage of PET to be consistent with this 
section. Nothing in this section shall be construed as preventing the 
Secretary from expanding such coverage decision beyond the coverage 
required under this section.
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