[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1422 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 1422

  To amend title XVIII of the Social Security Act to improve patient 
access to, and utilization of, the colorectal cancer screening benefit 
                      under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 25, 2003

  Mr. Cardin (for himself, Mr. English, Mr. Rangel, Mr. Portman, Mr. 
 Lewis of Georgia, Ms. Dunn, Mr. Towns, Mrs. Jones of Ohio, Mr. Wilson 
   of South Carolina, Mr. Gonzalez, Mr. Strickland, and Ms. Loretta 
    Sanchez of California) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
   the Committee on Ways and Means, 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 amend title XVIII of the Social Security Act to improve patient 
access to, and utilization of, the colorectal cancer screening benefit 
                      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 ``Colon Cancer Screen for Life Act of 
2003''.

SEC. 2. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) colorectal cancer screening tests (as defined in 
        section 1861(pp) of the Social Security Act (42 U.S.C. 
        1395x(pp)) covered under the medicare program have been 
        severely underutilized, with the Comptroller General of the 
        United States reporting in 2000 that since coverage of such 
        tests was implemented, the percentage of beneficiaries under 
        the medicare program receiving either a screening or a 
        diagnostic colonoscopy has increased by only 1 percent;
            (2) the Centers for Medicare & Medicaid Services should 
        encourage health care providers to use more effective screening 
        and diagnostic health care technologies in the area of 
        colorectal cancer screening;
            (3) in recent years, the Centers for Medicare & Medicaid 
        Services has subjected colorectal cancer screening tests to 
        some of the largest reimbursement reductions under the medicare 
        program;
            (4) unlike other preventive screening tests covered under 
        the medicare program, health care providers must consult with 
        beneficiaries prior to furnishing a screening colonoscopy in 
        order to--
                    (A) ascertain the medical and family history of the 
                beneficiary; and
                    (B) inform the beneficiary of preparatory steps 
                that must be taken prior to the procedure; and
            (5) reimbursement under the medicare program is not 
        currently available for the consultations described in 
        paragraph (4) despite the fact that reimbursement is provided 
        under such program for similar consultations prior to a 
        diagnostic colonoscopy.

SEC. 3. INCREASE IN REIMBURSEMENT FOR COLORECTAL CANCER SCREENING AND 
              DIAGNOSTIC TESTS.

    (a) In General.--Section 1834(d) of the Social Security Act (42 
U.S.C. 1395m(d)) is amended by adding at the end the following new 
paragraph:
            ``(4) Enhanced payment for colorectal cancer screening and 
        diagnostic tests.--
                    ``(A) Nonfacility rates.--Notwithstanding 
                paragraphs (2)(A) and (3)(A), the Secretary shall 
                establish national minimum payment amounts for CPT 
                codes 45330, 45378, 45380, 45385 and HCPCS codes GO104, 
                GO105, GO106, GO107, GO120, and GO121 for items and 
                services furnished during the last 6 months of 2003 and 
                in subsequent years which reflect a 10 percent increase 
                above the relative value units in effect as the 
                nonfacility rates for such codes on June 30, 2003, with 
                such revised payment level to apply to items and 
                services performed in a nonfacility setting, provided, 
                however, that such setting is consistent with quality 
                care, sound medical judgment, and prevention of 
                potential complications.
                    ``(B) Facility rates.--Notwithstanding paragraphs 
                (2)(A) and (3)(A), the Secretary shall establish 
                national minimum payment amounts for CPT codes 45330, 
                45378, 45380, 45385 and HCPCS codes GO104, GO105, 
                GO106, GO107, GO120, and GO121 for items and services 
                furnished during the last 6 months of 2003 and in 
                subsequent years which reflect a 30 percent increase 
                above the relative value units in effect as the 
                facility rates for such codes on June 30, 2003, with 
                such revised payment level to apply to items and 
                services performed in a facility setting.
                    ``(C) Annual adjustments.--In the case of items and 
                services furnished on or after January 1, 2004, the 
                payment rates described in subparagraphs (A) and (B) 
                shall, subject to the minimum payment amounts 
                established in such subparagraphs, be adjusted annually 
                as provided in section 1848.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to items and services furnished on or after July 1, 2003.

SEC. 4. MEDICARE COVERAGE OF OFFICE VISIT OR CONSULTATION PRIOR TO A 
              SCREENING COLONOSCOPY OR IN CONJUNCTION WITH A 
              BENEFICIARY'S DECISION TO OBTAIN SUCH A SCREENING.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (U), by striking ``and'' at the end;
            (2) in subparagraph (V), by inserting ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
            ``(W) an outpatient office visit or consultation for the 
        purpose of beneficiary education, assuring selection of the 
        proper screening test, and securing information relating to the 
        procedure and sedation of the beneficiary, prior to a 
        colorectal cancer screening test consisting of a screening 
colonoscopy or in conjunction with the beneficiary's decision to obtain 
such a screening, regardless of whether such screening is medically 
indicated with respect to the beneficiary;''.
    (b) Payment.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and'' before ``(U)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (V) with respect to an 
                outpatient office visit or consultation under section 
                1861(s)(2)(W), the amounts paid shall be 80 percent of 
                the lesser of the actual charge or the amount 
                established under section 1848, except that no payment 
                shall be made for such a visit or consultation if no 
                payment would be made for a colorectal cancer screening 
                test consisting of a screening colonoscopy for the 
                individual furnished on the date of such visit or 
                consultation because of the frequency limits described 
                in section 1834(d)(3)(E)''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``(2)(W),'' after ``(2)(S),''.
            (3) Requirement for establishment of payment amount under 
        physician fee schedule.--Section 1834(d) of the Social Security 
        Act (42 U.S.C. 1395m(d)), as amended by section 3, is amended 
        by adding at the end the following new paragraph:
            ``(5) Payment for outpatient office visit or consultation 
        prior to screening colonoscopy.--With respect to an outpatient 
        office visit or consultation under section 1861(s)(2)(W), 
        payment under section 1848 shall be consistent with the payment 
        amounts for CPT codes 99203 and 99243.''.
            (4) Frequency limitation.--Section 1862(a)(1) of the Social 
        Security Act (42 U.S.C. 1395y(a)(1)) is amended--
                    (A) in subparagraph (H), by striking ``and'' at the 
                end;
                    (B) in subparagraph (I), by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by inserting after subparagraph (I) the 
                following new subparagraph:
            ``(J) in the case of an outpatient office visit or 
        consultation under section 1861(s)(2)(W), which is performed 
        more frequently that is covered under section 1833(a)(1)(V);''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services provided on or after July 1, 2003.

SEC. 5. WAIVER OF DEDUCTIBLE FOR COLORECTAL CANCER SCREENING TESTS.

    (a) In General.--The first sentence of section 1833(b) of the 
Social Security Act (42 U.S.C. 1395l(b)) is amended--
            (1) by striking ``and'' before ``(6)''; and
            (2) by inserting before the period at the end the 
        following: ``, and (7) such deductible shall not apply with 
        respect to colorectal cancer screening tests (as described in 
        section 1861(pp)(1))''.
    (b) Conforming Amendments.--Paragraphs (2)(C)(ii) and (3)(C)(ii) of 
section 1834(d) of the Social Security Act (42 U.S.C. 1395m(d)) are 
each amended--
            (1) by striking ``deductible and'' in the heading; and
            (2) in subclause (I), by striking ``deductible or'' each 
        place it appears.
    (c) Effective Date.--The amendment made by this section shall apply 
to items and services furnished on or after July 1, 2003.
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