[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1010 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                S. 1010

  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 SENATE OF THE UNITED STATES

                              May 12, 2005

 Mr. Santorum (for himself, Mr. Lieberman, Ms. Collins, Mr. Bingaman, 
   Mr. Nelson of Nebraska, Ms. Snowe, Mr. Graham, Mr. Jeffords, Ms. 
Landrieu, and Mr. Dorgan) 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 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 
2005''.

SEC. 2. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) colorectal cancer screening tests (as defined in 
        section 1861(pp)(1) of the Social Security Act (42 U.S.C. 
        1395x(pp)(1)) 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) in recognition of the need to improve rates of 
        colorectal cancer screening in the medicare program, Congress 
        enacted provisions in the Medicare Prescription Drug, 
        Improvement, and Modernization Act of 2003 to require 
        physicians to provide a referral for colorectal cancer 
        screening as part of the new initial preventive physical 
        examination, beginning January 1, 2005;
            (3) 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;
            (4) 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;
            (5) 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
            (6) reimbursement under the medicare program is not 
        currently available for the consultations described in 
        paragraph (5) despite the fact that reimbursement is provided 
        under such program for similar consultations prior to a 
        diagnostic colonoscopy.

SEC. 3. INCREASE IN PART B 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 part b 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 45378, 45380, and 45385, and HCPCS codes G0105 
                and GO121 for items and services furnished on or after 
                January 1, 2006, which reflect a 10-percent increase 
                above the relative value units in effect as the 
                nonfacility rates for such codes on December 31, 2005, 
                with such revised payment level to apply to items and 
                services performed in a nonfacility setting.
                    ``(B) Facility rates.--Notwithstanding paragraphs 
                (2)(A) and (3)(A), the Secretary shall establish 
                national minimum payment amounts for CPT codes 45378, 
                45380, and 45385, and HCPCS codes G0105 and GO121 for 
                items and services furnished on or after January 1, 
                2006, which reflect a 30-percent increase above the 
                relative value units in effect as the facility rates 
                for such codes on December 31, 2005, 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, 2006, 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) No Effect on HOPD Payments.--The Secretary of Health and Human 
Services shall not take into account the provisions of section 
1834(d)(4) of the Social Security Act, as added by subsection (a), in 
determining the amount of payment for any covered OPD service under the 
prospective payment system for hospitals outpatient department services 
under section 1833(t) of such Act (42 U.S.C. 1395l(t)).

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 (Y), by striking ``and'' at the end;
            (2) in subparagraph (Z), by inserting ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
                    ``(AA) 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 ``(V)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (W) with respect to an 
                outpatient office visit or consultation under section 
                1861(s)(2)(AA), the amounts paid shall be 80 percent of 
                the lesser of the actual charge or the amount 
                established under section 1848''.
            (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)(AA),'' after ``(2)(W),''.
            (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)(AA), 
        payment under section 1848 shall be consistent with the payment 
        amounts for CPT codes 99203 and 99243.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services provided on or after January 1, 2006.

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 amendments made by this section shall 
apply to items and services furnished on or after January 1, 2006.
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