[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5461 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5461

  To amend title XVIII of the Social Security Act to cover screening 
computed tomography colonography as a colorectal cancer screening test 
                      under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 28, 2010

Mr. Davis of Illinois (for himself, Mr. Kirk, and Mr. Boren) 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 cover screening 
computed tomography colonography as a colorectal cancer screening test 
                      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 ``Virtual Screening for Colorectal 
Cancer Act of 2010''.

SEC. 2. COVERING SCREENING COMPUTED TOMOGRAPHY COLONOGRAPHY AS A 
              COLORECTAL CANCER SCREENING TEST UNDER MEDICARE..

    (a) In General.--Section 1861(pp)(1) of the Social Security Act (42 
U.S.C. 1395x(pp)(1)) is amended--
            (1) by redesignating subparagraph (D) as subparagraph (E); 
        and
            (2) by inserting after subparagraph (C) the following new 
        subparagraph:
                    ``(D) Screening computed tomography 
                colonography.''.
    (b) Frequency Limits and Payment.--Section 1834(d) of such Act (42 
U.S.C. 1395m(d)) is amended by adding at the end the following new 
paragraph:
            ``(4) Screening computed tomography colonography.--
                    ``(A) Fee schedule.--With respect to a colorectal 
                cancer screening test consisting of screening computed 
                tomography colonography, subject to subparagraph (B), 
                payment under section 1848 shall be consistent with 
                payment under such section for similar or related 
                services.
                    ``(B) Payment limit.--In the case of screening 
                computed tomography colonography, payment under this 
                part shall not exceed such amount as the Secretary 
                specifies.
                    ``(C) Facility payment limit.--
                            ``(i) Limitation on coinsurance.--
                        Notwithstanding any other provision of this 
                        title, in the case of an individual who 
                        receives screening computed tomography 
                        colonography--
                                    ``(I) in computing the amount of 
                                any applicable coinsurance, the 
                                computation of such coinsurance shall 
                                be based upon the fee schedule under 
                                which payment is made for the services; 
                                and
                                    ``(II) the amount of such 
                                coinsurance shall not exceed 25 percent 
                                of the payment amount under the fee 
                                schedule described in subparagraph (A).
                    ``(D) Frequency limit.--No payment may be made 
                under this part for a colorectal cancer screening test 
                consisting of a screening computed tomography 
                colonography--
                            ``(i) if the individual is under 50 years 
                        of age; or
                            ``(ii)(I) in the case of individuals at 
                        high risk for colorectal cancer, if the 
                        procedure is performed within the 23 months 
                        after a previous screening computed tomography 
                        colonography or a previous screening 
                        colonoscopy; or
                            ``(II) in the case of an individual who is 
                        not at high risk for colorectal cancer, if the 
                        procedure is performed within the 119 months 
                        after a previous screening colonoscopy or 
                        within the 59 months after a previous screening 
                        flexible sigmoidoscopy or a previous screening 
                        computed tomography colonography.''.
    (c) Conforming Frequency Limits for Other Colorectal Cancer 
Screening Tests.--
            (1) Screening flexible sigmoidoscopy.--Paragraph (2)(E)(ii) 
        of section 1834(d) of the Social Security Act (42 U.S.C. 
        1395m(d)) is amended by inserting ``or screening computed 
        tomography colonography'' after ``previous screening flexible 
        sigmoidoscopy''.
            (2) Screening colonoscopy.--Paragraph (3)(E) of such 
        section is amended--
                    (A) by inserting ``or screening computed tomography 
                colonography'' after ``23 months after a previous 
                screening colonoscopy''; and
                    (B) by inserting ``or screening computed tomography 
                colonography'' after ``screening flexible 
                sigmoidoscopy''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2011.

SEC. 3. EXEMPTION OF SCREENING COMPUTED TOMOGRAPHY COLONOGRAPHY FROM 
              SPECIAL RULE ON PAYMENT FOR IMAGING SERVICES.

    (a) In General.--Section 1848(b)(4)(B) of the Social Security Act 
(42 U.S.C. 1395w-4(b)(4)(B)) is amended by inserting ``and screening 
computed tomography colonography'' after ``diagnostic and screening 
mammography''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services furnished on or after January 1, 2011.

SEC. 4. REPORT ON THE EFFECTIVENESS OF SCREENING CTC IN IMPROVING 
              OVERALL CRC COMPLIANCE.

    (a) GAO Study and Reports on Effectiveness of Screening Computed 
Tomography Colonograpy in Improving Overall Colorectal Cancer 
Compliance.--
            (1) Study.--
                    (A) In general.--The Comptroller General of the 
                United States (in this subsection referred to as the 
                ``Comptroller General'') shall conduct a study, by 
                colorectal cancer screening procedure type, on--
                            (i) the effect of the addition of the 
                        screening computed tomography colonography (in 
                        this subsection referred to as ``screening 
                        CTC'') benefit under section 1861(pp)(1)(D) of 
                        the Social Security Act, as added by section 
                        2(a);
                            (ii) the effect of the addition of such 
                        benefit as part of an overall set of colorectal 
                        cancer screening (in this subsection referred 
                        to as the ``CRC screening'') made available to 
                        relevant Medicare population, including 
                        individuals over 50 years of age and over 75 
                        years of age; and
                            (iii) any other relevant questions 
                        involving access to, beneficiary preference of, 
                        and the value of, screening CTC for Medicare 
                        beneficiaries.
                    (B) Issues.--The study conducted under subparagraph 
                (A) shall examine the following:
                            (i) The impact of screening CTC on the 
                        change in CRC screening compliance of Medicare 
                        beneficiaries.
                            (ii) The various utilization rates for the 
                        each available CRC screening option before and 
                        after the availability of screening CTC, 
                        including--
                                    (I) by initial CRC screening 
                                performed as a Medicare beneficiary, 
                                including the beneficiary age when 
                                initial screening was performed; and
                                    (II) by follow-on screening 
                                performed, whereby the analysis 
                                demonstrates to what extent screening 
                                CTC was used as a substitute for a 
                                previous screening procedure.
                            (iii) The referral rate of screening CTC to 
                        follow-on optical colonoscopy.
                            (iv) An analysis of beneficiary preference 
                        to the various CRC screening options.
                            (v) Access to screening CTC by Medicare 
                        beneficiaries, especially in rural areas or 
                        underserved populations, before and after 
                        implementation of such screening benefit.
                            (vi) Such other issues as the Comptroller 
                        General determines appropriate.
            (2) Reports.--
                    (A) Preliminary report.--Not later than March 1, 
                2015, the Comptroller General shall submit a 
                preliminary report to Congress on the study conducted 
                under paragraph (1).
                    (B) Final report.--Not later than March 1, 2016, 
                the Comptroller General shall submit a final report to 
                Congress on the study conducted under paragraph (1), 
                together with recommendations for such legislation and 
                administrative action as the Comptroller General 
                determines appropriate.
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