I 111th CONGRESS 2d Session H. R. 5461 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.

1.

Short title

This Act may be cited as the Virtual Screening for Colorectal Cancer Act of 2010.

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.

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.

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.