1.This Act may be cited as
the Supporting ColoRectal Examination
and Education Now (SCREEN) Act of 2009
.
2.Findings and
sense of congress
(a)Congress makes the following
findings:
(1)A majority of the
deaths and costs associated with colorectal cancer, the second leading cause of
cancer deaths in the United States, are avoidable through timely preventive
screening, including colonoscopy.
(2)The United States
Preventive Services Task Force provides its only grade A
recommendation of cancer screenings for colorectal interventions.
(3)Colorectal cancer
screening test rates are far too low, with only 50 percent of recommended
populations receiving colorectal cancer screening tests, and rates of such
screening tests among minorities and those without insurance lag
considerably.
(4)The colorectal
cancer screening benefit under the Medicare Program under title XVIII of the
Social Security Act is severely underutilized.
(5)Numerous barriers
for patients, communities, and health care providers detrimentally affect the
utilization of colorectal cancer screening tests. Such barriers include patient
knowledge, coinsurance burdens, restrictions on Medicare coverage for an office
visit prior to a screening colonoscopy, and reductions in Medicare
reimbursement.
(b)It is the sense of Congress that—
(1)if legislation to
provide health insurance coverage, public or private, to persons under the age
of 65, is enacted, coverage of colorectal cancer screening tests and the
provisions of this Act should be included as part of any basic benefit package
required under such legislation; and
(2)Congress, Federal
agencies, State and local governments, health care providers, and patient
groups should make a concerted and sustained effort to increase the rate of
colorectal cancer screening tests.
3.Community and
patient interventions
(a)Grant program
To increase colorectal cancer awareness, screening, and treatment
(1)In
this subsection:
(A)Colorectal
cancer screening testsThe term colorectal cancer screening
test has the meaning given such term in section 1861(pp)(1) of the
Social Security Act (42 U.S.C. 1395x(pp)(1)).
(B)The term Indian tribe has the meaning given
such term in section 4 of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b).
(C)The
term Secretary means the Secretary of Health and Human Services,
acting through the Director of the Centers for Disease Control and
Prevention.
(D)The
term State means—
(i)a
State; and
(ii)the District of
Columbia.
(2)The Secretary is authorized to make grants to States
and Indian tribes for colorectal health programs. Such programs may include the
following:
(A)Provide
colorectal cancer screening tests, including colonoscopy, to individuals who
are over 50 years of age or who are determined to be at high risk for such
cancer.
(B)Provide case
management and referrals for medical treatment for individuals who are provided
colorectal cancer screening tests under the program.
(C)Programs to
ensure that individuals who are provided colorectal cancer screening tests
under the program receive the full continuum of follow up and cancer care, as
appropriate.
(D)Activities to
improve the education, training, and skills of health professionals in the
detection and treatment of colorectal cancer.
(E)The development
and dissemination of public information and education programs—
(i)for
the detection and treatment of colorectal cancer; and
(ii)promoting the
benefits of receiving colorectal cancer screening tests through the
program.
(3)In
making grants under paragraph (2), the Secretary shall give priority to States
and Indian tribes that will use grant funds to provide colorectal cancer
screening tests to low-income individuals who lack adequate health insurance
coverage with respect to such screening.
(4)Existing
funding authorityThe Secretary shall make a grant under this
section under an existing funding authority.
(b)Beneficiary
reminders for increasing colorectal cancer screening tests
(1)In
this subsection:
(A)Colorectal
cancer screening testsThe term colorectal cancer screening
test has the meaning given such term in section 1861(pp)(1) of the
Social Security Act (42 U.S.C. 1395x(pp)(1)).
(B)The term Medicare beneficiary means an
individual entitled to, or enrolled for, benefits under part A of title XVIII
of the Social Security Act and enrolled for benefits under part B of such
title.
(C)The
term Secretary means the Secretary of Health and Human
Services.
(2)Annual
notification under the Medicare programThe Secretary shall
establish a program under which all Medicare beneficiaries are notified
annually about the coverage of colorectal cancer screening tests under the
Medicare program under title XVIII of the Social Security Act. Under the
program, such notification—
(A)may be provided
through direct mail or direct electronic communications; and
(B)may accompany
other information currently provided to such beneficiaries, including marketing
materials or information provided to enrollees by Medicare Advantage
organizations under section 1852(c)(1) of the Social Security Act (42 U.S.C.
1395w–22) and information provided by PDP sponsors under section 1860D–4(a)(1)
of such Act (42 U.S.C. 1395w–104(a)(1)).
(3)State plan
amendment under Medicaid
(A)Section 1902(a) of the Social Security Act (42 U.S.C.
1396a(a)), as amended by section 5006(e)(2)(A) of division B of the American
Recovery and Reinvestment Act of 2009 (Public Law 111–5), is amended—
(i)in
paragraph (72), by striking and
at the end;
(ii)in
paragraph (73)(B), by striking the period at the end and inserting ;
and
; and
(iii)by inserting
after paragraph (73), the following new paragraph:
(74)if the State has
elected to provide medical assistance described in section 1905(a)(13) and such
assistance includes colorectal cancer screening tests, provide for the
establishment of a program under which individuals at risk for colon cancer,
including minorities who are identified as at high-risk for colon cancer, who
are over an age that the Secretary determines appropriate (based on the
recommendations of appropriate entities, including the United States Preventive
Services Task Force and appropriate medical specialty societies) are provided a
notification of the availability of medical assistance for colorectal cancer
screening tests and a reminder regarding the benefits of such
tests.
.
(B)
(i)Except as provided in clause (ii), the amendments made by
this paragraph take effect on January 1, 2011.
(ii)Extension of
effective date for state law amendmentIn the case of a State
plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which
the Secretary of Health and Human Services determines requires State
legislation in order for the plan to meet the additional requirements imposed
by the amendments made by this paragraph, the State plan shall not be regarded
as failing to comply with the requirements of such title solely on the basis of
its failure to meet these additional requirements before the first day of the
first calendar quarter beginning after the close of the first regular session
of the State legislature that begins after the date of enactment of this Act.
For purposes of the previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session is considered to be a separate
regular session of the State legislature.
4.Elimination of
coinsurance for colorectal cancer screening tests
(a)Section 1833(a)(1) of the Social Security Act (42 U.S.C.
1395l(a)(1)) is amended—
(1)by striking
and
before (W)
; and
(2)by inserting
before the semicolon at the end the following: , and (X) with respect to
colorectal cancer screening tests (as defined in subsection (pp)), the amount
paid shall be 100 percent of the lesser of the actual charge for the services
or the amount determined under the fee schedule that applies to such tests
under this part
.
(b)
(1)Screening
sigmoidoscopies and colonoscopiesSection 1834(d) of the Social
Security Act (42 U.S.C. 1395m(d)) is amended—
(A)in paragraph
(2)—
(i)in
subparagraph (A), by inserting , except that payment for such tests
under such section shall be 100 percent of the payment determined under such
section for such tests
before the period at the end; and
(ii)in
subparagraph (C)—
(I)by striking
clause (ii); and
(II)in clause
(i)—
- (aa)by
striking
(i) In
general.—Notwithstanding
and inserting
Notwithstanding
;
- (bb)by
redesignating subclauses (I) and (II) as clauses (i) and (ii), respectively,
and moving such clauses and the flush matter following such clauses 2 ems to
the left; and
- (cc)in
the flush matter following clause (ii), as so redesignated, by inserting
100 percent of
after based on
; and
(B)in paragraph
(3)—
(i)in
subparagraph (A), by inserting , except that payment for such tests
under such section shall be 100 percent of the payment determined under such
section for such tests
before the period at the end; and
(ii)in
subparagraph (C)—
(I)by striking
clause (ii); and
(II)in clause
(i)—
- (aa)by
striking
(i) In
general.—Notwithstanding
and inserting
Notwithstanding
; and
- (bb)by
inserting
100 percent of
after based on
.
(2)Outpatient
hospital settingsSection 1833(t) of the Social Security Act
(42 U.S.C.
1395l(t)) is amended—
(A)in paragraph
(4)(C), by striking paragraph (8)(C)
and inserting
subparagraphs (C) and (F) of paragraph (8)
; and
(B)in paragraph (8),
by adding at the end the following new subparagraph:
(F)No copayment
for colorectal cancer screening testsThe copayment amount that
would otherwise apply under this subsection to colorectal cancer screening
tests (as defined in section 1861(pp)) shall be reduced to
zero.
.
(c)The amendments made by this section shall apply to items and
services furnished on or after January 1, 2010.
5.Medicare
Advantage reporting requirements
(a)Section 1857(e) of the Social Security Act (42 U.S.C.
1395w–27(e)) is amended by adding at the end the following new
paragraph:
(4)Annual
reporting regarding colorectal cancer screening tests
(A)Not later than 6 months after the date of enactment of
this paragraph and annually thereafter, contract under this section with an MA
organization shall require the organization to submit to the Secretary an
annual report on the following:
(i)The coverage of
colorectal cancer screening tests (as defined in section 1861(pp)) under each
MA plan offered by the organization, including the level of any coinsurance or
copayments applicable for enrollees under the plan.
(ii)Any educational
outreach the organization provides to enrollees, providers of services, and
suppliers with respect to such tests.
(iii)Any
pay-for-performance incentives under MA plans offered by the organization for
providers of services and suppliers with respect to such tests, or any other
financial-sharing program with providers of services and suppliers with respect
to such tests.
(iv)The total number
of enrollees furnished such tests during the preceding year, listed according
to the specific test furnished, the type of facility in which the test was
furnished, and the gender and race of the enrollees to whom such tests were
furnished.
(B)Report to
Congress and public availability
(i)The
Secretary shall submit to Congress an annual report containing information
submitted in the annual reports under subparagraph (A).
(ii)The Secretary shall make such information available
to the public, including by posting such information on the Internet website of
the Centers for Medicare & Medicaid
Services.
.
(b)The amendment made by this section shall apply to contracts
entered into on or after January 1, 2011.
6.
(a)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)Preventive
service payment modified for certain colorectal cancer screening tests
(A)National
minimum standardsThe Secretary, in consultation with the
Institute of Medicine, shall establish a national minimum standard for basic
knowledge, training, continuing education, and documentation for suppliers who
furnish colorectal cancer screening tests (as defined in subsection (pp)). For
purposes of this paragraph, a supplier shall be deemed to meet such national
minimum standards if the supplier is certified in gastroenterology by the
American Board of Internal Medicine.
(B)Preventive
service payment modifier
(i)Determination
of rate goalsThe Secretary, in consultation with the United
States Preventive Services Task Force, the Institute of Medicine Colorectal
Cancer Working Group, and other clinical advisors as determined appropriate by
the Secretary, shall determine age-based goal rates for colorectal cancer
screening tests (as so defined) to be met or exceeded for beneficiaries under
this part not later than July 1, 2010. Such age-based goal rates shall be
consistent with the rates of screening for beneficiaries with respect to other
cancer screening tests (such as screening mammography and cervical cancer
screening).
(ii)Establishment
of preventive service modifier for qualified colorectal cancer screening
tests
(I)The Secretary shall establish an upward preventive
service payment modifier for qualifying colorectal cancer screening tests
furnished on or after January 1, 2010, which reflects the annual determination
by the Secretary of the appropriate amount of additional payment (not less than
10 percent of the amount of payment otherwise provided) sufficient to increase
the rate of colorectal cancer screening tests furnished under this part to the
goal rates determined under clause (i). The Secretary shall update such
modified on an annual basis, taking into consideration the rate of colorectal
cancer screening tests furnished under this part during the preceding year and
such goal rates.
(II)Qualifying
colorectal cancer screening testsFor purposes of subclause (I),
the term qualifying colorectal cancer screening tests means a
colorectal cancer screening test furnished by a supplier who meets the national
minimum standards established under subparagraph (A) (as determined by the
Secretary).
.
(b)Section 1833(t) of the Social Security Act (42 U.S.C.
1395l(t)) is amended by adding at the end the following new paragraph:
(18)
(A)National
minimum standardsThe Secretary, in consultation with the
Institute of Medicine, shall establish a national minimum standard for basic
knowledge, training, continuing education, and documentation for hospitals in
outpatient settings which furnish colorectal cancer screening tests (as defined
in subsection (pp)). For purposes of this paragraph, a hospital shall be deemed
to meet such national minimum standards if the hospital is certified by the
Joint Commission on the Accreditation of Healthcare Organizations, the
Accreditation Association for Ambulatory Health Care, or other accreditation
body designated by the Secretary.
(B)Preventive
service payment modifier
(i)Determination
of rate goalsThe Secretary, in consultation with the United
States Preventive Services Task Force, the Institute of Medicine Colorectal
Cancer Working Group, and other clinical advisors as determined appropriate by
the Secretary, shall determine age-based goal rates for colorectal cancer
screening tests (as so defined) to be met or exceeded for beneficiaries under
this part not later than July 1, 2010. Such age-based goal rates shall be
consistent with the rates of screening for beneficiaries with respect to other
cancer screening tests (such as screening mammography and cervical cancer
screening).
(ii)Establishment
of preventive service modifier for qualified colorectal cancer screening
tests
(I)The Secretary shall establish an upward preventive
service payment modifier for qualifying colorectal cancer screening tests
furnished on or after January 1, 2010, which reflects the annual determination
by the Secretary of the appropriate amount of additional payment (not less than
10 percent of the amount of payment otherwise provided) sufficient to increase
the rate of colorectal cancer screening tests furnished under this part to the
goal rates determined under clause (i). The Secretary shall update such
modifier on an annual basis, taking into consideration the rate of colorectal
cancer screening tests furnished under this part during the preceding year and
such goal rates.
(II)Qualifying
colorectal cancer screening testsFor purposes of subclause (I),
the term qualifying colorectal cancer screening tests means a
colorectal cancer screening test furnished by a hospital in an outpatient
setting which meets the national minimum standards established under
subparagraph (A) (as determined by the
Secretary).
.
(c)The amendments made by this section shall apply to items and
services furnished on or after January 1, 2010.
7.Coverage for an
office visit or consultation prior to a qualifying screening
colonoscopy
(a)Section
1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is
amended—
(1)in subparagraph
(DD), by striking and
at the end;
(2)in subparagraph
(EE), by inserting and
at the end; and
(3)by adding at the
end the following new subparagraph:
(FF)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)
(1)Section 1833(a)(1) of the Social Security Act (42 U.S.C.
1395l(a)(1)), as amended by section 4, is amended—
(A)by striking
and
before (W)
; and
(B)by inserting
before the semicolon at the end the following: , and (Y) with respect to
an outpatient office visit or consultation under section 1861(s)(2)(BB), 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 scheduleSection 1848(j)(3) of the Social Security
Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting (2)(FF),
after (2)(EE),
.
(3)Requirement for
establishment of payment amount under physician fee
scheduleSection 1834(d) of the Social Security Act (42 U.S.C.
1395m(d)), as amended by section 6, is amended by adding at the end the
following new paragraph:
(5)Payment for
outpatient office visit or consultation prior to screening
colonoscopyWith respect to an outpatient office visit or
consultation under section 1861(s)(2)(BB), payment under section 1848 shall be
consistent with the payment amounts for CPT codes 99203 and
99243.
.
(c)The amendments made by this section shall apply to items and
services furnished on or after January 1, 2010.