[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3198 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 3198

To amend title XVIII of the Social Security Act and title XXVII of the 
Public Health Service Act to improve coverage for colorectal screening 
  tests under Medicare and private health insurance coverage, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 13, 2011

   Mr. Neal 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 and title XXVII of the 
Public Health Service Act to improve coverage for colorectal screening 
  tests under Medicare and private health insurance coverage, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Supporting 
Colorectal Examination and Education Now Act of 2011'' or the ``SCREEN 
Act of 2011''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Temporary increase in payment rate for certain cancer screening 
                            tests.
Sec. 4. Waiving Medicare cost-sharing for colorectal cancer screening 
                            with therapeutic effect.
Sec. 5. Medicare coverage for an office visit or consultation prior to 
                            a qualifying screening colonoscopy.
Sec. 6. Budget neutrality.
Sec. 7. Expansion of coverage of activities related to recommended 
                            preventive health services under private 
                            health insurance.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Colon cancer is the third most common cause of cancer-
        related deaths and the second most common cancer for both men 
        and women.
            (2) According to the American Cancer Society, over 50,000 
        people will die this year from colon cancer.
            (3) Colorectal cancer is highly treatable with appropriate 
        screening. According to the American Cancer Society (2010 Facts 
        & Figures), the 5-year survival rate is 90 percent for those 
        individuals who are diagnosed at an early stage of the cancer. 
        However, less than 40 percent of colon cancer cases are 
        diagnosed at an early stage.
            (4) The Centers for Disease Control and Prevention recently 
        estimated that approximately 2,000 deaths could be avoided if 
        colonoscopy screening rates rose by just 10 percent.
            (5) Colonoscopies allow for simultaneous colorectal cancer 
        screenings and detection and the removal of precancerous 
        polyps, thus preventing cancer from developing.
            (6) The U.S. Preventive Services Task Force provides an 
        ``A'' rating for colorectal cancer screenings.
            (7) The Centers for Disease Control and Prevention's 
        colorectal cancer control program has set a target of screening 
        80 percent of eligible adults in certain States by 2014. The 
        American Cancer Society and other patient advocacy groups have 
        a target rate of 75 percent.
            (8) Only between 52 and 58 percent of Medicare 
        beneficiaries have had any colorectal cancer screening test, 
        despite Medicare coverage for such tests.
            (9) Only 49.3 percent of Medicare beneficiaries who are 50 
        to 80 years old receive colorectal cancer screenings within 
        recommended intervals.
            (10) The Centers for Medicare & Medicaid Services notes 
        that there is ``clearly an opportunity to improve colorectal 
        cancer screening rates in the Medicare population''.
            (11) A January 2011 study by the Colon Cancer Alliance 
        concludes that most Americans over the age of 50--
                    (A) wish a health care provider was able to sit 
                down with them to discuss a colonoscopy before 
                undergoing the test; and
                    (B) forgo a colonoscopy due to fear of the 
                procedure.
            (12) In February 2010, the National Institutes of Health 
        hosted a conference on colorectal cancer screening and cited 
        patient awareness and fears as barriers to increasing 
        colorectal cancer screening rates.
            (13) According to the Medicare Payment Advisory Commission, 
        colonoscopy is one of the most common procedures performed in 
        the ambulatory surgical centers (ASCs) and ``the decline in 
        payment rate for the highest volume procedures is especially a 
        strong concern for ASCs that focus on gastroenterology''.
            (14) An Institute of Medicine study on colorectal cancer 
        screening cited the inadequate reimbursement for preventive 
        care services as one of the constraints limiting colorectal 
        cancer screening rates.
            (15) Colorectal cancer screening by colonoscopy has been 
        demonstrated to reduce Medicare costs over the long-term.

SEC. 3. TEMPORARY INCREASE IN PAYMENT RATE FOR CERTAIN CANCER SCREENING 
              TESTS.

    (a) In General.--With respect to a qualifying cancer screening test 
furnished during the 5-year period beginning on January 1, 2013, by a 
qualifying provider, the amount otherwise payable under section 1833 or 
section 1848 of the Social Security Act (42 U.S.C. 1395l, 1395w-4) to 
such provider for such test shall be increased by 10 percent.
    (b) Qualifying Cancer Screening Test.--
            (1) In general.--For purposes of this section, subject to 
        paragraph (2), the term ``qualifying cancer screening test'' 
        means, with respect to a Medicare beneficiary, a cancer 
        screening test that has in effect with respect to such 
        beneficiary a rating of `A' in the current recommendations of 
        the United States Preventive Services Task Force.
            (2) Termination when high utilization rate reached.--If the 
        Secretary determines that a cancer screening test described in 
        paragraph (1) has a utilization rate of at least 75 percent of 
        the Medicare beneficiaries for whom such screening has such a 
        recommendation, effective as of the first day of the year after 
        the year in which such determination is made, the cancer 
        screening test shall not be a qualifying cancer screening test.
    (c) Qualifying Provider Defined.--For purposes of this section, the 
term ``qualifying provider'' means, with respect to a qualifying cancer 
screening test, an individual or entity--
            (1) that is eligible for payment for such test under 
        section 1833 or section 1848 of the Social Security Act; and
            (2) that--
                    (A) participates in a nationally recognized quality 
                improvement registry with respect to such test; and
                    (B) demonstrates, to the satisfaction of the 
                Secretary, based on the information in such registry, 
                that the tests were provided by such individual or 
                entity in accordance with accepted outcomes-based 
                quality measures.

SEC. 4. WAIVING MEDICARE COST-SHARING FOR COLORECTAL CANCER SCREENING 
              WITH THERAPEUTIC EFFECT.

    (a) In General.--Section 1833(a)(1)(Y) of the Social Security Act 
(42 U.S.C. 1395l(a)(1)(Y)) is amended by inserting ``, including tests 
and procedures described in the last sentence of subsection (b),'' 
after ``section 1861(ddd)(3)''.
    (b) Effective Date.--The amendments made by this section shall 
apply to tests and procedures performed on or after January 1, 2013.

SEC. 5. MEDICARE COVERAGE FOR AN OFFICE VISIT OR CONSULTATION PRIOR TO 
              A QUALIFYING SCREENING COLONOSCOPY.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (EE), by striking ``and'' at the end;
            (2) in subparagraph (FF), by inserting ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
            ``(GG) prior to a colorectal cancer screening test 
        consisting of a screening colonoscopy or in conjunction with an 
        individual's decision regarding the performance of such a test 
        on the individual, 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 the sedation of the individual;''.
    (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 ``(Z)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (AA) with respect to an 
                outpatient office visit or consultation under section 
                1861(s)(2)(GG), 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)(GG),'' after ``(2)(FF) (including 
        administration of the health risk assessment),''.
            (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)) is amended by adding at the end the 
        following new paragraph:
            ``(4) 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)(GG), 
        payment under section 1848 shall be consistent with the payment 
        amounts for CPT codes 99201, 99202, 99203, 99204, 99211, 99212, 
        99213, 99214, and 99215 (as in effect as of the date of the 
        enactment of this paragraph or any successors to such 
        codes).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2013.

SEC. 6. BUDGET NEUTRALITY.

    (a) Adjustment of Physician Fee Schedule Conversion Factor.--The 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') shall reduce the conversion factor established under 
subsection (d) of section 1848 of the Social Security Act (42 U.S.C. 
1395w-4) for each year (beginning with 2013) to the extent necessary to 
reduce expenditures under such section for items and services furnished 
during the year in the aggregate by the net offset amount determined 
under subsection (c)(5) attributable to such section for the year.
    (b) Adjustment of HOPD Conversion Factor.--The Secretary shall 
reduce the conversion factor established under paragraph (3)(C) of 
section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) for 
each year (beginning with 2013) to the extent necessary to reduce 
expenditures under such section for items and services furnished during 
the year in the aggregate by the net offset amount determined under 
subsection (c)(5) attributable to such section for the year.
    (c) Determinations Relating to Expenditures.--For purposes of this 
section, before the beginning of each year (beginning with 2013) at the 
time conversion factors described in subsection (a) and (b) are 
established for the year, the Secretary shall determine--
            (1) the amount of the gross additional expenditures under 
        title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
        estimated to result from the implementation of sections 3, 4, 
        and 5 for items and services furnished during the year;
            (2) the amount of any offsetting reductions in expenditures 
        under such title (such as reductions in payments for inpatient 
        hospital services) for such year attributable to the 
        implementation of such sections;
            (3) the amount (if any) by which the amount of the gross 
        additional expenditures determined under paragraph (1) for the 
        year exceeds the amount of offsetting reductions determined 
        under paragraph (2) for the year;
            (4) of the gross additional expenditures determined under 
        paragraph (1) for the year that are attributable to 
        expenditures under sections 1848 and 1833(t) of such Act, the 
        ratio of such expenditures that are attributable to each 
        respective section; and
            (5) with respect to section 1848 and section 1833(t) of 
        such Act, a net offset amount for the year equal to the product 
        of--
                    (A) the amount of the net additional expenditures 
                for the year determined under paragraph (3); and
                    (B) the ratio determined under paragraph (4) 
                attributable to the respective section.

SEC. 7. EXPANSION OF COVERAGE OF ACTIVITIES RELATED TO RECOMMENDED 
              PREVENTIVE HEALTH SERVICES UNDER PRIVATE HEALTH 
              INSURANCE.

    (a) In General.--Section 2713(a)(1) of the Public Health Service 
Act (42 U.S.C. 300gg-13(a)(1)) is amended by inserting ``(including 
related activities occurring as part of the same clinical encounter, 
such as conducting a biopsy or by removing a lesion or growth)'' after 
``Task Force''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to plan years beginning on or after January 1, 2013.
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