[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1079 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                S. 1079

To amend titles XI and 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 SENATE OF THE UNITED STATES

                             April 23, 2015

  Mr. Cardin introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend titles XI and 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 2015'' or the ``SCREEN 
Act of 2015''.
    (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. Maintaining calendar year 2015 Medicare reimbursement rates for 
                            colonoscopy procedures for providers 
                            participating in colorectal cancer 
                            screening quality improvement registry.
Sec. 4. Eliminating Medicare beneficiary cost-sharing for certain 
                            colorectal cancer screenings, colorectal 
                            cancer screenings with therapeutic effect, 
                            and follow-up diagnostic colorectal cancer 
                            screenings covered under Medicare.
Sec. 5. Medicare demonstration project to evaluate the effectiveness of 
                            a pre-operative visit prior to screening 
                            colonoscopy and hepatitis C screening.
Sec. 6. Budget neutrality.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Colorectal cancer is the second leading cause of cancer 
        death among men and women combined in the United States.
            (2) In 2015, more than 130,000 Americans will be diagnosed 
        with colorectal cancer, and nearly 50,000 Americans are 
        expected to die from it.
            (3) Approximately 60 percent of colorectal cancer cases and 
        70 percent of colorectal cancer deaths occur in those aged 65 
        and older.
            (4) Colorectal cancer screening colonoscopies allow for the 
        detection and removal of polyps before they progress to 
        colorectal cancer, as well as early detection of colorectal 
        cancer when treatment can be most effective.
            (5) According to a 2012 study published in the New England 
        Journal of Medicine, removing precancerous polyps through 
        colonoscopy could reduce the number of colorectal cancer deaths 
        by 53 percent.
            (6) Although colorectal cancer is highly preventable with 
        appropriate screening, one in three adults between the ages of 
        50 and 75 years are not up to date with recommended colorectal 
        cancer screening.
            (7) Over 200 organizations have committed to eliminating 
        colorectal cancer as a major health problem in the United 
        States and are working toward a shared goal of screening 80 
        percent of eligible Americans by 2018.
            (8) Hepatitis C is a liver disease that causes inflammation 
        of the liver and results from infection with the Hepatitis C 
        virus. Chronic Hepatitis C infection can lead to serious health 
        problems, including liver damage, cirrhosis, and liver cancer. 
        It is the leading cause of liver transplants in the United 
        States.
            (9) According to the Centers for Disease Control and 
        Prevention (CDC), more than 75 percent of adults infected with 
        the Hepatitis C virus in the United States were born between 
        1945 and 1965.
            (10) The CDC estimates that up to 75 percent of individuals 
        with Hepatitis C do not know that they are infected.
            (11) The CDC and the United States Preventive Services Task 
        Force (USPSTF) recommend a one-time screening for Hepatitis C 
        for all individuals born between 1945 and 1965.
            (12) A recent study suggests that offering Hepatitis C 
        screening to patients in connection with screening 
        colonoscopies may be an effective means of increasing Hepatitis 
        C screening rates among individuals born between 1945 and 1965.

SEC. 3. MAINTAINING CALENDAR YEAR 2015 MEDICARE REIMBURSEMENT RATES FOR 
              COLONOSCOPY PROCEDURES FOR PROVIDERS PARTICIPATING IN 
              COLORECTAL CANCER SCREENING QUALITY IMPROVEMENT REGISTRY.

    Section 1834(d)(3) of the Social Security Act (42 U.S.C. 
1395m(d)(3)) is amended by adding at the end the following new 
subparagraph:
                    ``(F) Maintaining calendar year 2015 reimbursement 
                rates for qualifying cancer screening tests furnished 
                by qualifying providers.--
                            ``(i) In general.--With respect to a 
                        qualifying cancer screening test furnished 
                        during each of 2016, 2017, and 2018, by a 
                        qualifying provider, the amount of payment to 
                        such provider for such test under section 1833 
                        or section 1848 shall be equal to the amount of 
                        payment for such test under such section 1833 
                        or 1848 during 2015.
                            ``(ii) Qualifying cancer screening test.--
                        For purposes of this subparagraph, the term 
                        `qualifying cancer screening test' means an 
                        optical screening colonoscopy (as described in 
                        section 1861(pp)(1)(C)).
                            ``(iii) Qualifying provider defined.--For 
                        purposes of this subparagraph, the term 
                        `qualifying provider' means, with respect to a 
                        qualifying cancer screening test, an individual 
                        or entity--
                                    ``(I) that is eligible for payment 
                                for such test under section 1833 or 
                                section 1848; and
                                    ``(II) that--
                                            ``(aa) participates in a 
                                        nationally recognized quality 
                                        improvement registry with 
                                        respect to such test; and
                                            ``(bb) 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. ELIMINATING MEDICARE BENEFICIARY COST-SHARING FOR CERTAIN 
              COLORECTAL CANCER SCREENINGS, COLORECTAL CANCER 
              SCREENINGS WITH THERAPEUTIC EFFECT, AND FOLLOW-UP 
              DIAGNOSTIC COLORECTAL CANCER SCREENINGS COVERED UNDER 
              MEDICARE.

    (a) Waiver of Cost-Sharing.--Section 1833(a)(1)(Y) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)(Y)) is amended by inserting ``, 
including colorectal cancer screening tests covered under this part 
described in section 1861(pp)(1)(C) (regardless of the code that is 
billed for the establishment of a diagnosis as a result of the 
screening test, for the removal of tissue or other matter during the 
screening test, or for a follow-up procedure that is furnished in 
connection with, or as a result of, the initial screening test)'' after 
``or population''.
    (b) Waiver of Application of Deductible.--Section 1833(b) of the 
Social Security Act (42 U.S.C. 1395l(b)) is amended--
            (1) in paragraph (1) of the first sentence, by striking 
        ``individual.'' and inserting ``individual, including 
        colorectal cancer screening tests covered under this part 
        described in section 1861(pp)(1)(C)''; and
            (2) by striking the last sentence and inserting the 
        following: ``Subsection (a)(1)(Y) and paragraph (1) of the 
        first sentence of this subsection shall apply with respect to a 
        colorectal cancer screening test covered under this part 
        described in section 1861(pp)(1)(C), regardless of the code 
        that is billed for the establishment of a diagnosis as a result 
        of the screening test, for the removal of tissue or other 
        matter during the screening test, or for a follow-up procedure 
        that is furnished in connection with, or as a result of, the 
        initial screening test.''
    (c) Effective Date.--The amendments made by this section shall 
apply to tests and procedures performed on or after January 1, 2016.

SEC. 5. MEDICARE DEMONSTRATION PROJECT TO EVALUATE THE EFFECTIVENESS OF 
              A PRE-OPERATIVE VISIT PRIOR TO SCREENING COLONOSCOPY AND 
              HEPATITIS C SCREENING.

    Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 
1315a(b)(2)) is amended--
            (1) in the last sentence of subparagraph (A), by inserting 
        ``, and shall include the model described in subparagraph (D)'' 
        before the period at the end; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Medicare demonstration project to evaluate 
                the effectiveness of a pre-operative visit prior to 
                screening colonoscopy and hepatitis c screening.--
                            ``(i) In general.--The model described in 
                        this subparagraph is a demonstration project 
                        under title XVIII to evaluate the effectiveness 
                        of a pre-operative visit with the provider 
                        performing the procedure prior to screening 
                        colonoscopy to--
                                    ``(I) ease any patient concern or 
                                fears with respect to the procedure and 
                                answer any questions relating to the 
                                screening;
                                    ``(II) ensure quality examinations 
                                and avoid unnecessary repeat 
                                examinations by educating individuals 
                                on the importance of following pre-
                                procedure instructions, such as bowel 
                                preparation, and addressing the 
                                individual's family history of or 
                                predisposition to colorectal cancer; 
                                and
                                    ``(III) increase Hepatitis C Virus 
                                (HCV) screening rates among Medicare 
                                beneficiaries by educating individuals 
                                about the importance of such screening 
                                during the pre-operative visit and 
                                having the pre-operative visit fulfill 
                                the referral requirement for such 
                                screening under title XVIII, allowing 
                                patients to be screened for colorectal 
                                cancer and HCV at the same time.
                            ``(ii) Consultation.--The Secretary shall 
                        consult with stakeholders who would be 
                        providing the pre-operative visit under the 
                        model described in this subparagraph on the 
                        implementation of such model, including payment 
                        for services furnished under the model.''.

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 2016) 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 2016) 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 2016) at the 
time conversion factors described in subsections (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 and 4 
        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.
                                 <all>