[Congressional Record Volume 143, Number 55 (Thursday, May 1, 1997)]
[Senate]
[Pages S3912-S3914]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BREAUX (for himself, Mr. Cochran, Mr. Conrad, Mr. Dorgan, 
        Ms. Moseley-Braun, Mr. Reid, Mr. Rockefeller, Mr. Daschle, and 
        Mr. Robb):
  S. 690. A bill to amend title XVIII of the Social Security Act to 
improve preventive benefits under the Medicare Program; to the 
Committee on Finance.


              the colorectal cancer screening act of 1997

  Mr. BREAUX. Mr. President, I rise today to introduce the Colorectal 
Cancer Screening Act of 1997 with my colleagues Senators Cochran, 
Conrad, Dorgan, Moseley-Braun, Reid, and Rockefeller.
  Let me share some tragic facts about colorectal cancer. According to 
the American Cancer Society, colorectal cancer is the second most 
deadly cancer based on the number of annual deaths. While breast cancer 
primarily afflicts women and prostate cancer is a disease of men, 
colorectal cancer strikes both men and women of all races, resulting in 
the high number of patients and the corresponding high number of 
deaths.
  This year alone, 140,000 Americans will be diagnosed with colon 
cancer and 54,000 Americans will die from the disease. In my own State 
of Louisiana, 2,200 new cases of colon cancer will be diagnosed this 
year and it will take the lives of 920 people. Yet, as is the case with 
most cancers, colon cancer is preventable and curable if detected 
early.
  The tragedy of colorectal cancer is that physicians have proven means 
to detect colorectal cancer early but these tests must be made 
available to people on a widespread basis. Death from this terrible 
disease can be reduced significantly by early detection. We know 
polyps, the initial presentation of early cancers, if detected early 
can be treated without major surgery while expensive, major surgery in 
a hospital is the only successful treatment for more advanced cancers.
  While many private health plans are starting to provide coverage for 
colorectal cancer screening, Medicare--which covers older Americans who 
are most at risk--does not. The Colorectal Cancer Screening Act of 1997 
would make colorectal cancer screening available to Medicare 
beneficiaries to improve the chance for early detection and diagnosis.
  The type and frequency of screening I suggest in my bill are 
compatible with the recommendations of several large physician groups 
as well as the American Cancer Society. It covers all the procedures 
that are currently used today but the type of screening process will 
depend on the patient's risk factors for colon cancer. Patients at 
higher risk, for example someone whose parent had colon cancer, receive 
more aggressive screening than someone with a normal risk for colon 
cancer.
  Mr. President, this legislation is not procedure specific. Although 
several screening tests for colorectal cancer are currently available, 
the best method for early detection has not been determined. Some tests 
are very simple and can be performed by any doctor. Others, such as 
barium enema and colonoscopy, are technically more difficult and 
require special equipment and facilities. Some tests only evaluate part 
of the colon.
  My bill basically recognizes that we need to start screening people 
right away. The Congress should not prevent seniors from getting 
screened because there is disagreement over which procedures are best. 
That is a decision best made by doctors, not the Congress. This bill 
would mandate that seniors on Medicare have access to all the screening 
methods currently used by doctors. In 2 years, the Secretary of Health 
and Human Services will report back to Congress on which tests are

[[Page S3913]]

the best and most cost-effective means of detecting colon cancer. If it 
is determined that a procedure is being used that is not effective, 
Medicare will no longer cover it. HHS will also study the needs of 
African-Americans who are at high risk for colon cancer and have a 
higher mortality rate. It makes much more sense for the experts in 
colon cancer, not the Congress, to determine the best, most cost-
effective screening techniques all the while making this important 
service available immediately to Medicare beneficiaries.
  This kind of preventive tool is critical in our battle against colon 
cancer. It will improve the quality of life for Medicare beneficiaries 
and save Medicare money in the long run by reducing the high costs of 
treating advanced colorectal cancer.
  I encourage my colleagues to join me in supporting passage of this 
legislation this Congress. I ask unanimous consent that a copy of the 
bill appear in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 690

       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 ``Colorectal Cancer Screening 
     Act of 1997''.

     SEC. 2. MEDICARE COVERAGE OF COLORECTAL SCREENING SERVICES.

       (a) Coverage.--
       (1) In general.--Section 1861 of the Social Security Act 
     (42 U.S.C. 1395x) is amended--
       (A) in subsection (s)(2)--
       (i) by striking ``and'' at the end of subparagraphs (N) and 
     (O); and
       (ii) by inserting after subparagraph (O) the following:
       ``(P) colorectal cancer screening tests (as defined in 
     subsection (oo)); and''; and
       (B) by adding at the end the following:

                  ``Colorectal Cancer Screening Tests

       ``(oo)(1) The term `colorectal cancer screening test' 
     means, unless determined otherwise pursuant to section 
     2(a)(2) of the Colorectal Cancer Screening Act of 1997, any 
     of the following procedures furnished to an individual for 
     the purpose of early detection of colorectal cancer:
       ``(A) Screening fecal-occult blood test.
       ``(B) Screening flexible sigmoidoscopy.
       ``(C) Screening barium enema.
       ``(D) In the case of an individual at high risk for 
     colorectal cancer, screening colonoscopy or screening barium 
     enema.
       ``(E) For years beginning after 2002, such other procedures 
     as the Secretary finds appropriate for the purpose of early 
     detection of colorectal cancer, taking into account changes 
     in technology and standards of medical practice, 
     availability, effectiveness, costs, the particular screening 
     needs of racial and ethnic minorities in the United States 
     and such other factors as the Secretary considers 
     appropriate.
       ``(2) In paragraph (1)(D), an `individual at high risk for 
     colorectal cancer' is an individual who, because of family 
     history, prior experience of cancer or precursor neoplastic 
     polyps, a history of chronic digestive disease condition 
     (including inflammatory bowel disease, Crohn's Disease, or 
     ulcerative colitis), the presence of any appropriate 
     recognized gene markers for colorectal cancer, or other 
     predisposing factors, faces a high risk for colorectal 
     cancer.''.
       (2) Review of coverage of colorectal cancer screening 
     tests.--
       (A) In general.--Not later than 2 years after the date of 
     enactment of this Act (and periodically thereafter), the 
     Secretary of Health and Human Services (in this paragraph 
     referred to as the ``Secretary'') shall review--
       (i) the standards of medical practice with regard to 
     colorectal cancer screening tests (as defined in section 
     1861(oo) of the Social Security Act (42 U.S.C. 1395x(oo))) 
     (as added by paragraph (1) of this section);
       (ii) the availability, effectiveness, costs, and cost-
     effectiveness of colorectal cancer screening tests covered 
     under the medicare program under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.) at the time of such 
     review;
       (iii) the particular screening needs of racial and ethnic 
     minorities in the United States; and
       (iv) such other factors as the Secretary considers 
     appropriate with regard to the coverage of colorectal cancer 
     screening tests under the medicare program.
       (B) Determination.--If the Secretary determines it 
     appropriate based on the review conducted pursuant to 
     subparagraph (A), the Secretary shall issue and publish a 
     determination that one or more colorectal cancer screening 
     tests described in section 1861(oo) of the Social Security 
     Act (42 U.S.C. 1395x(oo)) (as added by paragraph (1) of this 
     section) shall no longer be covered under that section.
       (b) Frequency and Payment Limits.--
       (1) In general.--Section 1834 of the Social Security Act 
     (42 U.S.C. 1395m) is amended by inserting after subsection 
     (c) the following:
       ``(d) Frequency and Payment Limits for Colorectal Cancer 
     Screening Tests.--
       ``(1) Screening fecal-occult blood tests.--
       ``(A) Payment limit.--In establishing fee schedules under 
     section 1833(h) with respect to colorectal cancer screening 
     tests consisting of screening fecal-occult blood tests, 
     except as provided by the Secretary under paragraph (5)(A), 
     the payment amount established for tests performed--
       ``(i) in 1998 shall not exceed $5; and
       ``(ii) in a subsequent year, shall not exceed the limit on 
     the payment amount established under this subsection for such 
     tests for the preceding year, adjusted by the applicable 
     adjustment under section 1833(h) for tests performed in such 
     year.
       ``(B) Frequency limit.--Subject to revision by the 
     Secretary under paragraph (5)(B), no payment may be made 
     under this part for colorectal cancer screening test 
     consisting of a screening fecal-occult blood test--
       ``(i) if the individual is under 50 years of age; or
       ``(ii) if the test is performed within the 11 months after 
     a previous screening fecal-occult blood test.
       ``(2) Screening for individuals not at high risk.--Subject 
     to revision by the Secretary under paragraph (5)(B), no 
     payment may be made under this part for a colorectal cancer 
     screening test consisting of a screening flexible 
     sigmoidoscopy or screening barium enema--
       ``(i) if the individual is under 50 years of age; or
       ``(ii) if the procedure is performed within the 47 months 
     after a previous screening flexible sigmoidoscopy or 
     screening barium enema.
       ``(3) Screening for individuals at high risk for colorectal 
     cancer.--Subject to revision by the Secretary under paragraph 
     (5)(B), no payment may be made under this part for a 
     colorectal cancer screening test consisting of a screening 
     colonoscopy or screening barium enema for individuals at high 
     risk for colorectal cancer if the procedure is performed 
     within the 23 months after a previous screening colonoscopy 
     or screening barium enema.
       ``(4) Payment amounts for certain colorectal cancer 
     screening tests.--The Secretary shall establish payment 
     amounts under section 1848 with respect each colorectal 
     cancer screening tests described in subparagraphs (B), (C), 
     and (D) of section 1861(oo)(1) that are consistent with 
     payment amounts under such section for similar or related 
     services, except that such payment amount shall be 
     established without regard to section 1848(a)(2)(A).
       ``(5) Reductions in payment limit and revision of 
     frequency.--
       ``(A) Reductions in payment limit for screening fecal-
     occult blood tests.--The Secretary shall review from time to 
     time the appropriateness of the amount of the payment limit 
     established for screening fecal-occult blood tests under 
     paragraph (1)(A). The Secretary may, with respect to tests 
     performed in a year after 2000, reduce the amount of such 
     limit as it applies nationally or in any area to the amount 
     that the Secretary estimates is required to assure that such 
     tests of an appropriate quality are readily and conveniently 
     available during the year.
       ``(B) Revision of frequency.--
       ``(i) Review.--The Secretary shall review periodically the 
     appropriate frequency for performing colorectal cancer 
     screening tests based on age and such other factors as the 
     Secretary believes to be pertinent.
       ``(ii) Revision of frequency.--The Secretary, taking into 
     consideration the review made under clause (i), may revise 
     from time to time the frequency with which such tests may be 
     paid for under this subsection, but no such revision shall 
     apply to tests performed before January 1, 2001.
       ``(6) Limiting charges of nonparticipating physicians.--
       ``(A) In general.--In the case of a colorectal cancer 
     screening test consisting of a screening flexible 
     sigmoidoscopy or screening barium enema, or a screening 
     colonoscopy or screening barium enema provided to an 
     individual at high risk for colorectal cancer for which 
     payment may be made under this part, if a nonparticipating 
     physician provides the procedure to an individual enrolled 
     under this part, the physician may not charge the individual 
     more than the limiting charge (as defined in section 
     1848(g)(2)).
       ``(B) Enforcement.--If a physician or supplier knowingly 
     and willfully imposes a charge in violation of subparagraph 
     (A), the Secretary may apply sanctions against such physician 
     or supplier in accordance with section 1842(j)(2).''.
       (c) Conforming Amendments.--
       (1) Paragraphs (1)(D) and (2)(D) of section 1833(a) of the 
     Social Security Act (42 U.S.C. 1395l(a)) are each amended by 
     inserting ``or section 1834(d)(1)'' after ``subsection 
     (h)(1)''.
       (2) Section 1833(h)(1)(A) of the Social Security Act (42 
     U.S.C. 1395l(h)(1)(A)) is amended by striking ``The 
     Secretary'' and inserting ``Subject to paragraphs (1) and 
     (5)(A) of section 1834(d), the Secretary''.
       (3) Clauses (i) and (ii) of section 1848(a)(2)(A) of the 
     Social Security Act (42 U.S.C. 1395w-4(a)(2)(A)) are each 
     amended by inserting after ``a service'' the following: 
     ``(other than a colorectal cancer screening test consisting 
     of a screening colonoscopy or screening barium enema provided 
     to an individual at high risk for colorectal cancer or a 
     screening flexible sigmoidoscopy or screening barium 
     enema)''.
       (4) Section 1862(a) of the Social Security Act (42 U.S.C. 
     1395y(a)) is amended--
       (A) in paragraph (1)--

[[Page S3914]]

       (i) in subparagraph (E), by striking ``and'' at the end;
       (ii) in subparagraph (F), by striking the semicolon at the 
     end and inserting ``, and''; and
       (iii) by adding at the end the following:
       ``(G) in the case of colorectal cancer screening tests, 
     which are performed more frequently than is covered under 
     section 1834(d);''; and
       (B) in paragraph (7), by striking ``paragraph (1)(B) or 
     under paragraph (1)(F)'' and inserting ``subparagraph (B), 
     (F), or (G) of paragraph (1)''.

     SEC. 3. EFFECTIVE DATE.

       The amendments made by section 2 shall apply to items and 
     services furnished on or after January 1, 1998.

                          ____________________