[Congressional Record Volume 159, Number 40 (Tuesday, March 19, 2013)]
[Senate]
[Pages S1953-S1954]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARDIN:
  S. 608. 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; to the Committee on Finance.
  Mr. CARDIN. Mr. President, I rise today to introduce the Supporting 
Colorectal Examination and Education Now, SCREEN, Act. This legislation 
promotes access to colon cancer screenings in an effort to help prevent 
colorectal cancer, save lives, and reduce costs for families, the 
Medicare program, and the health care system. I strongly urge my 
colleagues to support this critical piece of legislation.
  Colorectal cancer affects far too many Americans. The rate of colon 
cancer deaths is shocking--taking the lives of over 50,000 people this 
year alone, according to the American Cancer Society.
  Fortunately, colorectal cancer is highly preventable with screening, 
and colon cancer screening tests rank among the most effective 
preventive screenings available. A recent study in the New England 
Journal of Medicine found that removal of precancerous polyps during a 
screening colonoscopy may reduce colon cancer deaths by over 50 
percent. Early detection and intervention are key to preventing colon 
cancer. Colonoscopy screenings are different from other types of 
preventive or screening services because pre-cancerous polyps found 
during a screening are removed during the same visit, thus preventing a 
potential cancer from developing and helping to ensure detection, 
intervention, and prevention.
  Congress recognized the value of colon cancer screenings and, through 
bipartisan legislation that I authored in 1998, established a Medicate 
benefit for screening. The problem is that only half of individuals 
coveted by the Medicare program receive a screening colonoscopy, even 
though a Medicate

[[Page S1954]]

colorectal cancer screening benefit is available. According to the 
Centers for Medicare & Medicaid Services, CMS, Medicare claims show 
that only 52 percent of beneficiaries have had a colorectal cancer 
screening test. Many barriers account for this, including patient 
education on screenings and operational issues within the Medicare 
program, but colorectal cancer has become too widespread and we have 
reached the time to take action to promote prevention and save lives. 
Ensuring that individuals receive colorectal cancer screening tests is 
critical to this goal.
  In addition, detection and intervention through proper colonoscopy 
screening should reduce costs to the Medicare program and health care 
system overall. Once colon cancer develops, the direct costs of 
treating colon cancer are starting--reaching $4 billion in 2010. A 
recent study published in the New England Journal of Medicine concluded 
that colorectal cancer screening has been shown to reduce Medicare 
long-term costs.
  Congress must help promote access to colorectal cancer screenings and 
help increase the number of persons receiving these life-saving 
screening tests. The SCREEN Act takes many steps to increase the rate 
of colorectal cancer screenings and help prevent colon cancer, while 
also reducing Medicare costs.
  The SCREEN Act first waives cost sharing for Medicare beneficiaries 
receiving colorectal cancer screenings where precancerous polyps are 
removed during the visit. Currently, Medicare waives cost-sharing for 
any colorectal cancer screening recommended by the U.S. Preventive 
Services Task Force, USPSTF. Colorectal cancer screens have a grade 
``A'' recommendation by USPSTF. However, if the doctor finds and 
removes a precancerous polyp during the visit, the procedure is no 
longer considered a ``screening'' for Medicare purposes--and the 
beneficiary would be forced to pay the Medicare coinsurance. In 
February 2013, the Administration announced that private insurers 
participating in State-based health insurance exchanges must waive all 
cost sharing for colon cancers screenings where a polyp is removed. 
This bill promotes a similar policy by waiving Medicare cost sharing 
for diagnostic and screening colorectal cancer tests.
  Additionally, the SCREEN Act extends Medicare coverage to include an 
office visit or consultation so that a Medicare beneficiary may sit 
down and discuss the screening with a doctor prior to the colonoscopy 
procedures. One of the major barriers to increasing colorectal cancer 
screening rates is a patient's lack of knowledge and the ``fear of the 
procedure.'' This pre-procedure visit is not only good clinical 
practice but also would help increase patient utilization of colorectal 
cancer screening. This visit allows the individual to ask questions 
about the procedure, assures selection of the proper screening test, 
and increases beneficiary education and test preparation. There is no 
reason for a Medicare beneficiary to be seeing his or her physician for 
the first time only just before being sedated for the procedure.
  The SCREEN Act also provides incentives for Medicare providers to 
participate in nationally recognized quality improvement registries so 
that our Medicare beneficiaries are receiving the quality screening 
they deserve. Congress and other organizations can look to the SCREEN 
Act as a model for Medicare reimbursement reform as the bill reimburses 
providers in a budget neutral manner based on the quality of the 
procedure and not volume of services.
  Promoting access to colorectal cancer screening will help ensure 
detection and intervention of this highly preventable disease and 
reduce costs to the health care system. I ask my colleagues to join in 
support of this fight to end colorectal cancer by cosponsoring this 
important legislation.
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