[Congressional Record Volume 161, Number 60 (Thursday, April 23, 2015)]
[Senate]
[Pages S2403-S2405]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARDIN:
  S. 1079. 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; 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 colorectal cancer screenings in an effort to help 
prevent colorectal cancer and save lives.
  Colorectal cancer affects far too many Americans. The American Cancer 
Society, ACS, estimates that 1 in 18 Americans will be diagnosed with 
colorectal cancer in 2015, totaling an estimated 133,000 new cases. 
Colorectal cancer is expected to take the lives of nearly 50,000 
Americans in 2015, making it the second leading cause of cancer deaths 
in this country.
  Fortunately, colorectal cancer is also highly preventable, and 
colorectal cancer screening tests rank among the most effective 
preventive screenings available. Colonoscopy screenings are different 
from other types of preventive or screening services because pre-
cancerous polyps found during a screening can be removed during the 
same visit, before they progress to colorectal cancer. Early detection 
and intervention are key to preventing colon cancer. A 2012 study in 
the New England Journal of Medicine found that removal of precancerous 
polyps during a screening colonoscopy may prevent up to 53 percent of 
colorectal cancer deaths.
  The need to address barriers to colorectal cancer screening, 
particularly in the Medicare population, is clear. The Medicare 
population makes up approximately two-thirds of all new cases of 
colorectal cancer. However, according to the Centers for Medicare & 
Medicaid Service, CMS, only about half of Medicare beneficiaries have 
had a colorectal cancer screening test, and less than two-thirds of 
Medicare-aged adults are up to date with recommended screenings. The 
Centers for Disease Control and Prevention, CDC, American Cancer 
Society, ACS, American College of Gastroenterology, ACG, and more than 
200 national, State and local organizations have committed to work 
toward eliminating colorectal cancer through a national goal of 
screening 80 percent of eligible adults in the United States for 
colorectal cancer by 2018.
  Currently, Medicare waives cost-sharing for colorectal cancer 
screenings recommended by the U.S. Preventive Services Task Force, 
USPSTF, including screening colonoscopies. However, if the doctor finds 
and removes a pre-cancerous polyp during a screening colonoscopy, the 
procedure is no longer considered a ``screening'' by Medicare, and the 
beneficiary is required to pay the Medicare coinsurance. Because it is 
impossible to know in advance whether polyps will be found and removed 
during a screening colonoscopy, Medicare beneficiaries do not know 
whether the procedure will be fully covered until it is over. In 
February 2013, the administration announced that private insurers 
participating in State-based health insurance exchanges are required to 
waive all cost-sharing for screening colonoscopies during which a polyp 
is removed. Similarly, the SCREEN Act would waive Medicare's cost-
sharing requirement for screening colonoscopies during which polyps are 
removed in order to prevent the development of colorectal cancer. In 
addition, the SCREEN Act would waive cost-sharing for follow-up 
colonoscopies necessary to complete the ``screening continuum'' 
following a positive finding from another recommended colorectal cancer 
screening test.
  The SCREEN Act also seeks to improve coordination of care and promote 
other important age-based recommended screenings for Medicare 
beneficiaries, such as Hepatitis C virus, HCV, screening, by creating a 
demonstration project. The demonstration project would allow 
reimbursement for an office visit or consultation so that a Medicare 
beneficiary may sit down and discuss the screening with a doctor prior 
to the colonoscopy procedure. According to the National Institutes of 
Health, ``fear of the procedure itself'' is a barrier to increasing 
colorectal cancer screening utilization rates. This pre-procedure visit 
would allow providers to allay patient anxiety about the procedure, 
address any questions related to the colonoscopy, assess the patient's 
family history and risk factors for developing colorectal cancer, and 
educate the patient about the importance of following the pre-procedure 
instructions. In addition, this visit would provide an opportunity to 
educate Medicare beneficiaries about the importance of HCV screening. 
The CDC and the United States Preventive Services Task Force recommend 
a one-time HCV screening for all individuals born between 1945 and 
1965, and a recent study suggests offering the HCV screening in 
connection with colonoscopies may be an effective means of increasing 
HCV screening rates.
  Finally, the SCREEN Act would provide incentives for Medicare 
providers to participate in nationally recognized quality improvement 
registries to ensure that Medicare beneficiaries are receiving the 
quality screening they deserve.
  I urge my colleagues to join me in supporting the SCREEN Act, in 
order to help prevent colorectal cancer and save lives.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1079

       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

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     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

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     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.
                                 ______