[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
[[Page S2404]]
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
[[Page S2405]]
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.
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