[Congressional Record Volume 166, Number 208 (Wednesday, December 9, 2020)]
[House]
[Pages H7083-H7086]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      REMOVING BARRIERS TO COLORECTAL CANCER SCREENING ACT OF 2020

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 1570) to amend title XVIII of the Social Security Act to 
waive coinsurance under Medicare for colorectal cancer screening tests, 
regardless of whether therapeutic intervention is required during the 
screening, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 1570

       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 ``Removing Barriers to 
     Colorectal Cancer Screening Act of 2020''.

     SEC. 2. WAIVING MEDICARE COINSURANCE FOR CERTAIN COLORECTAL 
                   CANCER SCREENING TESTS.

       (a) In General.--Section 1833(a) of the Social Security Act 
     (42 U.S.C. 1395l(a)) is amended--
       (1) in the second sentence, by striking ``section 1834(0)'' 
     and inserting ``section 1834(o)'';
       (2) by moving such second sentence 2 ems to the left; and
       (3) by inserting the following third sentence following 
     such second sentence: ``For services furnished on or after 
     January 1, 2022, paragraph (1)(Y) shall apply with respect to 
     a colorectal cancer screening test regardless of the code 
     that is billed for the establishment of a diagnosis as a 
     result of the test, or for the removal of tissue or other 
     matter or other procedure that is furnished in connection 
     with, as a result of, and in the same clinical encounter as 
     the screening test.''.
       (b) Special Coinsurance Rule for Certain Tests.--Section 
     1833 of the Social Security Act (42 U.S.C. 1395l) is 
     amended--
       (1) in subsection (a)(1)(Y), by inserting ``subject to 
     subsection (dd),'' before ``with respect to''; and
       (2) by adding at the end the following new subsection:
       ``(dd) Special Coinsurance Rule for Certain Colorectal 
     Cancer Screening Tests.--
       ``(1) In general.--In the case of a colorectal cancer 
     screening test to which paragraph (1)(Y) of subsection (a) 
     would not apply but for the third sentence of such subsection 
     that is furnished during a year beginning on or after January 
     1, 2022, and before January 1, 2030, the amount paid shall be 
     equal to the specified percent (as defined in paragraph (2)) 
     for such year of the lesser of the actual charge for the 
     service or the amount determined under the fee schedule that 
     applies to such test under this part (or, in the case such 
     test is a covered OPD service (as defined in subsection 
     (t)(1)(B)), the amount determined under subsection (t)).
       ``(2) Specified percent defined.--For purposes of paragraph 
     (1), the term `specified percent' means--
       ``(A) for 2022 and 2023, 80 percent;
       ``(B) for 2024 and 2025, 85 percent;
       ``(C) for 2026 and 2027, 90 percent; and
       ``(D) for 2028 and 2029, 95 percent.''.
       (c) Conforming Amendments.--Paragraphs (2) and (3) of 
     section 1834(d) of the Social Security Act (42 U.S.C. 
     1395m(d)) are each amended--
       (1) in subparagraph (C)(ii), in the matter preceding 
     subclause (I), by striking ``Notwithstanding'' and inserting 
     ``Subject to section 1833(a)(1)(Y), but notwithstanding''; 
     and
       (2) in subparagraph (D), by striking ``If during'' and 
     inserting ``Subject to section 1833(a)(1)(Y), if during''.

     SEC. 3. REQUIRING CERTAIN MANUFACTURERS TO REPORT DRUG 
                   PRICING INFORMATION WITH RESPECT TO DRUGS UNDER 
                   THE MEDICARE PROGRAM.

       (a) In General.--Section 1847A of the Social Security Act 
     (42 U.S.C. 1395w-3a) is amended--
       (1) in subsection (b)--
       (A) in paragraph (2)(A), by inserting ``or subsection 
     (f)(2), as applicable'' before the period at the end;
       (B) in paragraph (3), in the matter preceding subparagraph 
     (A), by inserting ``or subsection (f)(2), as applicable,'' 
     before ``determined by''; and
       (C) in paragraph (6)(A), in the matter preceding clause 
     (i), by inserting ``or subsection (f)(2), as applicable,'' 
     before ``determined by''; and
       (2) in subsection (f)--
       (A) by striking ``For requirements'' and inserting the 
     following:
       ``(1) In general.--For requirements''; and
       (B) by adding at the end the following new paragraph:
       ``(2) Manufacturers without a rebate agreement under title 
     xix.--
       ``(A) In general.--If the manufacturer of a drug or 
     biological described in subparagraph (C), (E), or (G) of 
     section 1842(o)(1) or in section 1881(b)(14)(B) that is 
     payable under this part has not entered into and does not 
     have in effect a rebate agreement described in subsection (b) 
     of section 1927, for calendar quarters beginning with the 
     second calendar quarter beginning on or after the date of the 
     enactment of this paragraph, such manufacturer shall report 
     to the Secretary the information described in subsection 
     (b)(3)(A)(iii) of such section 1927 with respect to such drug 
     or biological in a time and manner specified by the 
     Secretary. For purposes of applying this paragraph, a drug or 
     biological described in the previous sentence includes items, 
     services, supplies, and products that are payable under this 
     part as a drug or biological.
       ``(B) Audit.--Information reported under subparagraph (A) 
     is subject to audit by the Inspector General of the 
     Department of Health and Human Services.
       ``(C) Verification.--The Secretary may survey wholesalers 
     and manufacturers that directly distribute drugs described in 
     subparagraph (A), when necessary, to verify manufacturer 
     prices and manufacturer's average sales prices (including 
     wholesale acquisition cost) if required to make payment 
     reported under subparagraph (A). The Secretary may impose a 
     civil monetary penalty in an amount not to exceed $100,000 on 
     a wholesaler, manufacturer, or direct seller, if the 
     wholesaler, manufacturer, or direct seller of such a drug 
     refuses a request for information about charges or prices by 
     the Secretary in connection with a survey under this 
     subparagraph or knowingly provides false information. The 
     provisions of section 1128A (other than subsections (a) (with 
     respect to amounts of penalties or additional assessments) 
     and (b)) shall apply to a civil money penalty under this 
     subparagraph in the same manner as such provisions apply to a 
     penalty or proceeding under section 1128A(a).
       ``(D) Confidentiality.--Notwithstanding any other provision 
     of law, information disclosed by manufacturers or wholesalers 
     under this paragraph (other than the wholesale acquisition 
     cost for purposes of carrying out this section) is 
     confidential and shall not be disclosed by the Secretary in a 
     form which discloses the identity of a specific manufacturer 
     or wholesaler or prices charged for drugs by such 
     manufacturer or wholesaler, except--
       ``(i) as the Secretary determines to be necessary to carry 
     out this section (including the determination and 
     implementation of the payment amount), or to carry out 
     section 1847B;
       ``(ii) to permit the Comptroller General of the United 
     States to review the information provided; and
       ``(iii) to permit the Director of the Congressional Budget 
     Office to review the information provided.''.
       (b) Enforcement.--Section 1847A of such Act (42 U.S.C. 
     1395w-3a) is further amended--
       (1) in subsection (d)(4)--
       (A) in subparagraph (A), by striking ``In general'' and 
     inserting ``Misrepresentation'';
       (B) in subparagraph (B), by striking ``subparagraph (B)'' 
     and inserting ``subparagraph (A), (B), or (C)'';
       (C) by redesignating subparagraph (B) as subparagraph (D); 
     and
       (D) by inserting after subparagraph (A) the following new 
     subparagraphs:
       ``(B) Failure to provide timely information.--If the 
     Secretary determines that a manufacturer described in 
     subsection (f)(2) has failed to report on information 
     described in section 1927(b)(3)(A)(iii) with respect to a 
     drug or biological in accordance with such subsection, the 
     Secretary shall apply a civil money penalty in an amount of 
     $10,000 for each day the manufacturer has failed to report 
     such information and such amount shall be paid to the 
     Treasury.
       ``(C) False information.--Any manufacturer required to 
     submit information under subsection (f)(2) that knowingly 
     provides false information is subject to a civil money 
     penalty in an amount not to exceed $100,000 for each item of 
     false information. Such civil money penalties are in addition 
     to other penalties as may be prescribed by law.''; and
       (2) in subsection (c)(6)(A), by striking the period at the 
     end and inserting ``, except that, for purposes of subsection 
     (f)(2), the Secretary may, if the Secretary determines 
     appropriate, exclude repackagers of a drug or biological from 
     such term.''.
       (c) Manufacturers With a Rebate Agreement.--
       (1) In general.--Section 1927(b)(3)(A) of the Social 
     Security Act (42 U.S.C. 1396r-8(b)(3)(A)) is amended by 
     adding at the end the following new sentence: ``For purposes 
     of applying clause (iii), a drug or biological described in 
     the flush matter following such clause includes items, 
     services, supplies, and products that are payable under this 
     part as a drug or biological.''.
       (2) Technical amendment.--Section 1927(b)(3)(A)(iii) of the 
     Social Security Act (42 U.S.C. 1396r-8(b)(3)(A)(iii)) is 
     amended by striking ``section 1881(b)(13)(A)(ii)'' and 
     inserting ``section 1881(b)(14)(B)''.

[[Page H7084]]

       (d) Report.--Not later than January 1, 2023, the Inspector 
     General of the Department of Health and Human Services shall 
     assess and submit to Congress a report on the accuracy of 
     average sales price information submitted by manufacturers 
     under section 1847A of the Social Security Act (42 U.S.C. 
     1395w-3a). Such report shall include any recommendations on 
     how to improve the accuracy of such information.

     SEC. 4. DETERMINATION OF BUDGETARY EFFECTS.

       The budgetary effects of this Act, for the purpose of 
     complying with the Statutory Pay-As-You-Go Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this Act, 
     submitted for printing in the Congressional Record by the 
     Chairman of the House Budget Committee, provided that such 
     statement has been submitted prior to the vote on passage.
  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Oregon (Mr. Walden) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on H.R. 1570.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 1570, the Removing Barriers to 
Colorectal Cancer Screening Act of 2020. This bill eliminates out-of-
pocket costs for colorectal cancer screening tests under Medicare, even 
in situations when a polyp is detected and removed.
  Colorectal cancer is the second leading cause of cancer death among 
men and women, combined, in the United States. The American Cancer 
Society predicts that more than 53,000 Americans will die from the 
disease this year. This is clearly a tragedy, especially because these 
deaths are so preventable.
  Approximately 90 percent of all individuals diagnosed with colorectal 
cancer at an early stage are still alive 5 years later. But research 
shows that out-of-pocket costs discourage individuals from seeking out 
preventative screenings that could save their lives.
  Under current law, Medicare waives coinsurance and deductibles for 
colonoscopies. However, when a polyp is discovered and removed during 
the procedure, it is then reclassified as therapeutic for Medicare 
billing purposes, and patients are required to pay the coinsurance.
  This simply is not right. Patients should not be saddled with 
hundreds of dollars in medical bills that they justifiably thought 
would be covered by Medicare as part of a preventative service.
  H.R. 1570 provides a commonsense fix to this oversight. The bill 
would ensure that colonoscopies, whether they are diagnostic or 
therapeutic, are treated equally at the billing stage so all cost-
sharing is waived under Medicare. By removing the financial burden 
associated with this procedure, Medicare beneficiaries may seek 
preventative care for colorectal cancer without the added deterrence of 
surprise bills.
  In addition, H.R. 1570 incorporates a policy that requires all part B 
drug manufacturers to report average sales price data to the Medicare 
program and provides the Secretary with new authority to verify this 
data.
  Under current law, only manufacturers with Medicare drug rebate 
agreements are required to report average sales price data, and in the 
absence of such data, the Medicare program ends up paying more. This 
legislation ensures that the government is paying the right price for 
part B drugs, saving taxpayers billions and allowing greater 
transparency around drug pricing.
  Mr. Speaker, I want to thank the bill's sponsors.
  First of all, I want to thank Representative   Donald Payne from my 
State. He has been working on this bill for so many years, and, of 
course, it came out of the passing of his dad from colorectal cancer. I 
remember his dad so fondly.
  Mr. Speaker, I also want to thank Representatives Davis, McEachin, 
and McKinley for their hard work on this important piece of 
legislation.
  I want to thank Representative Doggett for his work on the important 
drug pricing policy that is included today.
  Mr. Speaker, I urge my colleagues to support H.R. 1570, and I reserve 
the balance of my time.
                                         House of Representatives,


                                  Committee on Ways and Means,

                                 Washington, DC, December 7, 2020.
     Hon. Frank Pallone,
     Chairman, Committee on Energy and Commerce,
     Washington, DC.
       Dear Chairman Pallone: In recognition of the desire to 
     expedite consideration of H.R. 1570, Removing Barriers to 
     Colorectal Cancer Screening Act of 2019, the Committee on 
     Ways and Means agrees to waive formal consideration of the 
     bill as to provisions that fall within the rule X 
     jurisdiction of the Committee on Ways and Means.
       The Committee on Ways and Means takes this action with the 
     mutual understanding that we do not waive any jurisdiction 
     over the subject matter contained in this or similar 
     legislation, and the Committee will be appropriately 
     consulted and involved as the resolution or similar 
     legislation moves forward so that we may address any 
     remaining issues within our jurisdiction. The Committee also 
     reserves the right to seek appointment of an appropriate 
     number of conferees to any House-Senate conference involving 
     this or similar legislation.
       Finally, I would appreciate your response to this letter 
     confirming this understanding and would ask that a copy of 
     our exchange of letter on this matter be included in the 
     Congressional Record during floor consideration of H.R. 1570.
           Sincerely,
                                                  Richard E. Neal,
     Chairman.
                                  ____

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                 Washington, DC, December 8, 2020.
     Hon. Richard Neal,
     Chairman, Committee on Ways and Means,
     Washington, DC.
       Dear Chairman Neal: Thank you for consulting with the 
     Committee on Energy and Commerce and agreeing to discharge 
     H.R. 1570, the Removing Barriers to Colorectal Cancer 
     Screening Act of 2020, from further consideration, so that 
     the bill may proceed expeditiously to the House floor.
       I agree that your forgoing further action on this measure 
     does not in any way diminish or alter the jurisdiction of 
     your committee or prejudice its jurisdictional prerogatives 
     on this measure or similar legislation in the future. I would 
     support your effort to seek appointment of an appropriate 
     number of conferees from your committee to any House-Senate 
     conference on this legislation.
       I will ensure our letters on H.R. 1570 are entered into the 
     Congressional Record during floor consideration of the bill. 
     I appreciate your cooperation regarding this legislation and 
     look forward to continuing to work together as this measure 
     moves through the legislative process.
           Sincerely,
                                                Frank Pallone, Jr.
                                                         Chairman.

                              {time}  1445

  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 1570, the Removing Barriers to 
Colorectal Cancer Screening Act of 2020.
  This is really important legislation, as you have heard, and it has 
received strong bipartisan support from literally hundreds of our 
colleagues, including myself. It was a key provision of a bill I 
actually introduced last year, H.R. 19, the Lower Costs, More Cures Act 
of 2019, which had a lot of bipartisan solutions to lower drug prices 
without hindering the development of new therapeutics or cures.
  So I am happy to see the House take this action on this critical 
component of that other legislation.
  This bill would address an oversight in Medicare that requires 
beneficiaries to cover the cost of an unexpected polyp removal when 
provided a free screening colonoscopy.
  These surprise medical bills, as I would call them, create financial 
barriers for patient access to these lifesaving screenings, which can 
save thousands of lives a year.
  In the United States, colorectal cancer is the second leading cause 
of cancer-related deaths, Mr. Speaker. Screenings are the most 
effective way to detect and treat this devastating disease early on, 
and efforts must be made to ensure individuals have access to these 
important services.
  By removing these financial barriers for patients, this bill would 
enhance screening efforts and ultimately save lives. The bill is offset 
with another policy from H.R. 19 that would require pharmaceutical 
companies to report their average sales price, ASP.
  Right now, certain companies are exploiting a little loophole in the 
current law where they are not reporting their

[[Page H7085]]

ASP and drawing down higher reimbursement rates from Medicare as a 
result. This creates an unfair advantage with competitors who are doing 
the right thing, as the statute intended, and reporting their data.
  I am glad this package includes these two provisions of H.R. 19, 
further adding to the number of provisions from this bill that I hope 
are enacted into law during the remainder of this Congress.
  While I urge support of this bill that would end surprise billing for 
this select group of Americans, I am disappointed Congress has yet to 
pass a bill that would end surprise billing for all Americans. Mr. 
Pallone and I have worked closely on this legislation. We have a 
bipartisan bill. It is ready to go, and we could pass it into law 
before the end of the year and put an end to surprise billing for all 
Americans, not just those with an unexpected polyp removal.
  I urge Congress to take further swift action to do what the American 
people want us to do. Let's end surprise billing once and for all for 
everyone.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield such time as he may consume to the 
gentleman from New Jersey (Mr. Payne), the sponsor of this bill, who 
has worked so hard on it.
  Mr. PAYNE. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, I rise today to discuss my bill, the Removing Barriers 
to Colorectal Cancer Screening Act. It has been a long time coming.
  I thank my friend and New Jersey colleague, Congressman Frank 
Pallone, the chairman of the Energy and Commerce Committee. As chairman 
of the House committee, his leadership was critical to getting my bill 
to the floor today.
  I have been working on this bill since my arrival to the United 
States House of Representatives. Unfortunately, colorectal cancer is 
the reason that I am a member of this body.
  In addition, I thank my coleads on the bill, as you heard earlier, 
Congressman Rodney Davis and my colleague from Virginia, Donald 
McEachin, who has been instrumental in moving this bill forward. 
Congressman McEachin has done an incredible amount of work to promote 
the bill and increase awareness of colorectal cancer. I also thank my 
other colead, Congressman   David McKinley from West Virginia, for his 
efforts, as well.
  These great representatives understand the importance of this bill to 
the health and security of millions of Americans and know that 
colorectal cancer is bipartisan in nature of its negative impact on 
people in this country.
  Colorectal cancer is the second leading cause of cancer deaths in 
America. It only trails lung cancer, and it affects both men and women. 
It is the second leading cause of death in the United States in 
cancers.
  Like many cancers, it is treatable and patients can recover if it is 
caught early enough. But that depends on whether Americans get 
screened. And one of the reasons that we are here today, my bill would 
seek to remove one of the barriers to screenings. It would allow 
Medicare to cover screenings and surgical procedures to remove 
cancerous polyps during the screenings.
  Today, Medicare covers only screenings for eligible patients. If 
doctors find and remove a cancerous polyp during the screening, 
patients could wake up to a surprise bill that could cost thousands of 
dollars.
  After my father succumbed to this dreadful disease, I had my first 
colonoscopy, and at that time they found 13 polyps. So can you imagine 
the bill that I could have potentially awoken to, tens of thousands of 
dollars in bills that I did not even know that I had?
  Too many men refuse to get screened because of the fear of this 
surprise bill and a lot of the reason why men don't find this procedure 
very palatable. Then they wait to get screened until there is a 
problem, and potentially that is a decision that could be fatal.
  I encourage my House colleagues to vote for this bill so we can save 
thousands of American lives annually.
  It has been almost 9 years since I lost my father, Congressman Donald 
Payne, Sr., to colorectal cancer, and I do not want to see other 
families go through the same horror and pain.
  I ask that we pass this bill. I urge my colleagues to vote ``yes'' 
and save the lives of the American people.
  Mr. WALDEN. Mr. Speaker, I yield the balance of my time to the 
gentleman from Texas (Mr. Burgess) and I ask unanimous consent that he 
be allowed to control that time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Oregon?
  There was no objection.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I served with the gentleman's father for 9 years, and I 
certainly understand the pain that was reflected in his voice in those 
remarks.
  This is a commonsense bill. When a practitioner encounters a 
correctable lesion at the time of a screening colonoscopy, the curative 
procedure should be able to be undertaken without the worry of a 
patient waking up to an unintended charge.
  The other thing that crosses my mind as we sit here now, hopefully, 
on the downside of the pandemic is how many people have not proceeded 
with the screening procedure because of concern about going to a 
facility during the time of the coronavirus. And it is incumbent upon 
us as policymakers to ensure that people do understand the importance 
of undertaking these screenings and removing any obstacles that would 
prevent someone from having a potentially lifesaving screening 
procedure done.
  Further, Mr. Speaker, if I could, many people today have reflected on 
the time of service of Mr. Walden, who is retiring at the end of this 
Congress, and we will all miss him a great deal. As I have listened to 
several of the speakers give testimony to Mr. Walden's leadership on 
the committee, I am just reminded of so many times, both good times and 
rough times. We served together on the majority and the minority for a 
number of years on the Committee on Energy and Commerce.
  The country can look to things like the last 10-year reauthorization 
of the State Children's Health Insurance Program and thank Mr. Walden 
for the vision of getting that enacted. Certainly, the SUPPORT Act in 
the last Congress, starting with Member Day in the committee and 
culminating with the signing ceremony in the White House literally 12 
months later.
  These were some of the significant accomplishments of then-Chairman 
Walden, now Ranking Member Walden. He has left a rich legacy in this 
Congress, and we are all very much in his debt, and we will miss him 
terribly in the Congresses to come. I thank the gentleman for his 
indulgence.
  Mr. Speaker, I urge passage of this bill, and I yield back the 
balance of my time.
  Mr. PALLONE. Mr. Speaker, I ask that we support this legislation and 
pass it, and I yield back the balance of my time.
  Ms. ESHOO. Mr. Speaker, I rise in support of H.R. 1570, the Removing 
Barriers to Colorectal Cancer Screening Act. I advanced this bipartisan 
bill through my Health Subcommittee and I'm proud to support it on the 
Floor today.
  This legislation was introduced by Representatives Payne, Davis, 
McEachin, and McKinley to remove financial barriers to life-saving 
colorectal cancer screenings and treatment for Medicare beneficiaries.
  Currently, Medicare covers a colonoscopy without out-of-pocket costs 
for beneficiaries, but if the colonoscopy results in a polyp removal, 
patients are stuck with an unexpected copayment. This small distinction 
could mean hundreds of dollars of out-of-pocket expenses for seniors on 
Medicare who are often living on a fixed income.
  This bill would waive that cost-sharing and give millions of Medicare 
beneficiaries the peace of mind that they can receive the preventive 
care they need without being stuck with unexpected costs.
  I urge my colleagues to support this bill.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 1570, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  The title of the bill was amended so as to read: ``A bill to amend 
title XVIII of the Social Security Act to waive coinsurance under 
Medicare for

[[Page H7086]]

colorectal cancer screening tests, regardless of whether therapeutic 
intervention is required during the screening, and for other 
purposes.''.
  A motion to reconsider was laid on the table.

                          ____________________