[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.
____________________