110th CONGRESS
1st Session
S. 1164
To amend title XVIII of the Social Security Act to improve patient
access to, and utilization of, the colorectal cancer screening benefit under
the Medicare Program.
IN THE SENATE OF THE UNITED STATES
April 19, 2007
Mr. CARDIN (for himself, Ms. COLLINS, Mr. LIEBERMAN, Mr. GRAHAM, and Mr.
NELSON of Nebraska) introduced the following bill; which was read twice
and referred to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to improve patient
access to, and utilization of, the colorectal cancer screening benefit under
the Medicare Program.
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 `Colon Cancer Screen for Life Act of 2007'.
SEC. 2. SENSE OF CONGRESS.
It is the sense of Congress that--
(1) colorectal cancer screening tests (as defined in section 1861(pp)(1)
of the Social Security Act (42 U.S.C. 1395x(pp)(1)) covered under the
Medicare Program have been severely underutilized, with the Comptroller
General of the United States reporting in 2000 that since coverage of
such tests was implemented, the percentage of beneficiaries under the
Medicare Program receiving either a screening or a diagnostic colonoscopy
has increased by only 1 percent;
(2) in recognition of the need to improve rates of colorectal cancer screening
in the Medicare Program, Congress enacted provisions in the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 to require physicians
to provide a referral for colorectal cancer screening as part of the new
initial preventive physical examination, beginning January 1, 2005;
(3) the Centers for Medicare & Medicaid Services should encourage
health care providers to use more effective screening and diagnostic health
care technologies in the area of colorectal cancer screening;
(4) in recent years, the Centers for Medicare & Medicaid Services
has subjected colorectal cancer screening tests to some of the largest
reimbursement reductions under the Medicare Program;
(5) unlike other preventive screening tests covered under the Medicare
Program, health care providers must consult with beneficiaries prior to
furnishing a screening colonoscopy in order to--
(A) ascertain the medical and family history of the beneficiary; and
(B) inform the beneficiary of preparatory steps that must be taken prior
to the procedure; and
(6) reimbursement under the Medicare Program is not currently available
for the consultations described in paragraph (5) despite the fact that
reimbursement is provided under such program for similar consultations
prior to a diagnostic colonoscopy.
SEC. 3. INCREASE IN PART B REIMBURSEMENT FOR COLORECTAL CANCER SCREENING
AND DIAGNOSTIC TESTS.
(a) In General- Section 1834(d) of the Social Security Act (42 U.S.C. 1395m(d))
is amended by adding at the end the following new paragraph:
`(4) ENHANCED PART B PAYMENT FOR COLORECTAL CANCER SCREENING AND DIAGNOSTIC
TESTS-
`(A) NONFACILITY RATES- Notwithstanding paragraphs (2)(A) and (3)(A),
the Secretary shall establish national minimum payment amounts for CPT
codes 45378, 45380, and 45385, and HCPCS codes G0105 and GO121 for items
and services furnished on or after January 1, 2008, which reflect a
10-percent increase above the relative value units in effect as the
nonfacility rates for such codes on December 31, 2007, with such revised
payment level to apply to items and services performed in a nonfacility
setting.
`(B) FACILITY RATES- Notwithstanding paragraphs (2)(A) and (3)(A), the
Secretary shall establish national minimum payment amounts for CPT codes
45378, 45380, and 45385, and HCPCS codes G0105 and GO121 for items and
services furnished on or after January 1, 2008, which reflect a 30-percent
increase above the relative value units in effect as the facility rates
for such codes on December 31, 2007, with such revised payment level
to apply to items and services performed in a facility setting.
`(C) ANNUAL ADJUSTMENTS- In the case of items and services furnished
on or after January 1, 2008, the payment rates described in subparagraphs
(A) and (B) shall, subject to the minimum payment amounts established
in such subparagraphs, be adjusted annually as provided in section 1848.'.
(b) No Effect on HOPD Payments- The Secretary of Health and Human Services
shall not take into account the provisions of section 1834(d)(4) of the
Social Security Act, as added by subsection (a), in determining the amount
of payment for any covered OPD service under the prospective payment system
for hospital outpatient department services under section 1833(t) of such
Act (42 U.S.C. 1395l(t)).
SEC. 4. MEDICARE COVERAGE OF OFFICE VISIT OR CONSULTATION PRIOR TO A SCREENING
COLONOSCOPY OR IN CONJUNCTION WITH A BENEFICIARY'S DECISION TO OBTAIN SUCH
A SCREENING.
(a) Coverage- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2))
is amended--
(1) in subparagraph (Z), by striking `and' at the end;
(2) in subparagraph (AA), by inserting `and' at the end; and
(3) by adding at the end the following new subparagraph:
`(BB) an outpatient office visit or consultation for the purpose of
beneficiary education, assuring selection of the proper screening test,
and securing information relating to the procedure and sedation of the
beneficiary, prior to a colorectal cancer screening test consisting
of a screening colonoscopy or in conjunction with the beneficiary's
decision to obtain such a screening, regardless of whether such screening
is medically indicated with respect to the beneficiary;'.
(1) IN GENERAL- Section 1833(a)(1) of the Social Security Act (42 U.S.C.
1395l(a)(1)) is amended--
(A) by striking `and' before `(V)'; and
(B) by inserting before the semicolon at the end the following: `, and
(W) with respect to an outpatient office visit or consultation under
section 1861(s)(2)(BB), the amounts paid shall be 80 percent of the
lesser of the actual charge or the amount established under section
1848'.
(2) PAYMENT UNDER PHYSICIAN FEE SCHEDULE- Section 1848(j)(3) of the Social
Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(BB),'
after `(2)(AA),'.
(3) REQUIREMENT FOR ESTABLISHMENT OF PAYMENT AMOUNT UNDER PHYSICIAN FEE
SCHEDULE- Section 1834(d) of the Social Security Act (42 U.S.C. 1395m(d)),
as amended by section 3, is amended by adding at the end the following
new paragraph:
`(5) PAYMENT FOR OUTPATIENT OFFICE VISIT OR CONSULTATION PRIOR TO SCREENING
COLONOSCOPY- With respect to an outpatient office visit or consultation
under section 1861(s)(2)(BB), payment under section 1848 shall be consistent
with the payment amounts for CPT codes 99203 and 99243.'.
(c) Effective Date- The amendments made by this section shall apply to items
and services provided on or after January 1, 2008.
SEC. 5. TECHNICAL AMENDMENT TO WAIVER OF DEDUCTIBLE FOR COLORECTAL CANCER
SCREENING TESTS.
(a) In General- Section 1833(b)(8) of the Social Security Act (42 U.S.C.
1395l(b)(8)), as inserted by section 5113(a) of the Deficit Reduction Act
of 2005 (Public Law 109-171), is amended by inserting `, regardless of the
code applied, a particular diagnosis, or whether a connected procedure is
performed' after `1861(pp)(1))'.
(b) Effective Date- The amendment made by this section shall apply to items
and services furnished on or after January 1, 2008.
END
