[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4167 Introduced in House (IH)]
103d CONGRESS
2d Session
H. R. 4167
To amend title XVIII of the Social Security Act to provide for coverage
of colorectal screening under part B of the medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 12, 1994
Mr. Cardin introduced the following bill; which was referred jointly to
the Committees on Ways and Means and Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for coverage
of colorectal screening under part B of 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 Screening and
Prevention Act''.
SEC. 2. MEDICARE COVERAGE OF COLORECTAL SCREENING.
(a) In General.--Section 1834 of the Social Security Act (42 U.S.C.
1395m) is amended by inserting after subsection (c) the following new
subsection:
``(d) Frequency and Payment Limits for Screening Fecal-Occult Blood
Tests, Screening Flexible Sigmoidoscopies, and Screening Colonoscopy.--
``(1) Screening fecal-occult blood tests.--
``(A) Payment limit.--In establishing fee schedules
under section 1833(h) with respect to screening fecal-
occult blood tests provided for the purpose of early
detection of colon cancer, except as provided by the
Secretary under paragraph (3)(A), the payment amount
established for tests performed--
``(i) in 1995 shall not exceed $5; and
``(ii) in a subsequent year, shall not
exceed the limit on the payment amount
established under this subsection for such
tests for the preceding year, adjusted by the
applicable adjustment under section 1833(h) for
tests performed in such year.
``(B) Frequency limit.--Subject to revision by the
Secretary under paragraph (3)(B), no payment may be
made under this part for a screening fecal-occult blood
test provided to an individual for the purpose of early
detection of colon cancer--
``(i) if the individual is under 50 years
of age; or
``(ii) if the test is performed within the
11 months after a previous screening fecal-
occult blood test.
``(2) Screening flexible sigmoid- oscopies.--
``(A) Payment amount.--The Secretary shall
establish a payment amount under section 1848 with
respect to screening flexible sigmoidoscopies provided
for the purpose of early detection of colon cancer that
is consistent with payment amounts under such section
for similar or related services, except that such
payment amount shall be established without regard to
subsection (a)(2)(A) of such section.
``(B) Frequency limit.--Subject to revision by the
Secretary under paragraph (4)(B), no payment may be
made under this part for a screening flexible
sigmoidoscopy provided to an individual for the purpose
of early detection of colon cancer--
``(i) if the individual is under 50 years
of age; or
``(ii) if the procedure is performed within
the 47 months after a previous screening
flexible sigmoidoscopy.
``(3) Screening colonoscopy for individuals at high risk
for colorectal cancer.--
``(A) Payment amount.--The Secretary shall
establish a payment amount under section 1848 with
respect to screening colonoscopy for individuals at
high risk for colorectal cancer (as determined in
accordance with criteria established by the Secretary)
provided for the purpose of early detection of colon
cancer that is consistent with payment amounts under
such section for similar or related services, except
that such payment amount shall be established without
regard to subsection (a)(2)(A) of such section.
``(B) Frequency limit.--Subject to revision by the
Secretary under paragraph (4)(B), no payment may be
made under this part for a screening colonoscopy for
individuals at high risk for colorectal cancer provided
to an individual for the purpose of early detection of
colon cancer if the procedure is performed within the
23 months after a previous screening colonoscopy.
``(C) Factors considered in establishing criteria
for determining individuals at high risk.--In
establishing criteria for determining whether an
individual is at high risk for colorectal cancer for
purposes of this paragraph, the Secretary shall take
into consideration family history, prior experience of
cancer or precursor neoplastic polyps, a history of
chronic digestive disease condition (including
inflammatory bowel disease, Crohn's Disease, or
ulcerative colitis), the presence of any appropriate
recognized gene markers for colorectal cancer, and
other appropriate factors.
``(4) Reductions in payment limit and revision of
frequency.--
``(A) Reductions in payment limit.--The Secretary
shall review from time to time the appropriateness of
the amount of the payment limit established for
screening fecal-occult blood tests under paragraph
(1)(A). The Secretary may, with respect to tests
performed in a year after 1997, reduce the amount of
such limit as it applies nationally or in any area to
the amount that the Secretary estimates is required to
assure that such tests of an appropriate quality are
readily and conveniently available during the year.
``(B) Revision of frequency.--
``(i) Review.--The Secretary shall review
periodically the appropriate frequency for
performing screening fecal-occult blood tests,
screening flexible sigmoidoscopies, and
screening colonoscopy based on age and such
other factors as the Secretary believes to be
pertinent.
``(ii) Revision of frequency.--The
Secretary, taking into consideration the review
made under clause (i), may revise from time to
time the frequency with which such tests and
procedures may be paid for under this
subsection, but no such revision shall apply to
tests or procedures performed before January 1,
1998.
``(5) Limiting charges of nonparticipating physicians.--
``(A) In general.--In the case of a screening
flexible sigmoidoscopy provided to an individual for
the purpose of early detection of colon cancer or a
screening colonoscopy provided to an individual at high
risk for colorectal cancer for the purpose of early
detection of colon cancer for which payment may be made
under this part, if a nonparticipating physician
provides the procedure to an individual enrolled under
this part, the physician may not charge the individual
more than the limiting charge (as defined in section
1848(g)(2)).
``(B) Enforcement.--If a physician or supplier
knowing and willfully imposes a charge in violation of
subparagraph (A), the Secretary may apply sanctions
against such physician or supplier in accordance with
section 1842(j)(2).''.
(b) Conforming Amendments.--(1) Paragraphs (1)(D) and (2)(D) of
section 1833(a) of such Act (42 U.S.C. 1395l(a)) are each amended by
striking ``subsection (h)(1),'' and inserting ``subsection (h)(1) or
section 1834(d)(1),''.
(2) Section 1833(h)(1)(A) of such Act (42 U.S.C. 1395l(h)(1)(A)) is
amended by striking ``The Secretary'' and inserting ``Subject to
paragraphs (1) and (3)(A) of section 1834(d), the Secretary''.
(3) Clauses (i) and (ii) of section 1848(a)(2)(A) of such Act (42
U.S.C. 1395w-4(a)(2)(A)) are each amended by striking ``a service'' and
inserting ``a service (other than a screening flexible sigmoidoscopy
provided to an individual for the purpose of early detection of colon
cancer or a screening colonoscopy provided to an individual at high
risk for colorectal cancer for the purpose of early detection of colon
cancer)''.
(4) Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (E), by striking ``and'' at the
end,
(ii) in subparagraph (F), by striking the semicolon
at the end and inserting ``, and'', and
(iii) by adding at the end the following new
subparagraph:
``(G) in the case of screening fecal-occult blood tests,
screening flexible sigmoidoscopies, and screening colonoscopy
provided for the purpose of early detection of colon cancer,
which are performed more frequently than is covered under
section 1834(d);''; and
(B) in paragraph (7), by striking ``paragraph (1)(B) or
under paragraph (1)(F)'' and inserting ``subparagraphs (B),
(F), or (G) of paragraph (1)''.
SEC. 3. EFFECTIVE DATE.
The amendments made by section 2 shall apply to screening fecal-
occult blood tests, screening flexible sigmoidoscopies, and screening
colonoscopy performed on or after January 1, 1995.
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