,,ii #aacth ,,congress #ast ,session ,s4 #fjh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ai1 #bjac ,mr4 ,cardin introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,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 coverage1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,supporting ,colorectal ,examination and ,education ,now ,act of #bjac or the ,,screen ,act of #bjac4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,findings4 ,sec4 #c4 ,temporary increase in payment rate for certain cancer screening tests4 ,sec4 #d4 ,waiving ,medicare cost-sharing for colorectal cancer screening with therapeutic effect4 ,sec4 #e4 ,medicare coverage for an office visit or consultation prior to a qualifying screening colonoscopy4 ,sec4 #f4 ,budget neutrality4 ,sec4 #g4 ,expansion of coverage of activities related to recommended preventive health services under private health insurance4 #b4 ,findings ,congress finds the following3 7#a7 ,colon cancer is the third most common cause of cancer-related deaths and the second most common cancer for both men and women4 7#b7 ,according to the ,american ,cancer ,society1 over #ej1jjj people will die this year from colon cancer4 7#c7 ,colorectal cancer is highly treatable with appropriate screening4 ,according to the ,american ,cancer ,society 7#bjaj ,facts ,figures71 the #e-year survival rate is #ij percent for those individuals who are diagnosed at an early stage of the cancer4 ,however1 less than #dj percent of colon cancer cases are diagnosed at an early stage4 7#d7 ,the ,centers for ,disease ,control and ,prevention recently estimated that approximately #b1jjj deaths could be avoided if colonoscopy screening rates rose by just #aj percent4 7#e7 ,colonoscopies allow for simultaneous colorectal cancer screenings and detection and the removal of precancerous polyps1 thus preventing cancer from developing4 7#f7 ,the ,u4,s4 ,preventive ,services ,task ,force provides an ,a rating for colorectal cancer screenings4 7#g7 ,the ,centers for ,disease ,control and ,prevention's colorectal cancer control program has set a target of screening #hj percent of eligible adults in certain ,states by #bjad4 ,the ,american ,cancer ,society and other patient advocacy groups have a target rate of #ge percent4 7#h7 ,only between #eb and #eh percent of ,medicare beneficiaries have had any colorectal cancer screening test1 despite ,medicare coverage for such tests4 7#i7 ,only #di4c percent of ,medicare beneficiaries who are #ej to #hj years old receive colorectal cancer screenings within recommended intervals4 7#aj7 ,the ,centers for ,medicare ,medicaid ,services notes that there is clearly an opportunity to improve colorectal cancer screening rates in the ,medicare population4 7#aa7 ,a ,january #bjaa study by the ,colon ,cancer ,alliance concludes that most ,americans over the age of #ej-- 7,a7 wish a health care provider was able to sit down with them to discuss a colonoscopy before undergoing the test2 and 7,b7 forgo a colonoscopy due to fear of the procedure4 7#ab7 ,in ,february #bjaj1 the ,national ,institutes of ,health hosted a conference on colorectal cancer screening and cited patient awareness and fears as barriers to increasing colorectal cancer screening rates4 7#ac7 ,according to the ,medicare ,payment ,advisory ,commission1 colonoscopy is one of the most common procedures performed in the ambulatory surgical centers 7,a,s,cs7 and the decline in payment rate for the highest volume procedures is especially a strong concern for ,a,s,cs that focus on gastroenterology4 7#ad7 ,an ,institute of ,medicine study on colorectal cancer screening cited the inadequate reimbursement for preventive care services as one of the constraints limiting colorectal cancer screening rates4 7#ae7 ,colorectal cancer screening by colonoscopy has been demonstrated to reduce ,medicare costs over the long term4 #c4 ,temporary increase in payment rate for certain cancer screening tests 7a7 ,in general ,with respect to a qualifying cancer screening test furnished during the #e-year period beginning on ,january #a1 #bjad1 by a qualifying provider1 the amount otherwise payable under section #ahcc or section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel1 #aciew-#d7 to such provider for such test shall be increased by #aj percent4 7b7 ,qualifying cancer screening test 7#a7 ,in general ,for purposes of this section1 subject to paragraph 7#b71 the term qualifying cancer screening test means1 with respect to a ,medicare beneficiary1 a cancer screening test that has in effect with respect to such beneficiary a rating of #8,a' in the current recommendations of the ,united ,states ,preventive ,services ,task ,force4 7#b7 ,termination when high utilization rate reached ,if the ,secretary determines that a cancer screening test described in paragraph 7#a7 has a utilization rate of at least #ge percent of the ,medicare beneficiaries for whom such screening has such a recommendation1 effective as of the first day of the year after the year in which such determination is made1 the cancer screening test shall not be a qualifying cancer screening test4 7c7 ,qualifying provider defined ,for purposes of this section1 the term qualifying provider means1 with respect to a qualifying cancer screening test1 an individual or entity-- 7#a7 that is eligible for payment for such test under section #ahcc or section #ahdh of the ,social ,security ,act2 and 7#b7 that-- 7,a7 participates in a nationally recognized quality improvement registry with respect to such test2 and 7,b7 demonstrates1 to the satisfaction of the ,secretary1 based on the information in such registry1 that the tests were provided by such individual or entity in accordance with accepted outcomes-based quality measures4 #d4 ,waiving ,medicare cost-sharing for colorectal cancer screening with therapeutic effect 7a7 ,in general ,section #ahcc7;a77#a77,y7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77,y77 is amended by inserting 1 including tests and procedures described in the last sentence of subsection 7b71 after section #ahfa7;ddd77#c7 4 7b7 ,effective ,date ,the amendments made by this section shall apply to tests and procedures performed on or after ,january #a1 #bjad4 #e4 ,medicare coverage for an office visit or consultation prior to a qualifying screening colonoscopy 7a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7#a7 in subparagraph 7,,ee71 by striking and at the end2 7#b7 in subparagraph 7,,ff71 by inserting and at the end2 and 7#c7 by adding at the end the following new subparagraph3 7,,gg7 prior to a colorectal cancer screening test consisting of a screening colonoscopy or in conjunction with an individual's decision regarding the performance of such a test on the individual1 an outpatient office visit or consultation for the purpose of beneficiary education1 assuring selection of the proper screening test1 and securing information relating to the procedure and the sedation of the individual2 4 7b7 ,payment 7#a7 ,in general ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and before 7,z72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,aa7 with respect to an outpatient office visit or consultation under section #ahfa7s77#b77;,,gg71 the amounts paid shall be #hj percent of the lesser of the actual charge or the amount established under section #ahdh4 7#b7 ,payment under physician fee schedule ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is amended by inserting 7#b77;,,gg71 after 7#b77;,,ff7 7including administration of the health risk assessment714 7#c7 ,requirement for establishment of payment amount under physician fee schedule ,section #ahcd7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7d77 is amended by adding at the end the following new paragraph3 7#d7 ,payment for outpatient office visit or consultation prior to screening colonoscopy ,with respect to an outpatient office visit or consultation under section #ahfa7s77#b77;,,gg71 payment under section #ahdh shall be consistent with the payment amounts for ,,cpt codes #iibja1 #iibjb1 #iibjc1 #iibjd1 #iibaa1 #iibab1 #iibac1 #iibad1 and #iibae 7as in effect as of the date of the enactment of this paragraph or any successors to such codes74 4 7c7 ,effective ,date ,the amendments made by this section shall apply to items and services furnished on or after ,january #a1 #bjad4 #f4 ,budget neutrality 7a7 ,adjustment of physician fee schedule conversion factor ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall reduce the conversion factor established under subsection 7d7 of section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 for each year 7beginning with #bjad7 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 7c77#e7 attributable to such section for the year4 7b7 ,adjustment of ,,hopd conversion factor ,the ,secretary shall reduce the conversion factor established under paragraph 7#c77;,c7 of section #ahcc7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77 for each year 7beginning with #bjad7 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 7c77#e7 attributable to such section for the year4 7c7 ,determinations relating to expenditures ,for purposes of this section1 before the beginning of each year 7beginning with #bjad7 at the time conversion factors described in subsections 7a7 and 7b7 are established for the year1 the ,secretary shall determine-- 7#a7 the amount of the gross additional expenditures under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 estimated to result from the implementation of sections #c1 #d1 and #e for items and services furnished during the year2 7#b7 the amount of any offsetting reductions in expenditures under such title 7such as reductions in payments for inpatient hospital services7 for such year attributable to the implementation of such sections2 7#c7 the amount 7if any7 by which the amount of the gross additional expenditures determined under paragraph 7#a7 for the year exceeds the amount of offsetting reductions determined under paragraph 7#b7 for the year2 7#d7 of the gross additional expenditures determined under paragraph 7#a7 for the year that are attributable to expenditures under sections #ahdh and #ahcc7t7 of such ,act1 the ratio of such expenditures that are attributable to each respective section2 and 7#e7 with respect to section #ahdh and section #ahcc7t7 of such ,act1 a net offset amount for the year equal to the product of-- 7,a7 the amount of the net additional expenditures for the year determined under paragraph 7#c72 and 7,b7 the ratio determined under paragraph 7#d7 attributable to the respective section4 #g4 ,expansion of coverage of activities related to recommended preventive health services under private health insurance 7a7 ,in general ,section #bgac7;a77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ac7;a77#a77 is amended by inserting 7including related activities occurring as part of the same clinical encounter1 such as conducting a biopsy or by removing a lesion or growth7 after ,task ,force4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to plan years beginning on or after ,january #a1 #bjad4