,,ii  #aac? ,,congress  #a/ ,session    
,s4 #fjh  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #ai1 #bjac ,mr4   
,c>d9 introduc$ ! foll[+ bill2 :i* 0    
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act &    
title ,,xxvii ( ! ,public ,heal? ,s]vice
 ,act to improve cov]age = colorectal   
scre5+ te/s "u ,m$ic>e & private heal?  
insurance cov]age1 & = o!r purposes4    
#a4 ,%ort title2 table ( cont5ts  7a7   
,%ort title ,?is ,act may be cit$ z !   
,support+ ,colorectal ,exam9ation &     
,education ,n[ ,act ( #bjac or ! ,,scre5
 ,act ( #bjac4  7b7 ,table ( cont5ts ,! 
table ( cont5ts ( ?is ,act is z foll[s3 
,sec4 #a4 ,%ort title2 table ( cont5ts4 
,sec4 #b4 ,f9d+s4 ,sec4 #c4 ,tempor>y   
increase 9 paym5t rate = c]ta9 canc]    
scre5+ te/s4 ,sec4 #d4 ,waiv+ ,m$ic>e   
co/-%>+ = colorectal canc] scre5+ )     
!rapeutic effect4 ,sec4 #e4 ,m$ic>e     
cov]age = an (fice visit or consultation
 prior to a qualify+ scre5+ colonoscopy4

 ,sec4 #f4 ,budget neutrality4 ,sec4 #g4
 ,expansion ( cov]age ( activities      
relat$ to recomm5d$ prev5tive heal?     
s]vices "u private heal? insurance4  #b4
 ,f9d+s ,congress f9ds ! foll[+3  7#a7  
,colon canc] is ! ?ird mo/ common cause 
( canc]-relat$ dea?s & ! second mo/     
common canc] = bo? m5 & wom54  7#b7     
,accord+ to ! ,am]ican ,canc] ,society1 
ov] #ej1jjj p w die ?is ye> f colon     
canc]4  7#c7 ,colorectal canc] is highly
 treatable ) appropriate scre5+4        
,accord+ to ! ,am]ican ,canc] ,society  
7#bjaj ,facts  ,figures71 ! #e-ye>      
survival rate is #ij p]c5t = ^?         
individuals :o are diagnos$ at an e>ly  
/age ( ! canc]4 ,h[ev]1 less ?an #dj    
p]c5t ( colon canc] cases are diagnos$  
at an e>ly /age4  7#d7 ,! ,c5t]s =      
,disease ,control & ,prev5tion rec5tly  
e/imat$ t approximately #b1jjj dea?s    
c\ld be avoid$ if colonoscopy scre5+    
rates rose by j #aj p]c5t4  7#e7        
,colonoscopies all[ = simultane\s       
colorectal canc] scre5+s & detection & !

 removal ( precanc]\s polyps1 ?us       
prev5t+ canc] f develop+4  7#f7 ,!      
,u4,s4 ,prev5tive ,s]vices ,task ,=ce   
provides an ,a rat+ = colorectal canc]  
scre5+s4  7#g7 ,! ,c5t]s = ,disease     
,control & ,prev5tion's colorectal canc]
 control program has set a t>get (      
scre5+ #hj p]c5t ( eligible adults 9    
c]ta9 ,/ates by #bjad4 ,! ,am]ican      
,canc] ,society & o!r pati5t advocacy   
gr\ps h a t>get rate ( #ge p]c5t4  7#h7 
,only betwe5 #eb & #eh p]c5t ( ,m$ic>e  
b5efici>ies h _h any colorectal canc]   
scre5+ te/1 despite ,m$ic>e cov]age =   
su* te/s4  7#i7 ,only #di4c p]c5t (     
,m$ic>e b5efici>ies :o are #ej to #hj   
ye>s old receive colorectal canc]       
scre5+s )9 recomm5d$ int]vals4  7#aj7 ,!
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices    
notes t !re is cle>ly an opportunity to 
improve colorectal canc] scre5+ rates 9 
! ,m$ic>e population4  7#aa7 ,a ,janu>y 
#bjaa /udy by ! ,colon ,canc] ,alliance 
concludes t mo/ ,am]icans ov] ! age (   
#ej--  7,a7 wi% a heal? c>e provid] 0   

able to sit d[n ) !m to discuss a       
colonoscopy be=e und]go+ ! te/2 &  7,b7 
=go a colonoscopy due to fe> ( !        
proc$ure4  7#ab7 ,9 ,febru>y #bjaj1 !   
,national ,in/itutes ( ,heal? ho/$ a    
conf]5ce on colorectal canc] scre5+ &   
cit$ pati5t aw>5ess & fe>s z b>ri]s to  
increas+ colorectal canc] scre5+ rates4 
7#ac7 ,accord+ to ! ,m$ic>e ,paym5t     
,advisory ,commission1 colonoscopy is "o
 ( ! mo/ common proc$ures p]=m$ 9 !     
ambulatory surgical c5t]s 7,a,s,cs7 & ! 
decl9e 9 paym5t rate = ! highe/ volume  
proc$ures is especially a /rong conc]n =
 ,a,s,cs t focus on ga/ro5t]ology4      
7#ad7 ,an ,in/itute ( ,m$ic9e /udy on   
colorectal canc] scre5+ cit$ !          
inadequate reimbursem5t = prev5tive c>e 
s]vices z "o ( ! con/ra9ts limit+       
colorectal canc] scre5+ rates4  7#ae7   
,colorectal canc] scre5+ by colonoscopy 
has be5 demon/rat$ to r$uce ,m$ic>e co/s
 ov] ! long t]m4  #c4 ,tempor>y increase
 9 paym5t rate = c]ta9 canc] scre5+ te/s
  7a7 ,9 g5]al ,) respect to a qualify+ 

canc] scre5+ te/ furni%$ dur+ ! #e-ye>  
p]iod beg9n+ on ,janu>y #a1 #bjad1 by a 
qualify+ provid]1 ! am\nt o!rwise       
payable "u section #ahcc or section     
#ahdh ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciel1 #aciew-#d7 to su*     
provid] = su* te/ %all be increas$ by   
#aj p]c5t4  7b7 ,qualify+ canc] scre5+  
te/  7#a7 ,9 g5]al ,= purposes ( ?is    
section1 subject to p>agraph 7#b71 ! t]m
 qualify+ canc] scre5+ te/ means1 )     
respect to a ,m$ic>e b5efici>y1 a canc] 
scre5+ te/ t has 9 effect ) respect to  
su* b5efici>y a rat+ ( #8,a' 9 ! curr5t 
recomm5dations ( ! ,unit$ ,/ates        
,prev5tive ,s]vices ,task ,=ce4  7#b7   
,t]m9ation :5 high utilization rate     
rea*$ ,if ! ,secret>y det]m9es t a canc]
 scre5+ te/ describ$ 9 p>agraph 7#a7 has
 a utilization rate ( at lea/ #ge p]c5t 
( ! ,m$ic>e b5efici>ies = :om su* scre5+
 has su* a recomm5dation1 effective z ( 
! fir/ day ( ! ye> aft] ! ye> 9 :i* su* 
det]m9ation is made1 ! canc] scre5+ te/ 
%all n be a qualify+ canc] scre5+ te/4  

7c7 ,qualify+ provid] def9$ ,= purposes 
( ?is section1 ! t]m qualify+ provid]   
means1 ) respect to a qualify+ canc]    
scre5+ te/1 an individual or entity--   
7#a7 t is eligible = paym5t = su* te/ "u
 section #ahcc or section #ahdh ( !     
,social ,security ,act2 &  7#b7 t--     
7,a7 p>ticipates 9 a nationally         
recogniz$ quality improvem5t regi/ry )  
respect to su* te/2 &  7,b7 demon/rates1
 to ! satisfaction ( ! ,secret>y1 bas$  
on ! in=mation 9 su* regi/ry1 t ! te/s 7
 provid$ by su* individual or entity 9  
accordance ) accept$ outcomes-bas$      
quality measures4  #d4 ,waiv+ ,m$ic>e   
co/-%>+ = colorectal canc] scre5+ )     
!rapeutic effect  7a7 ,9 g5]al ,section 
#ahcc7;a77#a77,y7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciel7a77#a77,y77  
is am5d$ by ins]t+ 1 includ+ te/s &     
proc$ures describ$ 9 ! la/ s5t5ce (     
subsection 7b71 aft] section            
#ahfa7;ddd77#c7 4  7b7 ,effective ,date 
,! am5dm5ts made by ?is section %all    
apply to te/s & proc$ures p]=m$ on or   

aft] ,janu>y #a1 #bjad4  #e4 ,m$ic>e    
cov]age = an (fice visit or consultation
 prior to a qualify+ scre5+ colonoscopy 
7a7 ,cov]age ,section #ahfa7s77#b7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7s77#b77 is am5d$--  7#a7 9       
subp>agraph 7,,ee71 by /rik+ & at ! end2
  7#b7 9 subp>agraph 7,,ff71 by ins]t+ &
 at ! end2 &  7#c7 by add+ at ! end !   
foll[+ new subp>agraph3  7,,gg7 prior to
 a colorectal canc] scre5+ te/ consi/+ (
 a scre5+ colonoscopy or 9 conjunction )
 an individual's decision reg>d+ !      
p]=mance ( su* a te/ on ! individual1 an
 outpati5t (fice visit or consultation =
 ! purpose ( b5efici>y education1 assur+
 selection ( ! prop] scre5+ te/1 &      
secur+ in=mation relat+ to ! proc$ure & 
! s$ation ( ! individual2  4  7b7       
,paym5t  7#a7 ,9 g5]al ,section         
#ahcc7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciel7a77#a77 is       
am5d$--  7,a7 by /rik+ & be=e 7,z72 &   
7,b7 by ins]t+ be=e ! semicolon at ! end
 ! foll[+3 1 & 7,,aa7 ) respect to an   

outpati5t (fice visit or consultation "u
 section #ahfa7s77#b77;,,gg71 ! am\nts  
paid %all be #hj p]c5t ( ! less] ( !    
actual *>ge or ! am\nt e/abli%$ "u      
section #ahdh4  7#b7 ,paym5t "u         
physician fee s*$ule ,section           
#ahdh7;j77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is   
am5d$ by ins]t+ 7#b77;,,gg71 aft]       
7#b77;,,ff7 7includ+ adm9i/ration ( !   
heal? risk assessm5t714  7#c7           
,requirem5t = e/abli%m5t ( paym5t am\nt 
"u physician fee s*$ule ,section        
#ahcd7;d7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciem7d77 is am5d$ by   
add+ at ! end ! foll[+ new p>agraph3    
7#d7 ,paym5t = outpati5t (fice visit or 
consultation prior to scre5+ colonoscopy
 ,) respect to an outpati5t (fice visit 
or consultation "u section              
#ahfa7s77#b77;,,gg71 paym5t "u section  
#ahdh %all be consi/5t ) ! paym5t am\nts
 = ,,cpt codes #iibja1 #iibjb1 #iibjc1  
#iibjd1 #iibaa1 #iibab1 #iibac1 #iibad1 
& #iibae 7z 9 effect z ( ! date ( !     

enactm5t ( ?is p>agraph or any          
successors to su* codes74  4  7c7       
,effective ,date ,! am5dm5ts made by ?is
 section %all apply to items & s]vices  
furni%$ on or aft] ,janu>y #a1 #bjad4   
#f4 ,budget neutrality  7a7 ,adju/m5t ( 
physician fee s*$ule conv]sion factor ,!
 ,secret>y ( ,heal? & ,human ,s]vices 79
 ?is section ref]r$ to z ! ,secret>y7   
%all r$uce ! conv]sion factor e/abli%$  
"u subsection 7d7 ( section #ahdh ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7 = ea* ye> 7beg9n+ ) #bjad7 to
 ! ext5t necess>y to r$uce exp5ditures  
"u su* section = items & s]vices furni%$
 dur+ ! ye> 9 ! aggregate by ! net (fset
 am\nt det]m9$ "u subsection 7c77#e7    
attributable to su* section = ! ye>4    
7b7 ,adju/m5t ( ,,hopd conv]sion factor 
,! ,secret>y %all r$uce ! conv]sion     
factor e/abli%$ "u p>agraph 7#c77;,c7 ( 
section #ahcc7t7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #aciel7t77 = ea* ye>
 7beg9n+ ) #bjad7 to ! ext5t necess>y to
 r$uce exp5ditures "u su* section =     

items & s]vices furni%$ dur+ ! ye> 9 !  
aggregate by ! net (fset am\nt det]m9$  
"u subsection 7c77#e7 attributable to   
su* section = ! ye>4  7c7 ,det]m9ations 
relat+ to exp5ditures ,= purposes ( ?is 
section1 be=e ! beg9n+ ( ea* ye> 7beg9n+
 ) #bjad7 at ! "t conv]sion factors     
describ$ 9 subsections 7a7 & 7b7 are    
e/abli%$ = ! ye>1 ! ,secret>y %all      
det]m9e--  7#a7 ! am\nt ( ! gross       
additional exp5ditures "u title ,,xviii 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie et seq47 e/imat$ to     
result f ! implem5tation ( sections #c1 
#d1 & #e = items & s]vices furni%$ dur+ 
! ye>2  7#b7 ! am\nt ( any (fsett+      
r$uctions 9 exp5ditures "u su* title    
7su* z r$uctions 9 paym5ts = inpati5t   
hospital s]vices7 = su* ye> attributable
 to ! implem5tation ( su* sections2     
7#c7 ! am\nt 7if any7 by :i* ! am\nt ( !
 gross additional exp5ditures det]m9$ "u
 p>agraph 7#a7 = ! ye> exce$s ! am\nt ( 
(fsett+ r$uctions det]m9$ "u p>agraph   
7#b7 = ! ye>2  7#d7 ( ! gross additional

 exp5ditures det]m9$ "u p>agraph 7#a7 = 
! ye> t are attributable to exp5ditures 
"u sections #ahdh & #ahcc7t7 ( su* ,act1
 ! ratio ( su* exp5ditures t are        
attributable to ea* respective section2 
&  7#e7 ) respect to section #ahdh &    
section #ahcc7t7 ( su* ,act1 a net (fset
 am\nt = ! ye> equal to ! product (--   
7,a7 ! am\nt ( ! net additional         
exp5ditures = ! ye> det]m9$ "u p>agraph 
7#c72 &  7,b7 ! ratio det]m9$ "u        
p>agraph 7#d7 attributable to !         
respective section4  #g4 ,expansion (   
cov]age ( activities relat$ to recomm5d$
 prev5tive heal? s]vices "u private     
heal? insurance  7a7 ,9 g5]al ,section  
#bgac7;a77#a7 ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4                    
#cjj;gg-#ac7;a77#a77 is am5d$ by ins]t+ 
7includ+ relat$ activities occurr+ z "p 
( ! same cl9ical enc\nt]1 su* z conduct+
 a biopsy or by remov+ a lesion or gr[?7
 aft] ,task ,=ce4  7b7 ,effective date  
,! am5dm5t made by subsection 7a7 %all  
apply to plan ye>s beg9n+ on or aft]    

,janu>y #a1 #bjad4