,,ii  #aadth ,,congress  #ast ,session  
,s4 #ajgi  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,april #bc1    
#bjae ,mr4 ,cardin introduced the       
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,to amend titles ,,xi and    
,,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 #bjae or   
the ,,screen ,act of #bjae4  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 ,maintaining   
calendar year #bjae ,medicare           
reimbursement rates for colonoscopy     
procedures for providers participating  

in colorectal cancer screening quality  
improvement registry4 ,sec4 #d4         
,eliminating ,medicare beneficiary      
cost-sharing for certain colorectal     
cancer screenings1 colorectal cancer    
screenings with therapeutic effect1 and 
follow-up diagnostic colorectal cancer  
screenings covered under ,medicare4     
,sec4 #e4 ,medicare demonstration       
project to evaluate the effectiveness of
 a pre-operative visit prior to         
screening colonoscopy and hepatitis ,c  
screening4 ,sec4 #f4 ,budget neutrality4
  #b4 ,findings ,congress finds the     
following3 7#a7 ,colorectal cancer is   
the second leading cause of cancer death
 among men and women combined in the    
,united ,states4  7#b7 ,in #bjae1 more  
than #acj1jjj ,americans will be        
diagnosed with colorectal cancer1 and   
nearly #ej1jjj ,americans are expected  
to die from it4  7#c7 ,approximately #fj
 percent of colorectal cancer cases and 
#gj percent of colorectal cancer deaths 
occur in those aged #fe and older4  7#d7

 ,colorectal cancer screening           
colonoscopies allow for the detection   
and removal of polyps before they       
progress to colorectal cancer1 as well  
as early detection of colorectal cancer 
when treatment can be most effective4   
7#e7 ,according to a #bjab study        
published in the ,new ,england ,journal 
of ,medicine1 removing precancerous     
polyps through colonoscopy could reduce 
the number of colorectal cancer deaths  
by #ec percent4  7#f7 ,although         
colorectal cancer is highly preventable 
with appropriate screening1 one in three
 adults between the ages of #ej and #ge 
years are not up to date with           
recommended colorectal cancer screening4
  7#g7 ,over #bjj organizations have    
committed to eliminating colorectal     
cancer as a major health problem in the 
,united ,states and are working toward a
 shared goal of screening #hj percent of
 eligible ,americans by #bjah4  7#h7    
,hepatitis ,c is a liver disease that   
causes inflammation of the liver and    

results from infection with the         
,hepatitis ,c virus4 ,chronic ,hepatitis
 ,c infection can lead to serious health
 problems1 including liver damage1      
cirrhosis1 and liver cancer4 ,it is the 
leading cause of liver transplants in   
the ,united ,states4  7#i7 ,according to
 the ,centers for ,disease ,control and 
,prevention 7,,cdc71 more than #ge      
percent of adults infected with the     
,hepatitis ,c virus in the ,united      
,states were born between #aide and     
#aife4  7#aj7 ,the ,,cdc estimates that 
up to #ge percent of individuals with   
,hepatitis ,c do not know that they are 
infected4  7#aa7 ,the ,,cdc and the     
,united ,states ,preventive ,services   
,task ,force 7,,uspstf7 recommend a     
one-time screening for ,hepatitis ,c for
 all individuals born between #aide and 
#aife4  7#ab7 ,a recent study suggests  
that offering ,hepatitis ,c screening to
 patients in connection with screening  
colonoscopies may be an effective means 
of increasing ,hepatitis ,c screening   

rates among individuals born between    
#aide and #aife4  #c4 ,maintaining      
calendar year #bjae ,medicare           
reimbursement rates for colonoscopy     
procedures for providers participating  
in colorectal cancer screening quality  
improvement registry ,section           
#ahcd7;d77#c7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciem7d77#c77 is   
amended by adding at the end the        
following new subparagraph3  7,f7       
,maintaining calendar year #bjae        
reimbursement rates for qualifying      
cancer screening tests furnished by     
qualifying providers  7i7 ,in general   
,with respect to a qualifying cancer    
screening test furnished during each of 
#bjaf1 #bjag1 and #bjah1 by a qualifying
 provider1 the amount of payment to such
 provider for such test under section   
#ahcc or section #ahdh shall be equal to
 the amount of payment for such test    
under such section #ahcc or #ahdh during
 #bjae4  7ii7 ,qualifying cancer        
screening test ,for purposes of this    

subparagraph1 the term qualifying cancer
 screening test means an optical        
screening colonoscopy 7as described in  
section #ahfa7pp77#a77;,c774  7iii7     
,qualifying provider defined ,for       
purposes of this subparagraph1 the term 
qualifying provider means1 with respect 
to a qualifying cancer screening test1  
an individual or entity-- 7,i7 that is  
eligible for payment for such test under
 section #ahcc or section #ahdh2 and    
7,,ii7 that-- 7aa7 participates in a    
nationally recognized quality           
improvement registry with respect to    
such test2 and  7bb7 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  4  #d4 ,eliminating  
,medicare beneficiary cost-sharing for  
certain colorectal cancer screenings1   
colorectal cancer screenings with       
therapeutic effect1 and follow-up       

diagnostic colorectal cancer screenings 
covered under ,medicare  7a7 ,waiver of 
cost-,sharing ,section #ahcc7;a77#a77,y7
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #aciel7a77#a77,y77 is amended 
by inserting 1 including colorectal     
cancer screening tests covered under    
this part described in section          
#ahfa7pp77#a77;,c7 7regardless of the   
code that is billed for the             
establishment of a diagnosis as a result
 of the screening test1 for the removal 
of tissue or other matter during the    
screening test1 or for a follow-up      
procedure that is furnished in          
connection with1 or as a result of1 the 
initial screening test7 after or        
population4  7b7 ,waiver of application 
of deductible ,section #ahcc7;b7 of the 
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7b77 is amended-- 7#a7 in         
paragraph 7#a7 of the first sentence1 by
 striking individual4 and inserting     
individual1 including colorectal cancer 
screening tests covered under this part 

described in section #ahfa7pp77#a77;,c72
 and  7#b7 by striking the last sentence
 and inserting the following3           
,subsection 7a77#a77,y7 and paragraph   
7#a7 of the first sentence of this      
subsection shall apply with respect to a
 colorectal cancer screening test       
covered under this part described in    
section #ahfa7pp77#a77;,c71 regardless  
of the code that is billed for the      
establishment of a diagnosis as a result
 of the screening test1 for the removal 
of tissue or other matter during the    
screening test1 or for a follow-up      
procedure that is furnished in          
connection with1 or as a result of1 the 
initial screening test4  7c7 ,effective 
,date ,the amendments made by this      
section shall apply to tests and        
procedures performed on or after        
,january #a1 #bjaf4  #e4 ,medicare      
demonstration project to evaluate the   
effectiveness of a pre-operative visit  
prior to screening colonoscopy and      
hepatitis ,c screening ,section         

#aaae;,a7b77#b7 of the ,social ,security
 ,act 7#db ,u4,s4,c4 #acae;a7b77#b77 is 
amended-- 7#a7 in the last sentence of  
subparagraph 7,a71 by inserting 1 and   
shall include the model described in    
subparagraph 7,d7 before the period at  
the end2 and  7#b7 by adding at the end 
the following new subparagraph3  7,d7   
,medicare demonstration project to      
evaluate the effectiveness of a         
pre-operative visit prior to screening  
colonoscopy and hepatitis ,c screening  
7i7 ,in general ,the model described in 
this subparagraph is a demonstration    
project under title ,,xviii to evaluate 
the effectiveness of a pre-operative    
visit with the provider performing the  
procedure prior to screening colonoscopy
 to--  7,i7 ease any patient concern or 
fears with respect to the procedure and 
answer any questions relating to the    
screening2  7,,ii7 ensure quality       
examinations and avoid unnecessary      
repeat examinations by educating        
individuals on the importance of        

following pre-procedure instructions1   
such as bowel preparation1 and          
addressing the individual's family      
history of or predisposition to         
colorectal cancer2 and  7,,iii7 increase
 ,hepatitis ,c ,virus 7,,hcv7 screening 
rates among ,medicare beneficiaries by  
educating individuals about the         
importance of such screening during the 
pre-operative visit and having the      
pre-operative visit fulfill the referral
 requirement for such screening under   
title ,,xviii1 allowing patients to be  
screened for colorectal cancer and ,,hcv
 at the same time4  7ii7 ,consultation  
,the ,secretary shall consult with      
stakeholders who would be providing the 
pre-operative visit under the model     
described in this subparagraph on the   
implementation of such model1 including 
payment for services furnished under the
 model4  4  #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 #bjaf7 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 #bjaf7 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 #bjaf7 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 #c and #d 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