,,ii  #aad? ,,congress  #a/ ,session    
,s4 #ajgi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #bc1 #bjae ,mr4 
,c>d9 introduc$ ! foll[+ bill2 :i* 0    
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d titles ,,xi
 & ,,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 ( #bjae or ! ,,scre5
 ,act ( #bjae4  7b7 ,table ( cont5ts ,! 
table ( cont5ts ( ?is ,act is z foll[s3 
,sec4 #a4 ,%ort title2 table ( cont5ts4 
,sec4 #b4 ,f9d+s4 ,sec4 #c4 ,ma9ta9+    
cal5d> ye> #bjae ,m$ic>e reimbursem5t   
rates = colonoscopy proc$ures = provid]s
 p>ticipat+ 9 colorectal canc] scre5+   
quality improvem5t regi/ry4 ,sec4 #d4   
,elim9at+ ,m$ic>e b5efici>y co/-%>+ =   
c]ta9 colorectal canc] scre5+s1         

colorectal canc] scre5+s ) !rapeutic    
effect1 & foll[-up diagno/ic colorectal 
canc] scre5+s cov]$ "u ,m$ic>e4 ,sec4   
#e4 ,m$ic>e demon/ration project to     
evaluate ! effectiv5ess ( a pre-op]ative
 visit prior to scre5+ colonoscopy &    
hepatitis ,c scre5+4 ,sec4 #f4 ,budget  
neutrality4  #b4 ,f9d+s ,congress f9ds !
 foll[+3 7#a7 ,colorectal canc] is !    
second lead+ cause ( canc] dea? among m5
 & wom5 comb9$ 9 ! ,unit$ ,/ates4  7#b7 
,9 #bjae1 m ?an #acj1jjj ,am]icans w be 
diagnos$ ) colorectal canc]1 & ne>ly    
#ej1jjj ,am]icans are expect$ to die f  
x4  7#c7 ,approximately #fj p]c5t (     
colorectal canc] cases & #gj p]c5t (    
colorectal canc] dea?s occur 9 ^? ag$   
#fe & old]4  7#d7 ,colorectal canc]     
scre5+ colonoscopies all[ = ! detection 
& removal ( polyps be=e !y progress to  
colorectal canc]1 z well z e>ly         
detection ( colorectal canc] :5 treatm5t
 c be mo/ effective4  7#e7 ,accord+ to a
 #bjab /udy publi%$ 9 ! ,new ,engl&     
,j\rnal ( ,m$ic9e1 remov+ precc]ous     

polyps ?r\gh colonoscopy c\ld r$uce !   
numb] ( colorectal canc] dea?s by #ec   
p]c5t4  7#f7 ,al?\gh colorectal canc] is
 highly prev5table ) appropriate scre5+1
 "o 9 ?ree adults betwe5 ! ages ( #ej & 
#ge ye>s are n up to date ) recomm5d$   
colorectal canc] scre5+4  7#g7 ,ov] #bjj
 organizations h committ$ to elim9at+   
colorectal canc] z a major heal? problem
 9 ! ,unit$ ,/ates & are work+ t[>d a   
%>$ goal ( scre5+ #hj p]c5t ( eligible  
,am]icans by #bjah4  7#h7 ,hepatitis ,c 
is a liv] disease t causes inflammation 
( ! liv] & results f infection ) !      
,hepatitis ,c virus4 ,*ronic ,hepatitis 
,c infection c lead to s]i\s heal?      
problems1 includ+ liv] damage1          
cirrhosis1 & liv] canc]4 ,x is ! lead+  
cause ( liv] transplants 9 ! ,unit$     
,/ates4  7#i7 ,accord+ to ! ,c5t]s =    
,disease ,control & ,prev5tion 7,,cdc71 
m ?an #ge p]c5t ( adults infect$ ) !    
,hepatitis ,c virus 9 ! ,unit$ ,/ates 7 
born betwe5 #aide & #aife4  7#aj7 ,!    
,,cdc e/imates t up to #ge p]c5t (      

individuals ) ,hepatitis ,c d n "k t !y 
are infect$4  7#aa7 ,! ,,cdc & ! ,unit$ 
,/ates ,prev5tive ,s]vices ,task ,=ce   
7,,usp/f7 recomm5d a "o-"t scre5+ =     
,hepatitis ,c = all individuals born    
betwe5 #aide & #aife4  7#ab7 ,a rec5t   
/udy sugge/s t (f]+ ,hepatitis ,c scre5+
 to pati5ts 9 connection ) scre5+       
colonoscopies may be an effective means 
( increas+ ,hepatitis ,c scre5+ rates   
among individuals born betwe5 #aide &   
#aife4  #c4 ,ma9ta9+ cal5d> ye> #bjae   
,m$ic>e reimbursem5t rates = colonoscopy
 proc$ures = provid]s p>ticipat+ 9      
colorectal canc] scre5+ quality         
improvem5t regi/ry ,section             
#ahcd7;d77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciem7d77#c77 is am5d$ 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,f7 ,ma9ta9+ cal5d> ye>  
#bjae reimbursem5t rates = qualify+     
canc] scre5+ te/s furni%$ by qualify+   
provid]s  7i7 ,9 g5]al ,) respect to a  
qualify+ canc] scre5+ te/ furni%$ dur+  
ea* ( #bjaf1 #bjag1 & #bjah1 by a       

qualify+ provid]1 ! am\nt ( paym5t to   
su* provid] = su* te/ "u section #ahcc  
or section #ahdh %all be equal to !     
am\nt ( paym5t = su* te/ "u su* section 
#ahcc or #ahdh dur+ #bjae4  7ii7        
,qualify+ canc] scre5+ te/ ,= purposes (
 ?is subp>agraph1 ! t]m qualify+ canc]  
scre5+ te/ means an optical scre5+      
colonoscopy 7z describ$ 9 section       
#ahfa7pp77#a77;,c774  7iii7 ,qualify+   
provid] def9$ ,= purposes ( ?is         
subp>agraph1 ! t]m qualify+ provid]     
means1 ) respect to a qualify+ canc]    
scre5+ te/1 an individual or entity--   
7,i7 t is eligible = paym5t = su* te/ "u
 section #ahcc or section #ahdh2 &      
7,,ii7 t-- 7aa7 p>ticipates 9 a         
nationally recogniz$ quality improvem5t 
regi/ry ) respect to su* te/2 &  7bb7   
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 
4  #d4 ,elim9at+ ,m$ic>e b5efici>y      

co/-%>+ = c]ta9 colorectal canc]        
scre5+s1 colorectal canc] scre5+s )     
!rapeutic effect1 & foll[-up diagno/ic  
colorectal canc] scre5+s cov]$ "u       
,m$ic>e  7a7 ,waiv] ( co/-,%>+ ,section 
#ahcc7;a77#a77,y7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciel7a77#a77,y77  
is am5d$ by ins]t+ 1 includ+ colorectal 
canc] scre5+ te/s cov]$ "u ?is "p       
describ$ 9 section #ahfa7pp77#a77;,c7   
7reg>dless ( ! code t is bill$ = !      
e/abli%m5t ( a diagnosis z a result ( ! 
scre5+ te/1 = ! removal ( tissue or o!r 
matt] dur+ ! scre5+ te/1 or = a foll[-up
 proc$ure t is furni%$ 9 connection )1  
or z a result (1 ! initial scre5+ te/7  
aft] or population4  7b7 ,waiv] (       
application ( d$uctible ,section        
#ahcc7;b7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciel7b77 is am5d$--    
7#a7 9 p>agraph 7#a7 ( ! fir/ s5t5ce1 by
 /rik+ individual4 & ins]t+ individual1 
includ+ colorectal canc] scre5+ te/s    
cov]$ "u ?is "p describ$ 9 section      
#ahfa7pp77#a77;,c72 &  7#b7 by /rik+ !  

la/ s5t5ce & ins]t+ ! foll[+3           
,subsection 7a77#a77,y7 & p>agraph 7#a7 
( ! fir/ s5t5ce ( ?is subsection %all   
apply ) respect to a colorectal canc]   
scre5+ te/ cov]$ "u ?is "p describ$ 9   
section #ahfa7pp77#a77;,c71 reg>dless ( 
! code t is bill$ = ! e/abli%m5t ( a    
diagnosis z a result ( ! scre5+ te/1 = !
 removal ( tissue or o!r matt] dur+ !   
scre5+ te/1 or = a foll[-up proc$ure t  
is furni%$ 9 connection )1 or z a result
 (1 ! initial scre5+ te/4  7c7          
,effective ,date ,! am5dm5ts made by ?is
 section %all apply to te/s & proc$ures 
p]=m$ on or aft] ,janu>y #a1 #bjaf4  #e4
 ,m$ic>e demon/ration project to        
evaluate ! effectiv5ess ( a pre-op]ative
 visit prior to scre5+ colonoscopy &    
hepatitis ,c scre5+ ,section            
#aaae;,a7b77#b7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acae;a7b77#b77 is  
am5d$-- 7#a7 9 ! la/ s5t5ce (           
subp>agraph 7,a71 by ins]t+ 1 & %all    
include ! model describ$ 9 subp>agraph  
7,d7 be=e ! p]iod at ! end2 &  7#b7 by  

add+ at ! end ! foll[+ new subp>agraph3 
7,d7 ,m$ic>e demon/ration project to    
evaluate ! effectiv5ess ( a pre-op]ative
 visit prior to scre5+ colonoscopy &    
hepatitis ,c scre5+  7i7 ,9 g5]al ,!    
model describ$ 9 ?is subp>agraph is a   
demon/ration project "u title ,,xviii to
 evaluate ! effectiv5ess ( a            
pre-op]ative visit ) ! provid] p]=m+ !  
proc$ure prior to scre5+ colonoscopy    
to--  7,i7 ease any pati5t conc]n or    
fe>s ) respect to ! proc$ure & answ] any
 que/ions relat+ to ! scre5+2  7,,ii7   
ensure quality exam9ations & avoid      
unnecess>y repeat exam9ations by educat+
 individuals on ! importance ( foll[+   
pre-proc$ure in/ructions1 su* z b[el    
prep>ation1 & address+ ! individual's   
family hi/ory ( or pr$isposition to     
colorectal canc]2 &  7,,iii7 increase   
,hepatitis ,c ,virus 7,,hcv7 scre5+     
rates among ,m$ic>e b5efici>ies by      
educat+ individuals ab\t ! importance ( 
su* scre5+ dur+ ! pre-op]ative visit &  
hav+ ! pre-op]ative visit fulfill !     

ref]ral requirem5t = su* scre5+ "u title
 ,,xviii1 all[+ pati5ts to be scre5$ =  
colorectal canc] & ,,hcv at ! same "t4  
7ii7 ,consultation ,! ,secret>y %all    
consult ) /akehold]s :o w\ld be provid+ 
! pre-op]ative visit "u ! model describ$
 9 ?is subp>agraph on ! implem5tation ( 
su* model1 includ+ paym5t = s]vices     
furni%$ "u ! model4  4  #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+ ) #bjaf7 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+ ) #bjaf7 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+
 ) #bjaf7 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 #c &
 #d = 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