Colon Cancer Screen for Life Act of 2005 - Expresses the sense of the Congress with respect to the use of and reimbursement for colorectal cancer screening tests covered under the Medicare program under title XVIII of the Social Security Act (SSA).
Amends SSA title XVIII to: (1) increase Medicare part B (Supplementary Medical Insurance) reimbursement for colorectal cancer screening and diagnostic tests; (2) cover an outpatient office visit or consultation for the purpose of beneficiary education before a colorectal cancer screening test consisting of a colonoscopy, or in conjunction with the beneficiary's decision to obtain such a screening, regardless of whether the screening is medically indicated with respect to the beneficiary; and (3) waive the deductible for such tests.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1010 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 1010
To amend title XVIII of the Social Security Act to improve patient
access to, and utilization of, the colorectal cancer screening benefit
under the Medicare Program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 12, 2005
Mr. Santorum (for himself, Mr. Lieberman, Ms. Collins, Mr. Bingaman,
Mr. Nelson of Nebraska, Ms. Snowe, Mr. Graham, Mr. Jeffords, Ms.
Landrieu, and Mr. Dorgan) introduced the following bill; which was read
twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to improve patient
access to, and utilization of, the colorectal cancer screening benefit
under 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 Screen for Life Act of
2005''.
SEC. 2. SENSE OF CONGRESS.
It is the sense of Congress that--
(1) colorectal cancer screening tests (as defined in
section 1861(pp)(1) of the Social Security Act (42 U.S.C.
1395x(pp)(1)) covered under the medicare program have been
severely underutilized, with the Comptroller General of the
United States reporting in 2000 that since coverage of such
tests was implemented, the percentage of beneficiaries under
the medicare program receiving either a screening or a
diagnostic colonoscopy has increased by only 1 percent;
(2) in recognition of the need to improve rates of
colorectal cancer screening in the medicare program, Congress
enacted provisions in the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 to require
physicians to provide a referral for colorectal cancer
screening as part of the new initial preventive physical
examination, beginning January 1, 2005;
(3) the Centers for Medicare & Medicaid Services should
encourage health care providers to use more effective screening
and diagnostic health care technologies in the area of
colorectal cancer screening;
(4) in recent years, the Centers for Medicare & Medicaid
Services has subjected colorectal cancer screening tests to
some of the largest reimbursement reductions under the medicare
program;
(5) unlike other preventive screening tests covered under
the medicare program, health care providers must consult with
beneficiaries prior to furnishing a screening colonoscopy in
order to--
(A) ascertain the medical and family history of the
beneficiary; and
(B) inform the beneficiary of preparatory steps
that must be taken prior to the procedure; and
(6) reimbursement under the medicare program is not
currently available for the consultations described in
paragraph (5) despite the fact that reimbursement is provided
under such program for similar consultations prior to a
diagnostic colonoscopy.
SEC. 3. INCREASE IN PART B REIMBURSEMENT FOR COLORECTAL CANCER
SCREENING AND DIAGNOSTIC TESTS.
(a) In General.--Section 1834(d) of the Social Security Act (42
U.S.C. 1395m(d)) is amended by adding at the end the following new
paragraph:
``(4) Enhanced part b payment for colorectal cancer
screening and diagnostic tests.--
``(A) Nonfacility rates.--Notwithstanding
paragraphs (2)(A) and (3)(A), the Secretary shall
establish national minimum payment amounts for CPT
codes 45378, 45380, and 45385, and HCPCS codes G0105
and GO121 for items and services furnished on or after
January 1, 2006, which reflect a 10-percent increase
above the relative value units in effect as the
nonfacility rates for such codes on December 31, 2005,
with such revised payment level to apply to items and
services performed in a nonfacility setting.
``(B) Facility rates.--Notwithstanding paragraphs
(2)(A) and (3)(A), the Secretary shall establish
national minimum payment amounts for CPT codes 45378,
45380, and 45385, and HCPCS codes G0105 and GO121 for
items and services furnished on or after January 1,
2006, which reflect a 30-percent increase above the
relative value units in effect as the facility rates
for such codes on December 31, 2005, with such revised
payment level to apply to items and services performed
in a facility setting.
``(C) Annual adjustments.--In the case of items and
services furnished on or after January 1, 2006, the
payment rates described in subparagraphs (A) and (B)
shall, subject to the minimum payment amounts
established in such subparagraphs, be adjusted annually
as provided in section 1848.''.
(b) No Effect on HOPD Payments.--The Secretary of Health and Human
Services shall not take into account the provisions of section
1834(d)(4) of the Social Security Act, as added by subsection (a), in
determining the amount of payment for any covered OPD service under the
prospective payment system for hospitals outpatient department services
under section 1833(t) of such Act (42 U.S.C. 1395l(t)).
SEC. 4. MEDICARE COVERAGE OF OFFICE VISIT OR CONSULTATION PRIOR TO A
SCREENING COLONOSCOPY OR IN CONJUNCTION WITH A
BENEFICIARY'S DECISION TO OBTAIN SUCH A SCREENING.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (Y), by striking ``and'' at the end;
(2) in subparagraph (Z), by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(AA) an outpatient office visit or consultation
for the purpose of beneficiary education, assuring
selection of the proper screening test, and securing
information relating to the procedure and sedation of
the beneficiary, prior to a colorectal cancer screening
test consisting of a screening colonoscopy or in
conjunction with the beneficiary's decision to obtain
such a screening, regardless of whether such screening
is medically indicated with respect to the
beneficiary;''.
(b) Payment.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and'' before ``(V)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (W) with respect to an
outpatient office visit or consultation under section
1861(s)(2)(AA), the amounts paid shall be 80 percent of
the lesser of the actual charge or the amount
established under section 1848''.
(2) Payment under physician fee schedule.--Section
1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3))
is amended by inserting ``(2)(AA),'' after ``(2)(W),''.
(3) Requirement for establishment of payment amount under
physician fee schedule.--Section 1834(d) of the Social Security
Act (42 U.S.C. 1395m(d)), as amended by section 3, is amended
by adding at the end the following new paragraph:
``(5) Payment for outpatient office visit or consultation
prior to screening colonoscopy.--With respect to an outpatient
office visit or consultation under section 1861(s)(2)(AA),
payment under section 1848 shall be consistent with the payment
amounts for CPT codes 99203 and 99243.''.
(c) Effective Date.--The amendments made by this section shall
apply to items and services provided on or after January 1, 2006.
SEC. 5. WAIVER OF DEDUCTIBLE FOR COLORECTAL CANCER SCREENING TESTS.
(a) In General.--The first sentence of section 1833(b) of the
Social Security Act (42 U.S.C. 1395l(b)) is amended--
(1) by striking ``and'' before ``(6)''; and
(2) by inserting before the period at the end the
following: ``, and (7) such deductible shall not apply with
respect to colorectal cancer screening tests (as described in
section 1861(pp)(1))''.
(b) Conforming Amendments.--Paragraphs (2)(C)(ii) and (3)(C)(ii) of
section 1834(d) of the Social Security Act (42 U.S.C. 1395m(d)) are
each amended--
(1) by striking ``deductible and'' in the heading; and
(2) in subclause (I), by striking ``deductible or'' each
place it appears.
(c) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2006.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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