Virtual Screening for Colorectal Cancer Act of 2010 - Amends title XVIII (Medicare) of the Social Security Act to: (1) provide Medicare coverage for screening computed tomography colonography (CTC) as a colorectal cancer (CRC) screening test; and (2) exclude screening CTC from the meaning of "imaging services" for which there is a special rule regarding outpatient services department (OPD) fee schedule payments.
Directs the Comptroller General to study, by CRC screening procedure type, and report to Congress on: (1) the effect of the addition of the screening CTC benefit under this Act; (2) the effect of the addition of such benefit as part of an overall set of CRC screening made available to relevant Medicare population, including individuals over age 50 and over age 75; and (3) any other relevant questions involving access to, beneficiary preference of, and value of, screening CTC for Medicare beneficiaries.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5461 Introduced in House (IH)]
111th CONGRESS
2d Session
H. R. 5461
To amend title XVIII of the Social Security Act to cover screening
computed tomography colonography as a colorectal cancer screening test
under the Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 28, 2010
Mr. Davis of Illinois (for himself, Mr. Kirk, and Mr. Boren) introduced
the following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to cover screening
computed tomography colonography as a colorectal cancer screening test
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 ``Virtual Screening for Colorectal
Cancer Act of 2010''.
SEC. 2. COVERING SCREENING COMPUTED TOMOGRAPHY COLONOGRAPHY AS A
COLORECTAL CANCER SCREENING TEST UNDER MEDICARE..
(a) In General.--Section 1861(pp)(1) of the Social Security Act (42
U.S.C. 1395x(pp)(1)) is amended--
(1) by redesignating subparagraph (D) as subparagraph (E);
and
(2) by inserting after subparagraph (C) the following new
subparagraph:
``(D) Screening computed tomography
colonography.''.
(b) Frequency Limits and Payment.--Section 1834(d) of such Act (42
U.S.C. 1395m(d)) is amended by adding at the end the following new
paragraph:
``(4) Screening computed tomography colonography.--
``(A) Fee schedule.--With respect to a colorectal
cancer screening test consisting of screening computed
tomography colonography, subject to subparagraph (B),
payment under section 1848 shall be consistent with
payment under such section for similar or related
services.
``(B) Payment limit.--In the case of screening
computed tomography colonography, payment under this
part shall not exceed such amount as the Secretary
specifies.
``(C) Facility payment limit.--
``(i) Limitation on coinsurance.--
Notwithstanding any other provision of this
title, in the case of an individual who
receives screening computed tomography
colonography--
``(I) in computing the amount of
any applicable coinsurance, the
computation of such coinsurance shall
be based upon the fee schedule under
which payment is made for the services;
and
``(II) the amount of such
coinsurance shall not exceed 25 percent
of the payment amount under the fee
schedule described in subparagraph (A).
``(D) Frequency limit.--No payment may be made
under this part for a colorectal cancer screening test
consisting of a screening computed tomography
colonography--
``(i) if the individual is under 50 years
of age; or
``(ii)(I) in the case of individuals at
high risk for colorectal cancer, if the
procedure is performed within the 23 months
after a previous screening computed tomography
colonography or a previous screening
colonoscopy; or
``(II) in the case of an individual who is
not at high risk for colorectal cancer, if the
procedure is performed within the 119 months
after a previous screening colonoscopy or
within the 59 months after a previous screening
flexible sigmoidoscopy or a previous screening
computed tomography colonography.''.
(c) Conforming Frequency Limits for Other Colorectal Cancer
Screening Tests.--
(1) Screening flexible sigmoidoscopy.--Paragraph (2)(E)(ii)
of section 1834(d) of the Social Security Act (42 U.S.C.
1395m(d)) is amended by inserting ``or screening computed
tomography colonography'' after ``previous screening flexible
sigmoidoscopy''.
(2) Screening colonoscopy.--Paragraph (3)(E) of such
section is amended--
(A) by inserting ``or screening computed tomography
colonography'' after ``23 months after a previous
screening colonoscopy''; and
(B) by inserting ``or screening computed tomography
colonography'' after ``screening flexible
sigmoidoscopy''.
(d) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2011.
SEC. 3. EXEMPTION OF SCREENING COMPUTED TOMOGRAPHY COLONOGRAPHY FROM
SPECIAL RULE ON PAYMENT FOR IMAGING SERVICES.
(a) In General.--Section 1848(b)(4)(B) of the Social Security Act
(42 U.S.C. 1395w-4(b)(4)(B)) is amended by inserting ``and screening
computed tomography colonography'' after ``diagnostic and screening
mammography''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to items and services furnished on or after January 1, 2011.
SEC. 4. REPORT ON THE EFFECTIVENESS OF SCREENING CTC IN IMPROVING
OVERALL CRC COMPLIANCE.
(a) GAO Study and Reports on Effectiveness of Screening Computed
Tomography Colonograpy in Improving Overall Colorectal Cancer
Compliance.--
(1) Study.--
(A) In general.--The Comptroller General of the
United States (in this subsection referred to as the
``Comptroller General'') shall conduct a study, by
colorectal cancer screening procedure type, on--
(i) the effect of the addition of the
screening computed tomography colonography (in
this subsection referred to as ``screening
CTC'') benefit under section 1861(pp)(1)(D) of
the Social Security Act, as added by section
2(a);
(ii) the effect of the addition of such
benefit as part of an overall set of colorectal
cancer screening (in this subsection referred
to as the ``CRC screening'') made available to
relevant Medicare population, including
individuals over 50 years of age and over 75
years of age; and
(iii) any other relevant questions
involving access to, beneficiary preference of,
and the value of, screening CTC for Medicare
beneficiaries.
(B) Issues.--The study conducted under subparagraph
(A) shall examine the following:
(i) The impact of screening CTC on the
change in CRC screening compliance of Medicare
beneficiaries.
(ii) The various utilization rates for the
each available CRC screening option before and
after the availability of screening CTC,
including--
(I) by initial CRC screening
performed as a Medicare beneficiary,
including the beneficiary age when
initial screening was performed; and
(II) by follow-on screening
performed, whereby the analysis
demonstrates to what extent screening
CTC was used as a substitute for a
previous screening procedure.
(iii) The referral rate of screening CTC to
follow-on optical colonoscopy.
(iv) An analysis of beneficiary preference
to the various CRC screening options.
(v) Access to screening CTC by Medicare
beneficiaries, especially in rural areas or
underserved populations, before and after
implementation of such screening benefit.
(vi) Such other issues as the Comptroller
General determines appropriate.
(2) Reports.--
(A) Preliminary report.--Not later than March 1,
2015, the Comptroller General shall submit a
preliminary report to Congress on the study conducted
under paragraph (1).
(B) Final report.--Not later than March 1, 2016,
the Comptroller General shall submit a final report to
Congress on the study conducted under paragraph (1),
together with recommendations for such legislation and
administrative action as the Comptroller General
determines appropriate.
<all>
Introduced in House
Introduced in House
Referred to House Energy and Commerce
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to House Ways and Means
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line