CT Colonography Screening for Colorectal Cancer Act of 2012 - 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 Secretary of Health and Human Services (HHS) to submit a preliminary report to Congress on the status of coverage of CTC as a CRC screening test under Medicare, including the extent to which such coverage as required by this Act has been implemented.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4165 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 4165
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
March 8, 2012
Mr. Hall (for himself, Mr. Davis of Illinois, and Mr. Cole) 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 ``CT Colonography Screening for
Colorectal Cancer Act of 2012''.
SEC. 2. COVERAGE OF COMPUTED TOMOGRAPHY COLONOGRAPHY SCREENING 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, based upon rates recognized for diagnostic
computed tomography colonography.
``(C) Facility payment limit.--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, 2013.
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, 2013.
SEC. 4. REPORTS ON THE STATUS OF COVERING COMPUTED TOMOGRAPHY
COLONOGRAPHY AS A COLORECTAL CANCER SCREENING TEST UNDER
MEDICARE.
(a) Preliminary Report.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Health and Human Services
shall submit a preliminary report to Congress on the status of coverage
of computed tomography colonography as a colorectal cancer screening
test under the Medicare program under title XVIII of the Social
Security Act, including the extent to which such coverage as required
by the amendments made by sections 2 and 3 has been implemented.
(b) Annual Report.--Not later than September 30 of each fiscal year
during the 5-year period beginning with fiscal year 2014, the Secretary
shall submit to the Congress, a status report on the following:
(1) The impact of screening computed tomography
colonography on the change in colorectal cancer screening
compliance of Medicare beneficiaries.
(2) The various utilization rates with respect to Medicare
beneficiaries for each available colorectal cancer screening
option before and after the availability of and coverage of
screening computed tomography colonography under the Medicare
program pursuant to the enactment of this Act, including--
(A) by initial CRC screening performed with respect
to a Medicare beneficiary per year, including the age
of the beneficiary when the initial screening was
performed; and
(B) by follow-on screening performed, whereby the
analysis demonstrates to what extent screening computed
tomography colonography was used as a substitute for a
previous screening procedure.
(3) Access to screening computed tomography colonography by
Medicare beneficiaries, especially in rural areas or
underserved populations, before and after the date of
implementation of coverage of such screening benefit under the
Medicare program pursuant to the enactment of this Act.
(4) Recommendations for such legislation and administrative
action as the Secretary determines appropriate to implement
this Act.
<all>
Introduced in House
Introduced in House
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 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 the Subcommittee on Health.
Referred to the Subcommittee on Health.
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