Supporting Colorectal Examination and Education Now Act of 2013 or SCREEN Act of 2013 - Increases Medicare payments to qualifying Medicare providers by 10% for cancer screening tests recommended by the U.S. Preventive Services Task Force. Terminates the increase for a test when it reaches a 75% utilization rate for beneficiaries for whom such screening is recommended. Makes a Medicare provider eligible for such increased payment only if the provider: (1) participates in a nationally recognized quality improvement registry with respect to such test, and (2) demonstrates that the tests were provided in accordance with accepted outcomes-based quality measures.
Amends title XVIII (Medicare) of the Social Security Act to waive cost-sharing for colorectal cancer screening tests.
Extends Medicare coverage to include an outpatient office visit or consultation prior to a colorectal cancer test consisting of a screening colonoscopy, or in conjunction with an individual's decision regarding the performance of such a test on the individual, for the purpose of beneficiary education, assuring selection of the proper screening test, and securing information relating to the procedure and the sedation of the individual.
Requires the Secretary of Health and Human Services (HHS) to reduce the conversion factors for purposes of payment to physicians and hospital outpatient departments under Medicare to offset the additional expenditures under this Act.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1320 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 1320
To amend title XVIII of the Social Security Act to improve coverage for
colorectal screening tests under Medicare, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 21, 2013
Mr. Neal 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 improve coverage for
colorectal screening tests under Medicare, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Supporting
Colorectal Examination and Education Now Act of 2013'' or the ``SCREEN
Act of 2013''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Temporary increase in payment rate for certain cancer screening
tests.
Sec. 4. Waiving Medicare cost-sharing for colorectal cancer screening
with therapeutic effect.
Sec. 5. Medicare coverage for an office visit or consultation prior to
a qualifying screening colonoscopy.
Sec. 6. Budget neutrality.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Colon cancer is the third most common cause of cancer-
related deaths and the second most common cancer for both men
and women.
(2) According to the American Cancer Society, over 50,000
people will die this year from colon cancer.
(3) Colorectal cancer is highly treatable with appropriate
screening. According to the American Cancer Society (2010 Facts
& Figures), the 5-year survival rate is 90 percent for those
individuals who are diagnosed at an early stage of the cancer.
However, less than 40 percent of colon cancer cases are
diagnosed at an early stage.
(4) The Centers for Disease Control and Prevention recently
estimated that approximately 2,000 deaths could be avoided if
colonoscopy screening rates rose by just 10 percent.
(5) Colonoscopies allow for simultaneous colorectal cancer
screenings and detection and the removal of precancerous
polyps, thus preventing cancer from developing.
(6) The U.S. Preventive Services Task Force provides an
``A'' rating for colorectal cancer screenings.
(7) The Centers for Disease Control and Prevention's
colorectal cancer control program has set a target of screening
80 percent of eligible adults in certain States by 2014. The
American Cancer Society and other patient advocacy groups have
a target rate of 75 percent.
(8) Only between 52 and 58 percent of Medicare
beneficiaries have had any colorectal cancer screening test,
despite Medicare coverage for such tests.
(9) Only 49.3 percent of Medicare beneficiaries who are 50
to 80 years old receive colorectal cancer screenings within
recommended intervals.
(10) The Centers for Medicare & Medicaid Services notes
that there is ``clearly an opportunity to improve colorectal
cancer screening rates in the Medicare population''.
(11) A January 2011 study by the Colon Cancer Alliance
concludes that most Americans over the age of 50--
(A) wish a health care provider was able to sit
down with them to discuss a colonoscopy before
undergoing the test; and
(B) forgo a colonoscopy due to fear of the
procedure.
(12) In February 2010, the National Institutes of Health
hosted a conference on colorectal cancer screening and cited
patient awareness and fears as barriers to increasing
colorectal cancer screening rates.
(13) According to the Medicare Payment Advisory Commission,
colonoscopy is one of the most common procedures performed in
the ambulatory surgical centers (ASCs) and ``the decline in
payment rate for the highest volume procedures is especially a
strong concern for ASCs that focus on gastroenterology''.
(14) An Institute of Medicine study on colorectal cancer
screening cited the inadequate reimbursement for preventive
care services as one of the constraints limiting colorectal
cancer screening rates.
(15) Colorectal cancer screening by colonoscopy has been
demonstrated to reduce Medicare costs over the long-term.
SEC. 3. TEMPORARY INCREASE IN PAYMENT RATE FOR CERTAIN CANCER SCREENING
TESTS.
(a) In General.--With respect to a qualifying cancer screening test
furnished during the 5-year period beginning on January 1, 2014, by a
qualifying provider, the amount otherwise payable under section 1833 or
section 1848 of the Social Security Act (42 U.S.C. 1395l, 1395w-4) to
such provider for such test shall be increased by 10 percent.
(b) Qualifying Cancer Screening Test.--
(1) In general.--For purposes of this section, subject to
paragraph (2), the term ``qualifying cancer screening test''
means, with respect to a Medicare beneficiary, a cancer
screening test that has in effect with respect to such
beneficiary a rating of `A' in the current recommendations of
the United States Preventive Services Task Force.
(2) Termination when high utilization rate reached.--If the
Secretary of Health and Human Services determines that a cancer
screening test described in paragraph (1) has a utilization
rate of at least 75 percent of the Medicare beneficiaries for
whom such screening has such a recommendation, effective as of
the first day of the year after the year in which such
determination is made, the cancer screening test shall not be a
qualifying cancer screening test.
(c) Qualifying Provider Defined.--For purposes of this section, the
term ``qualifying provider'' means, with respect to a qualifying cancer
screening test, an individual or entity--
(1) that is eligible for payment for such test under
section 1833 or section 1848 of the Social Security Act (42
U.S.C. 1395l, 1395w-4); and
(2) that--
(A) participates in a nationally recognized quality
improvement registry with respect to such test; and
(B) demonstrates, to the satisfaction of the
Secretary, based on the information in such registry,
that the tests were provided by such individual or
entity in accordance with accepted outcomes-based
quality measures.
SEC. 4. WAIVING MEDICARE COST-SHARING FOR COLORECTAL CANCER SCREENING
WITH THERAPEUTIC EFFECT.
(a) In General.--Section 1833(a)(1)(Y) of the Social Security Act
(42 U.S.C. 1395l(a)(1)(Y)) is amended by inserting ``, including tests
and procedures described in the last sentence of subsection (b),''
after ``section 1861(ddd)(3)''.
(b) Effective Date.--The amendment made by this section shall apply
to tests and procedures performed on or after January 1, 2014.
SEC. 5. MEDICARE COVERAGE FOR AN OFFICE VISIT OR CONSULTATION PRIOR TO
A QUALIFYING SCREENING COLONOSCOPY.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (EE), by striking ``and'' at the end;
(2) in subparagraph (FF), by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(GG) prior to a colorectal cancer screening test
consisting of a screening colonoscopy or in conjunction with an
individual's decision regarding the performance of such a test
on the individual, 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 the sedation of the individual;''.
(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 ``(Z)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (AA) with respect to an
outpatient office visit or consultation under section
1861(s)(2)(GG), 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)(GG),'' after ``(2)(FF) (including
administration of the health risk assessment),''.
(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)) is amended by adding at the end the
following new paragraph:
``(4) 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)(GG),
payment under section 1848 shall be consistent with the payment
amounts for CPT codes 99201, 99202, 99203, 99204, 99211, 99212,
99213, 99214, and 99215 (as in effect as of the date of the
enactment of this paragraph or any successors to such
codes).''.
(c) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2014.
SEC. 6. BUDGET NEUTRALITY.
(a) Adjustment of Physician Fee Schedule Conversion Factor.--The
Secretary of Health and Human Services (in this section referred to as
the ``Secretary'') shall reduce the conversion factor established under
subsection (d) of section 1848 of the Social Security Act (42 U.S.C.
1395w-4) for each year (beginning with 2014) 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 (c)(5) attributable to such section for the year.
(b) Adjustment of HOPD Conversion Factor.--The Secretary shall
reduce the conversion factor established under paragraph (3)(C) of
section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) for
each year (beginning with 2014) 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 (c)(5) attributable to such section for the year.
(c) Determinations Relating to Expenditures.--For purposes of this
section, before the beginning of each year (beginning with 2014) at the
time conversion factors described in subsection (a) and (b) are
established for the year, the Secretary shall determine--
(1) the amount of the gross additional expenditures under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
estimated to result from the implementation of sections 3, 4,
and 5 for items and services furnished during the year;
(2) the amount of any offsetting reductions in expenditures
under such title (such as reductions in payments for inpatient
hospital services) for such year attributable to the
implementation of such sections;
(3) the amount (if any) by which the amount of the gross
additional expenditures determined under paragraph (1) for the
year exceeds the amount of offsetting reductions determined
under paragraph (2) for the year;
(4) of the gross additional expenditures determined under
paragraph (1) for the year that are attributable to
expenditures under sections 1848 and 1833(t) of such Act (42
U.S.C. 1395w-4, 1395l(t)), the ratio of such expenditures that
are attributable to each respective section; and
(5) with respect to section 1848 and section 1833(t) of
such Act (42 U.S.C. 1395w-4, 1395l(t)), a net offset amount for
the year equal to the product of--
(A) the amount of the net additional expenditures
for the year determined under paragraph (3); and
(B) the ratio determined under paragraph (4)
attributable to the respective section.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E352)
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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