I
112th CONGRESS
2d Session
H. R. 4165
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.
Short title
This Act may be cited as the
CT Colonography Screening for
Colorectal Cancer Act of 2012
.
Coverage of computed tomography colonography screening as a colorectal cancer screening test under Medicare
In general
Section 1861(pp)(1) of the Social Security Act (42 U.S.C. 1395x(pp)(1)) is amended—
by redesignating subparagraph (D) as subparagraph (E); and
by inserting after subparagraph (C) the following new subparagraph:
Screening computed tomography colonography.
.
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:
Screening computed tomography colonography
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.
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.
Facility payment limit
Notwithstanding any other provision of this title, in the case of an individual who receives screening computed tomography colonography—
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
the amount of such coinsurance shall not exceed 25 percent of the payment amount under the fee schedule described in subparagraph (A).
Frequency limit
No payment may be made under this part for a colorectal cancer screening test consisting of a screening computed tomography colonography—
if the individual is under 50 years of age; or
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
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.
.
Conforming frequency limits for other colorectal cancer screening tests
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
.
Screening colonoscopy
Paragraph (3)(E) of such section is amended—
by inserting
or screening computed tomography colonography
after 23
months after a previous screening colonoscopy
; and
by inserting
or screening computed tomography colonography
after
screening flexible sigmoidoscopy
.
Effective date
The amendments made by this section shall apply to items and services furnished on or after January 1, 2013.
Exemption of screening computed tomography colonography from special rule on payment for imaging services
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
.
Effective date
The amendment made by subsection (a) shall apply to items and services furnished on or after January 1, 2013.
Reports on the status of covering computed tomography colonography as a colorectal cancer screening test under Medicare
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.
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:
The impact of screening computed tomography colonography on the change in colorectal cancer screening compliance of Medicare beneficiaries.
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—
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
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.
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.
Recommendations for such legislation and administrative action as the Secretary determines appropriate to implement this Act.
