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H.R. 2557 (115th): Prostate Cancer Misdiagnosis Elimination Act of 2017


The text of the bill below is as of Dec 6, 2017 (Reported by House Committee). The bill was not enacted into law.


IB

Union Calendar No. 331

115th CONGRESS

1st Session

H. R. 2557

[Report No. 115–449, Part I]

IN THE HOUSE OF REPRESENTATIVES

May 19, 2017

(for himself, Mr. Payne, Mr. Carson of Indiana, Mr. Mullin, and Mr. Rush) 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

December 6, 2017

Additional sponsors: Mrs. Walorski and Mrs. Brooks of Indiana

December 6, 2017

Reported from the Committee on Energy and Commerce with an amendment

Strike out all after the enacting clause and insert the part printed in italic

December 6, 2017

The Committee on Ways and Means discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed

For text of introduced bill, see copy of bill as introduced on May 19, 2017


A BILL

To amend title XVIII of the Social Security Act to provide for coverage under the Medicare program of certain DNA Specimen Provenance Assay clinical diagnostic laboratory tests.


1.

Short title

This Act may be cited as the Prostate Cancer Misdiagnosis Elimination Act of 2017.

2.

Coverage of certain DNA Specimen Provenance Assay clinical diagnostic laboratory tests under Medicare

(a)

Coverage

Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended—

(1)

in subparagraph (O), by striking and at the end;

(2)

in subparagraph (P), by striking the semicolon at the end and inserting , and; and

(3)

by adding at the end the following new subparagraph:

(Q)

in the case of a DNA Specimen Provenance Assay clinical diagnostic laboratory test (DSPA test) furnished on or after the date specified in section 1834A(j)(4), unless the DSPA test is furnished to an individual enrolled under part B who has had a prostate cancer biopsy the results of which are positive, the DSPA test is furnished with respect to such biopsy, and the DSPA test is ordered by the physician who furnished the prostate cancer biopsy that obtained the specimen tested;

.

(b)

Temporary payment amount for certain tests furnished before 2028 and related requirements

Section 1834A of the Social Security Act (42 U.S.C. 1395m–1) is amended—

(1)

in subsection (b)(1)(A), by striking and (d) and inserting , (d), and (j); and

(2)

by adding at the end the following new subsection:

(j)

DNA Specimen Provenance Assay clinical diagnostic laboratory tests

(1)

Temporary payment amount for certain tests furnished before 2028

With respect to a DNA Specimen Provenance Assay clinical diagnostic laboratory test furnished on or after the date specified in paragraph (4) and before January 1, 2028, the payment amount under this section for such test shall be equal to $200.

(2)

HCPCS code and modifier assignment

(A)

In general

The Secretary shall assign one or more HCPCS codes to the DNA Specimen Provenance Assay clinical diagnostic laboratory test and may use a modifier to facilitate making payment under this section with respect to such test.

(B)

Identification of DNA match on claim

The Secretary shall require an indication on a claim for a DNA Specimen Provenance Assay clinical diagnostic laboratory test of whether the DNA of the prostate biopsy specimen for such test matches the DNA of the individual with respect to whom the test was ordered. Such indication may be made through use of a HCPCS code, a modifier, or other means, as determined appropriate by the Secretary.

(3)

DNA match review

(A)

In general

The Secretary shall review at least three years of claims under part B for DNA Specimen Provenance Assay clinical diagnostic laboratory tests to identify whether the DNA of the prostate biopsy specimens for such tests matched the DNA of the individuals with respect to whom such tests were ordered.

(B)

Posting on Internet website

Not later than July 1, 2024, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services the findings of the review conducted under subparagraph (A).

(4)

Date specified

For purposes of paragraph (1) and section 1862(a)(1)(Q), the date specified in this paragraph is the first day of the second calendar quarter that begins at least 180 days after the date of the enactment of this subsection.

.

December 6, 2017

Reported from the Committee on Energy and Commerce with an amendment

December 6, 2017

The Committee on Ways and Means discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed