Prostate Cancer Diagnosis and Treatment Act of 1995

Summary: Prostate Cancer Diagnosis and Treatment Act of 1995 - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of services for the early detection of prostate cancer and certain drug treatments for such cancer.  Requires the Secretary of Health and Human Services to establish fee schedules for such services. 
Amends Federal law to cover such detection and treatment services for veterans as a preventive health service. 
Amends the Public Health Service Act to authorize appropriations for certain public health programs related to prostate cancer research and education. 
Directs the Administrator of the Agency for Health Care Policy and Research to:  (1) conduct and support prostate cancer health services and screening and treatment procedures; and (2) provide for the development, periodic review, and updating of clinically relevant guidelines, standards of quality, performance measures, and medical review criteria.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Prostate Cancer Diagnosis and 
Treatment Act of 1995''.

SEC. 2. MEDICARE COVERAGE OF PROSTATE CANCER SCREENING AND CERTAIN DRUG 
              TREATMENTS.

    (a) Coverage of Screening Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)), as amended by section 
        147(f)(6)(B)(iii) of the Social Security Act Amendments of 
        1994, is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (N);
                    (B) by striking ``and'' at the end of subparagraph 
                (O); and
                    (C) by inserting after subparagraph (O) the 
                following new subparagraph:
            ``(P) services for the early detection of prostate cancer 
        (as defined in subsection (oo)); and''.
            (2) Services described.--Section 1861 of such Act (42 
        U.S.C. 1395x) is amended by adding at the end the following new 
        subsection:

         ``Services for the Early Detection of Prostate Cancer

    ``(oo) The term `services for the early detection of prostate 
cancer' means the following procedures provided to a man for the 
purpose of early detection of prostate cancer:
            ``(1) Digital rectal examination.
            ``(2) Prostate-specific antigen blood test.
            ``(3) Transrectal ultrasonography.
            ``(4) Such other procedures as the Secretary may designate 
        as appropriate for early detection of prostate cancer.''.
            (3) Payment amounts; limitations on frequency of 
        coverage.--Section 1834 of such Act (42 U.S.C. 1395m) is 
        amended by inserting after subsection (c) the following new 
        subsection:
    ``(d) Payment Amounts and Frequency Limits for Services for the 
Early Detection of Prostate Cancer.--
            ``(1) In general.--Notwithstanding any other provision of 
        this part, with respect to expenses incurred for services for 
        the early detection of prostate cancer (as defined in section 
        1861(oo))--
                    ``(A) payment may be made only for services 
                provided consistent with the frequency permitted under 
                paragraph (2); and
                    ``(B) the amount of the payment under this part 
                shall be equal to 80 percent of the lesser of the 
                actual charge for the service or--
                            ``(i) in the case of a service for the 
                        early detection of prostate cancer consisting 
                        of a prostate-specific antigen blood test, the 
                        fee schedule amount established for the service 
                        under section 1833(h) (relating to payments for 
                        clinical diagnostic laboratory tests); or
                            ``(ii) in the case of any other service for 
                        the early detection of prostate cancer, the 
                        amount provided under the fee schedule 
                        established by the Secretary under paragraph 
                        (3) (subject to the deductible established 
                        under section 1833(b)).
            ``(2) Frequency covered.--
                    ``(A) In general.--Subject to subparagraph (B) and 
                to revision by the Secretary under subparagraph (C), no 
                payment may be made under this part for a service for 
                the early detection of prostate cancer provided to an 
                individual--
                            ``(i) if the individual is under 50 years 
                        of age; or
                            ``(ii) if the service is provided within 
                        the 11 months after a previous service for the 
                        early detection of prostate cancer.
                    ``(B) Exception for high risk individuals.--Payment 
                may be made under this part for a service for the early 
                detection of prostate cancer provided to an individual 
                more frequently than the limit established under 
                subparagraph (A)(ii) if the individual is at a high 
                risk of developing prostate cancer (as determined 
                pursuant to factors identified by the Secretary).
                    ``(C) Revision by secretary.--
                            ``(i) Review.--The Secretary, in 
                        consultation with the Director of the National 
                        Cancer Institute, shall review periodically the 
                        appropriate frequency for performing services 
                        for the early detection of prostate cancer 
                        based on age and such other factors as the 
                        Secretary believes to be pertinent.
                            ``(ii) Revision of frequency.--The 
                        Secretary, taking into consideration the review 
                        made under clause (i), may revise from time to 
                        time the frequency with which such services may 
                        be paid for under this subsection, but no such 
                        revision shall apply to services performed 
                        before January 1, 1998.
            ``(3) Establishment of fee schedule.--
                    ``(A) In general.--The Secretary shall establish 
                fee schedules (on such geographic basis as the 
                Secretary considers appropriate) for payment for 
                services for the early detection of prostate cancer 
                under this part (other than prostate-specific antigen 
                blood tests), effective for services furnished after 
                the expiration of the 90-day period beginning on the 
                date the Secretary establishes the fee schedules.
                    ``(B) Factors considered.--In establishing fee 
                schedules under subparagraph (A), the Secretary shall 
                take into consideration variations in the cost of 
                furnishing such services among geographic areas and 
                among different sites where services are furnished, 
                together with such other factors as may be appropriate 
                to assure that payment amounts are equitable.
            ``(4) Limiting charges of nonparticipating physicians.--In 
        the case of a service for the early detection of prostate 
        cancer for which payment may be made under this part, if a 
        nonparticipating physician or nonparticipating supplier or 
        other person (as defined in section 1842(i)(2)) who does not 
        accept payment on an assignment-related basis provides the 
        service to an individual enrolled under this part, section 
        1848(g)(1) shall apply to the service in the same manner as 
        such section applies to a physician's service.''.
            (4) Conforming amendments.--(A) Paragraphs (1)(D) and 
        (2)(D) of section 1833(a) of such Act (42 U.S.C. 1395l(a)) are 
        each amended by striking ``subsection (h)(1),'' and inserting 
        ``subsection (h)(1) or section 1834(d)(1)(B)(i),''.
            (B) Section 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) 
        is amended--
                    (i) by striking ``and (P)'' and inserting ``(P)''; 
                and
                    (ii) by striking the semicolon at the end and 
                inserting the following: ``, and (Q) with respect to 
                services for the early detection of prostate cancer (as 
                defined in section 1861(oo)) (other than prostate-
                specific antigen tests), the amounts paid shall be the 
                amounts described in section 1834(d)(1);''.
            (C) Section 1833(a) of such Act (42 U.S.C. 1395l(a)) is 
        amended--
                    (i) by striking ``and'' at the end of paragraph 
                (6);
                    (ii) by striking the period at the end of paragraph 
                (7) and inserting ``; and''; and
                    (iii) by adding at the end the following new 
                paragraph:
            ``(8) in the case of services for the early detection of 
        prostate cancer (as defined in section 1861(oo)) (other than 
        prostate-specific antigen tests), the amounts described in 
        section 1834(d)(1).''.
            (D) Section 1833(h)(1)(A) of such Act (42 U.S.C. 
        1395l(h)(1)(A)) is amended by striking ``The Secretary'' and 
        inserting ``Subject to section 1834(d), the Secretary''.
            (E) Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is 
        amended--
                    (i) in paragraph (1)--
                            (I) in subparagraph (E), by striking 
                        ``and'' at the end,
                            (II) in subparagraph (F), by striking the 
                        semicolon at the end and inserting ``, and'', 
                        and
                            (III) by adding at the end the following 
                        new subparagraph:
            ``(G) in the case of services for the early detection of 
        prostate cancer (as defined in section 1861(oo)), which are 
        performed more frequently than is covered under section 
        1834(d)(2);''; and
                    (ii) in paragraph (7), by striking ``paragraph 
                (1)(B) or under paragraph (1)(F)'' and inserting 
                ``subparagraphs (B), (F), or (G) of paragraph (1)''.
    (b) Coverage of Certain Drug Treatments.--Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by subsection 
(a)(1), is further amended--
            (1) by striking ``and'' at the end of subparagraph (P);
            (2) by adding ``and'' at the end of subparagraph (Q); and
            (3) by adding at the end the following new subparagraph:
            ``(R) an oral drug prescribed for the treatment of prostate 
        cancer, if the use of the drug for such purpose is a medically 
        accepted indication under subsection (t)(2);''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services provided on or after January 1, 1996, without regard 
to whether or not the Secretary has established fee schedules under 
section 1834(d)(3) of the Social Security Act (as added by subsection 
(a)(3)) or promulgated other regulations to carry out such amendments 
by that date.

SEC. 3. EARLY DETECTION AND TREATMENT OF PROSTATE CANCER IN VETERANS.

    (a) Preventive Health Services.--Section 1701(9) of title 38, 
United States Code is amended--
            (1) by redesignating subparagraphs (J) and (K) as 
        subparagraphs (K) and (L), respectively; and
            (2) by inserting after subparagraph (I) the following new 
        subparagraph (J):
            ``(J) tests for the early detection and diagnosis of 
        prostate cancer;''.
    (b) Coverage of Services for Early Detection and Treatment of 
Prostate Cancer.--
            (1) In general.--Chapter 17 of such title is amended by 
        inserting after section 1724 the following new section:
``Sec. 1725. Prostate cancer detection and treatment
    ``(a) The Secretary shall include in the medical services furnished 
to veterans under this chapter--
            ``(1) services for the early detection and treatment of 
        prostate cancer;
            ``(2) information on the early detection and treatment of 
        prostate cancer; and
            ``(3) counseling regarding prostate cancer.
    ``(b) Based on the best available medical evidence, the Secretary 
shall implement a schedule for early detection of prostate cancer for 
veterans confined to hospitals or other institutions.
    ``(c) For the purposes of this section--
            ``(1) services for the early detection of prostate cancer 
        are procedures provided to a male for the purpose of the early 
        detection of prostate cancer, including digital rectal 
        examinations, prostate-specific antigen blood tests, and 
        transrectal ultrasonography; and
            ``(2) services for treatment of prostate cancer may include 
        the furnishing of drugs approved by the Food and Drug 
        Administration for the treatment of prostate cancer.
    ``(d) The Secretary may carry out research and research training in 
the diagnosis and treatment of prostate cancer based upon the prostate 
cancer services provided under this section and may develop guidelines 
outlining effective treatment regimens for prostate cancer.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 1724 the following new item:

``1725. Prostate cancer detection and treatment.''.

SEC. 4. RESEARCH AND EDUCATION REGARDING PROSTATE CANCER; CERTAIN 
              PROGRAMS OF PUBLIC HEALTH SERVICE.

    (a) National Institutes of Health.--Section 417B(c) of the Public 
Health Service Act (42 U.S.C. 286a-8(c)) is amended in the first 
sentence by striking ``$72,000,000'' and all that follows and inserting 
the following: ``$86,000,000 for fiscal year 1996, $100,000,000 for 
fiscal year 1997, $115,000,000 for fiscal year 1998, and $130,000,000 
for fiscal year 1999.''.
    (b) Agency for Health Care Policy and Research.--Section 902 of the 
Public Health Service Act (42 U.S.C. 299a) is amended by adding at the 
end the following subsection:
    ``(f) Activities Regarding Prostate Cancer.--The Administrator 
shall, with respect to prostate cancer--
            ``(1) conduct and support research on the outcomes, 
        effectiveness, and appropriateness of health services and 
        procedures; and
            ``(2) in carrying out section 912(a), provide for the 
        development, periodic review, and updating of clinically 
        relevant guidelines, standards of quality, performance 
        measures, and medical review criteria.''.