Colorectal Cancer Screening Act of 1997

Summary: Colorectal Cancer Screening Act of 1997 - Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to:  (1) cover colorectal cancer screening tests for individuals age 50 or over (screening fecal-occult blood tests, flexible sigmoidoscopies, barium enemas, and, for high-risk individuals, colonoscopy); and (2) prescribe frequency and payment limits.  Requires the Secretary of Health and Human Services to review such coverage after two years and determine whether to terminate it for one or more of such tests.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Colorectal Cancer Screening Act of 
1997''.

SEC. 2. MEDICARE COVERAGE OF COLORECTAL SCREENING SERVICES.

    (a) Coverage.--
            (1) In general.--Section 1861 of the Social Security Act 
        (42 U.S.C. 1395x) is amended--
                    (A) in subsection (s)(2)--
                            (i) by striking ``and'' at the end of 
                        subparagraphs (N) and (O); and
                            (ii) by inserting after subparagraph (O) 
                        the following:
            ``(P) colorectal cancer screening tests (as defined in 
        subsection (oo)); and''; and
                    (B) by adding at the end the following:

                  ``Colorectal Cancer Screening Tests

    ``(oo)(1) The term `colorectal cancer screening test' means, unless 
determined otherwise pursuant to section 2(a)(2) of the Colorectal 
Cancer Screening Act of 1997, any of the following procedures furnished 
to an individual for the purpose of early detection of colorectal 
cancer:
            ``(A) Screening fecal-occult blood test.
            ``(B) Screening flexible sigmoidoscopy.
            ``(C) Screening barium enema.
            ``(D) In the case of an individual at high risk for 
        colorectal cancer, screening colonoscopy or screening barium 
        enema.
            ``(E) For years beginning after 2002, such other procedures 
        as the Secretary finds appropriate for the purpose of early 
        detection of colorectal cancer, taking into account changes in 
        technology and standards of medical practice, availability, 
        effectiveness, costs, the particular screening needs of racial 
        and ethnic minorities in the United States and such other 
        factors as the Secretary considers appropriate.
    ``(2) In paragraph (1)(D), an `individual at high risk for 
colorectal cancer' is an individual who, because of family history, 
prior experience of cancer or precursor neoplastic polyps, a history of 
chronic digestive disease condition (including inflammatory bowel 
disease, Crohn's Disease, or ulcerative colitis), the presence of any 
appropriate recognized gene markers for colorectal cancer, or other 
predisposing factors, faces a high risk for colorectal cancer.''.
            (2) Review of coverage of colorectal cancer screening 
        tests.--
                    (A) In general.--Not later than 2 years after the 
                date of enactment of this Act (and periodically 
                thereafter), the Secretary of Health and Human Services 
                (in this paragraph referred to as the ``Secretary'') 
                shall review--
                            (i) the standards of medical practice with 
                        regard to colorectal cancer screening tests (as 
                        defined in section 1861(oo) of the Social 
                        Security Act (42 U.S.C. 1395x(oo))) (as added 
                        by paragraph (1) of this section);
                            (ii) the availability, effectiveness, 
                        costs, and cost-effectiveness of colorectal 
                        cancer screening tests covered under the 
                        medicare program under title XVIII of the 
                        Social Security Act (42 U.S.C. 1395 et seq.) at 
                        the time of such review;
                            (iii) the particular screening needs of 
                        racial and ethnic minorities in the United 
                        States; and
                            (iv) such other factors as the Secretary 
                        considers appropriate with regard to the 
                        coverage of colorectal cancer screening tests 
                        under the medicare program.
                    (B) Determination.--If the Secretary determines it 
                appropriate based on the review conducted pursuant to 
                subparagraph (A), the Secretary shall issue and publish 
                a determination that one or more colorectal cancer 
                screening tests described in section 1861(oo) of the 
                Social Security Act (42 U.S.C. 1395x(oo)) (as added by 
                paragraph (1) of this section) shall no longer be 
                covered under that section.
    (b) Frequency and Payment Limits.--
            (1) In general.--Section 1834 of the Social Security Act 
        (42 U.S.C. 1395m) is amended by inserting after subsection (c) 
        the following:
    ``(d) Frequency and Payment Limits for Colorectal Cancer Screening 
Tests.--
            ``(1) Screening fecal-occult blood tests.--
                    ``(A) Payment limit.--In establishing fee schedules 
                under section 1833(h) with respect to colorectal cancer 
                screening tests consisting of screening fecal-occult 
                blood tests, except as provided by the Secretary under 
                paragraph (5)(A), the payment amount established for 
                tests performed--
                            ``(i) in 1998 shall not exceed $5; and
                            ``(ii) in a subsequent year, shall not 
                        exceed the limit on the payment amount 
                        established under this subsection for such 
                        tests for the preceding year, adjusted by the 
                        applicable adjustment under section 1833(h) for 
                        tests performed in such year.
                    ``(B) Frequency limit.--Subject to revision by the 
                Secretary under paragraph (5)(B), no payment may be 
                made under this part for colorectal cancer screening 
                test consisting of a screening fecal-occult blood 
                test--
                            ``(i) if the individual is under 50 years 
                        of age; or
                            ``(ii) if the test is performed within the 
                        11 months after a previous screening fecal-
                        occult blood test.
            ``(2) Screening for individuals not at high risk.--Subject 
        to revision by the Secretary under paragraph (5)(B), no payment 
        may be made under this part for a colorectal cancer screening 
        test consisting of a screening flexible sigmoidoscopy or 
        screening barium enema--
                            ``(i) if the individual is under 50 years 
                        of age; or
                            ``(ii) if the procedure is performed within 
                        the 47 months after a previous screening 
                        flexible sigmoidoscopy or screening barium 
                        enema.
            ``(3) Screening for individuals at high risk for colorectal 
        cancer.--Subject to revision by the Secretary under paragraph 
        (5)(B), no payment may be made under this part for a colorectal 
        cancer screening test consisting of a screening colonoscopy or 
        screening barium enema for individuals at high risk for 
        colorectal cancer if the procedure is performed within the 23 
        months after a previous screening colonoscopy or screening 
        barium enema.
            ``(4) Payment amounts for certain colorectal cancer 
        screening tests.--The Secretary shall establish payment amounts 
        under section 1848 with respect each colorectal cancer 
        screening tests described in subparagraphs (B), (C), and (D) of 
        section 1861(oo)(1) that are consistent with payment amounts 
        under such section for similar or related services, except that 
        such payment amount shall be established without regard to 
        section 1848(a)(2)(A).
            ``(5) Reductions in payment limit and revision of 
        frequency.--
                    ``(A) Reductions in payment limit for screening 
                fecal-occult blood tests.--The Secretary shall review 
                from time to time the appropriateness of the amount of 
                the payment limit established for screening fecal-
                occult blood tests under paragraph (1)(A). The 
                Secretary may, with respect to tests performed in a 
                year after 2000, reduce the amount of such limit as it 
                applies nationally or in any area to the amount that 
the Secretary estimates is required to assure that such tests of an 
appropriate quality are readily and conveniently available during the 
year.
                    ``(B) Revision of frequency.--
                            ``(i) Review.--The Secretary shall review 
                        periodically the appropriate frequency for 
                        performing colorectal cancer screening tests 
                        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 tests may be 
                        paid for under this subsection, but no such 
                        revision shall apply to tests performed before 
                        January 1, 2001.
            ``(6) Limiting charges of nonparticipating physicians.--
                    ``(A) In general.--In the case of a colorectal 
                cancer screening test consisting of a screening 
                flexible sigmoidoscopy or screening barium enema, or a 
                screening colonoscopy or screening barium enema 
                provided to an individual at high risk for colorectal 
                cancer for which payment may be made under this part, 
                if a nonparticipating physician provides the procedure 
                to an individual enrolled under this part, the 
                physician may not charge the individual more than the 
                limiting charge (as defined in section 1848(g)(2)).
                    ``(B) Enforcement.--If a physician or supplier 
                knowingly and willfully imposes a charge in violation 
                of subparagraph (A), the Secretary may apply sanctions 
                against such physician or supplier in accordance with 
                section 1842(j)(2).''.
    (c) Conforming Amendments.--
            (1) Paragraphs (1)(D) and (2)(D) of section 1833(a) of the 
        Social Security Act (42 U.S.C. 1395l(a)) are each amended by 
        inserting ``or section 1834(d)(1)'' after ``subsection 
        (h)(1)''.
            (2) Section 1833(h)(1)(A) of the Social Security Act (42 
        U.S.C. 1395l(h)(1)(A)) is amended by striking ``The Secretary'' 
        and inserting ``Subject to paragraphs (1) and (5)(A) of section 
        1834(d), the Secretary''.
            (3) Clauses (i) and (ii) of section 1848(a)(2)(A) of the 
        Social Security Act (42 U.S.C. 1395w-4(a)(2)(A)) are each 
        amended by inserting after ``a service'' the following: 
        ``(other than a colorectal cancer screening test consisting of 
        a screening colonoscopy or screening barium enema provided to 
        an individual at high risk for colorectal cancer or a screening 
        flexible sigmoidoscopy or screening barium enema)''.
            (4) Section 1862(a) of the Social Security Act (42 U.S.C. 
        1395y(a)) is amended--
                    (A) 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:
            ``(G) in the case of colorectal cancer screening tests, 
        which are performed more frequently than is covered under 
        section 1834(d);''; and
                    (B) in paragraph (7), by striking ``paragraph 
                (1)(B) or under paragraph (1)(F)'' and inserting 
                ``subparagraph (B), (F), or (G) of paragraph (1)''.

SEC. 3. EFFECTIVE DATE.

    The amendments made by section 2 shall apply to items and services 
furnished on or after January 1, 1998.