Prostate Cancer Diagnosis and Treatment Act of 1994

Summary: Prostate Cancer Diagnosis and Treatment Act of 1994 - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of specified prostate cancer screening services 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 screening 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 1994''.

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 13553(a) of 
        the Omnibus Budget Reconciliation Act of 1993 (hereafter in 
        this Act referred to as ``OBRA-1993''), is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (P);
                    (B) by adding ``and'' at the end of subparagraph 
                (Q); and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(R) prostate cancer screening services (as defined in 
        subsection (ll));''.
            (2) Services described.--Section 1861 of such Act (42 
        U.S.C. 1395x) is amended--
                    (A) by redesignating the subsection (jj) inserted 
                by section 4156(a)(2) of the Omnibus Budget 
                Reconciliation Act of 1990 as subsection (kk); and
                    (B) by inserting after such subsection the 
                following new subsection:

                  ``Prostate Cancer Screening Services

    ``(ll) The term `prostate cancer screening services' 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 Prostate Cancer 
Screening Services.--
            ``(1) In general.--Notwithstanding any other provision of 
        this part, with respect to expenses incurred for prostate 
        cancer screening services (as defined in section 1861(ll))--
                    ``(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 prostate cancer 
                        screening service 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 prostate 
                        cancer screening service, 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 prostate 
                cancer screening service provided to an individual for 
                the purpose of early detection of prostate cancer--
                            ``(i) if the individual is under 50 years 
                        of age; or
                            ``(ii) if the service is provided within 
                        the 11 months after a previous prostate cancer 
                        screening service.
                    ``(B) Exception for high risk individuals.--Payment 
                may be made under this part for a prostate cancer 
                screening service 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 prostate 
                        cancer screening services 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 
                prostate cancer screening services 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.--
                    ``(A) In general.--In the case of a prostate cancer 
                screening service provided to an individual for the 
                purpose of early detection of prostate cancer for which 
                payment may be made under this part, if a 
                nonparticipating physician or supplier provides the 
                procedure to an individual enrolled under this part, 
                the physician or supplier may not charge the individual 
                more than the limiting charge (as defined in section 
                1848(g)(2)).
                    ``(B) Enforcement.--If a physician or supplier 
                knowing 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).''.
            (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)), 
        as amended by section 13544(b)(2) of OBRA-1993, 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 
                prostate cancer screening services (as defined in 
                section 1861(ll)) (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 prostate cancer screening services (as 
        defined in section 1861(ll)) (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 1861(s)(2)(O) of such Act (42 U.S.C. 
        1395x(s)(2)(O)) is amended by striking ``(jj)'' and inserting 
        ``(kk)''.
            (F) 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 prostate cancer screening services (as 
        defined in section 1861(ll)) provided for the purpose of early 
        detection of prostate cancer, 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 (Q);
            (2) by adding ``and'' at the end of subparagraph (R); and
            (3) by adding at the end the following new subparagraph:
            ``(S) 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, 1995, 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. COVERAGE OF PROSTATE CANCER SCREENING AND TREATMENT SERVICES 
              FOR VETERANS.

    (a) Prostate Cancer Screening and Diagnosis Defined as Preventive 
Health Service.--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) screening and diagnostic tests approved for prostate 
        cancer;''.
    (b) Coverage of Prostate Cancer Screening and Treatment.--
            (1) In general.--Chapter 17 of title 38, United States 
        Code, is amended by inserting after section 1724 a new section 
        as follows:
``Sec. 1725. Prostate cancer screening and treatment
    ``(a) The Secretary shall include in the medical services made 
available to veterans under this chapter appropriate prostate cancer 
screening, counseling, treatment, and information. Based on the best 
available medical evidence, the Secretary shall develop and implement 
an appropriate prostate cancer screening schedule for those veterans 
confined to hospitals or other institutions.
    ``(b) For the purposes of this section--
            ``(1) appropriate prostate cancer screening means 
        procedures provided to a man for the purpose of early detection 
        of prostate cancer, including digital rectal examinations, 
        prostate-specific antigen blood tests, and transrectal 
        ultrasonography; and
            ``(2) appropriate prostate cancer treatment includes drugs 
        approved by the Food and Drug Administration for the treatment 
        of prostate cancer.
    ``(c) 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 screening 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: ``$72,000,000 for fiscal year 1994, $86,000,000 for 
fiscal year 1995, $100,000,000 for fiscal year 1996, and such sums as 
may be necessary for each of the fiscal years 1997 and 1998.''.
    (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.''.