I

103D CONGRESS

2D SESSION H. R. 4988

To provide for a four year demonstration project under Medicare which

shall establish a preventive health care screening examination program.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 18, 1994

Mr. REGULA (for himself and Mr. HUGHES) introduced the following bill;

which was referred jointly to the Committees on Ways and Means and

Energy and Commerce

A BILL

To provide for a four year demonstration project under Medicare which shall establish a preventive health care screening examination program.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. ESTABLISHMENT OF PREVENTIVE HEALTH

4 CARE EXAMINATIONS.

5 (a) COVERAGE OF PREVENTIVE HEALTH CARE EX6 AMINATIONS.—Section 1861(s)(2) of the Social Security

7 Act (42 U.S.C. 1395x(s)(2)) is amended by inserting

8 ‘‘and’’ at the end of paragraph (M) and adding at the end

9 thereof the following:
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1 ‘‘(N) colon cancer preventive screening ex2 amination which shall be limited to either fecal

3 occult blood tests on an annual basis, or

4 sigmoidoscopy examination on an biannual

5 basis, furnished to an individual to assist in the

6 preventive and early diagnose of colon cancer;

7 and

8 ‘‘(O) physical examination, associated

9 blood tests, and such other tests performed by

10 a physician, or qualified health care profes11 sional, on an annual basis in the preventive and

12 early diagnose of prostate cancer; and

13 ‘‘(P) bone mass measurements (including

14 but not limited to radiographic absorptiometry,

15 single-energy photon absorptiometry or single16 energy x-ray absorptiometry, dual-energy x-ray

17 absorptiometry and quantitative computed to18 mography), and such other tests as deemed ap19 propriate by the Secretary of Health and

20 Human Services, in the preventive and early di21 agnose of osteoporosis.’’.

22 (b) CONTINGENT EFFECTIVE DATE; DEMONSTRA23 TION PROJECT.—
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1 (1) The amendments made by this section shall

2 become effective (if at all) in accordance with para3 graph (2).

4 (2) The Secretary of Health and Human Serv5 ices (in this paragraph referred to as the ‘‘Sec6 retary’’) shall establish a demonstration project to

7 begin on October 1, 1994, to test the cost-effective8 ness of furnishing colon, prostrate, and uterine can9 cer preventive screening examinations (in this para10 graph referred to as ‘‘preventive health care exami11 nations’’) under the medicare program to the extent

12 provided under the amendments made by this sec13 tion to a sample group of medicare beneficiaries.

14 (B)(i) The demonstration project under

15 subparagraph (A) shall be conducted for an ini16 tial period of twenty-four months. Not later

17 than October 1, 1996, the Secretary shall re18 port to the Congress on the results of such

19 project. If the Secretary finds, on the basis of

20 existing data, that furnishing any of these ex21 aminations under the Medicare program to the

22 extent provided under the amendments made by

23 this section is cost-effective, and useful in de24 creasing incidents of such cancers, the Sec25 retary shall include such finding in such report,
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1 such project shall be discontinued, and the

2 amendments made by this section shall become

3 effective on November 1, 1966.

4 (ii) If the Secretary determines that such

5 finding cannot be made on the basis of existing

6 data, such project shall continue for an addi7 tional twenty-four months. Not later than April

8 1, 1998, the Secretary shall submit a final re9 port to Congress on the results of such project.

10 The amendments made by this section shall be11 come effective on the first day of the first

12 month to begin after such report is submitted

13 to the Congress unless the report contains a

14 finding by the Secretary that furnishing preven15 tive health care examinations under the amend16 ments made by this section is not cost effective

17 or does not reduce the incidence of such cancers

18 (in which case the amendments made by this

19 section shall not become effective).

20 (3) In conducting the demonstration project in

21 order to determine the cost effectiveness and effec22 tiveness in reducing the incidence of such cancers of

23 including preventive health care examinations in the

24 medicare program, the Secretary is required to con25 duct a demonstration of the provision of preventive
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1 health care examinations as a service for medicare

2 beneficiaries and to expend $15,000,000 each year

3 of the demonstration project for this purpose. In

4 conducting this demonstration, the Secretary is au5 thorized to reimburse for such services in large scale

6 demonstration projects, including statewide projects.

7 In determining cost effectiveness, the Secretary shall

8 consider the direct cost of providing such services,

9 the utilization of such services which might other10 wise not have occurred, the costs of illnesses and

11 nursing home days avoided, and other relevant fac12 tors, except that extended life for beneficiaries shall

13 not be considered to reduce the cost effectiveness of

14 preventive health care examinations.

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