I

104TH CONGRESS

1ST SESSION H. R. 1496

To amend title XVIII of the Social Security Act to provide for coverage

of early detection of prostate cancer and certain drug treatment services

under part B of the medicare program, to amend chapter 17 of title

38, United States Code, to provide for coverage of such early detection

and treatment services under the programs of the Department of Veterans Affairs, and to expand research and education programs of the

National Institutes of Health and the Public Health Service relating

to prostate cancer.

IN THE HOUSE OF REPRESENTATIVES

APRIL 7, 1995

Mr. FIELDS of Texas (for himself, Mr. MCDERMOTT, Mrs. MINK of Hawaii,

Mr. KING, Mr. FATTAH, Mr. YATES, Mr. OXLEY, Mr. LIPINSKI, Mr.

CALVERT, Mr. FRAZER, Mr. BROWN of Ohio, Mr. GENE GREEN of Texas,

Mr. JEFFERSON, Mr. HANSEN, Mr. HALL of Texas, Mrs. CLAYTON, Mr.

FOX of Pennsylvania, Ms. DELAURO, Ms. LOFGREN, Mr. MONTGOMERY,

Mrs. KENNELLY, Mr. HORN, Mr. PALLONE, Mr. JACOBS, Mrs. LOWEY,

Mr. FROST, Mr. EVANS, Mrs. MEEK of Florida, Mr. OLVER, Ms. PELOSI,

Mr. SANDERS, Mr. SCHUMER, Mr. ENGEL, Mr. GUTIERREZ, Mr. GEJDENSON, Mr. ROMERO-BARCELO ́, Mr. BORSKI, Mr. WYNN, Mr. HALL of

Ohio, Mr. BOUCHER, Mr. MCHALE, Mr. JOHNSON of South Dakota, and

Mr. FOGLIETTA) introduced the following bill; which was referred to the

Committee on Commerce, and in addition to the Committees on Ways

and Means and Veterans’ Affairs, 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

A BILL

To amend title XVIII of the Social Security Act to provide

for coverage of early detection of prostate cancer and

certain drug treatment services under part B of the
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medicare program, to amend chapter 17 of title 38,

United States Code, to provide for coverage of such

early detection and treatment services under the programs of the Department of Veterans Affairs, and to

expand research and education programs of the National

Institutes of Health and the Public Health Service relating to prostate cancer.

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

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Prostate Cancer Diag5 nosis and Treatment Act of 1995’’.

6 SEC. 2. MEDICARE COVERAGE OF PROSTATE CANCER

7 SCREENING AND CERTAIN DRUG TREAT8 MENTS.

9 (a) COVERAGE OF SCREENING SERVICES.—

10 (1) IN GENERAL.—Section 1861(s)(2) of the

11 Social Security Act (42 U.S.C. 1395x(s)(2)), as

12 amended by section 147(f)(6)(B)(iii) of the Social

13 Security Act Amendments of 1994, is amended—

14 (A) by striking ‘‘and’’ at the end of sub15 paragraph (N);

16 (B) by striking ‘‘and’’ at the end of sub17 paragraph (O); and

18 (C) by inserting after subparagraph (O)

19 the following new subparagraph:
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1 ‘‘(P) services for the early detection of prostate

2 cancer (as defined in subsection (oo)); and’’.

3 (2) SERVICES DESCRIBED.—Section 1861 of

4 such Act (42 U.S.C. 1395x) is amended by adding

5 at the end the following new subsection:

6 ‘‘Services for the Early Detection of Prostate Cancer

7 ‘‘(oo) The term ‘services for the early detection of

8 prostate cancer’ means the following procedures provided

9 to a man for the purpose of early detection of prostate

10 cancer:

11 ‘‘(1) Digital rectal examination.

12 ‘‘(2) Prostate-specific antigen blood test.

13 ‘‘(3) Transrectal ultrasonography.

14 ‘‘(4) Such other procedures as the Secretary

15 may designate as appropriate for early detection of

16 prostate cancer.’’.

17 (3) PAYMENT AMOUNTS; LIMITATIONS ON FRE18 QUENCY OF COVERAGE.—Section 1834 of such Act

19 (42 U.S.C. 1395m) is amended by inserting after

20 subsection (c) the following new subsection:

21 ‘‘(d) PAYMENT AMOUNTS AND FREQUENCY LIMITS

22 FOR SERVICES FOR THE EARLY DETECTION OF PROS23 TATE CANCER.—

24 ‘‘(1) IN GENERAL.—Notwithstanding any other

25 provision of this part, with respect to expenses in-
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1 curred for services for the early detection of prostate

2 cancer (as defined in section 1861(oo))—

3 ‘‘(A) payment may be made only for serv4 ices provided consistent with the frequency per5 mitted under paragraph (2); and

6 ‘‘(B) the amount of the payment under

7 this part shall be equal to 80 percent of the

8 lesser of the actual charge for the service or—

9 ‘‘(i) in the case of a service for the

10 early detection of prostate cancer consist11 ing of a prostate-specific antigen blood

12 test, the fee schedule amount established

13 for the service under section 1833(h) (re14 lating to payments for clinical diagnostic

15 laboratory tests); or

16 ‘‘(ii) in the case of any other service

17 for the early detection of prostate cancer,

18 the amount provided under the fee sched19 ule established by the Secretary under

20 paragraph (3) (subject to the deductible

21 established under section 1833(b)).

22 ‘‘(2) FREQUENCY COVERED.—

23 ‘‘(A) IN GENERAL.—Subject to subpara24 graph (B) and to revision by the Secretary

25 under subparagraph (C), no payment may be
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1 made under this part for a service for the early

2 detection of prostate cancer provided to an indi3 vidual—

4 ‘‘(i) if the individual is under 50 years

5 of age; or

6 ‘‘(ii) if the service is provided within

7 the 11 months after a previous service for

8 the early detection of prostate cancer.

9 ‘‘(B) EXCEPTION FOR HIGH RISK INDIVID10 UALS.—Payment may be made under this part

11 for a service for the early detection of prostate

12 cancer provided to an individual more fre13 quently than the limit established under sub14 paragraph (A)(ii) if the individual is at a high

15 risk of developing prostate cancer (as deter16 mined pursuant to factors identified by the Sec17 retary).

18 ‘‘(C) REVISION BY SECRETARY.—

19 ‘‘(i) REVIEW.—The Secretary, in con20 sultation with the Director of the National

21 Cancer Institute, shall review periodically

22 the appropriate frequency for performing

23 services for the early detection of prostate

24 cancer based on age and such other factors

25 as the Secretary believes to be pertinent.
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1 ‘‘(ii) REVISION OF FREQUENCY.—The

2 Secretary, taking into consideration the re3 view made under clause (i), may revise

4 from time to time the frequency with

5 which such services may be paid for under

6 this subsection, but no such revision shall

7 apply to services performed before January

8 1, 1998.

9 ‘‘(3) ESTABLISHMENT OF FEE SCHEDULE.—

10 ‘‘(A) IN GENERAL.—The Secretary shall

11 establish fee schedules (on such geographic

12 basis as the Secretary considers appropriate)

13 for payment for services for the early detection

14 of prostate cancer under this part (other than

15 prostate-specific antigen blood tests), effective

16 for services furnished after the expiration of the

17 90-day period beginning on the date the Sec18 retary establishes the fee schedules.

19 ‘‘(B) FACTORS CONSIDERED.—In estab20 lishing fee schedules under subparagraph (A),

21 the Secretary shall take into consideration vari22 ations in the cost of furnishing such services

23 among geographic areas and among different

24 sites where services are furnished, together with
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1 such other factors as may be appropriate to as2 sure that payment amounts are equitable.

3 ‘‘(4) LIMITING CHARGES OF NONPARTICIPATING

4 PHYSICIANS.—In the case of a service for the early

5 detection of prostate cancer for which payment may

6 be made under this part, if a nonparticipating physi7 cian or nonparticipating supplier or other person (as

8 defined in section 1842(i)(2)) who does not accept

9 payment on an assignment-related basis provides the

10 service to an individual enrolled under this part, sec11 tion 1848(g)(1) shall apply to the service in the

12 same manner as such section applies to a physician’s

13 service.’’.

14 (4) CONFORMING AMENDMENTS.—(A) Para15 graphs (1)(D) and (2)(D) of section 1833(a) of such

16 Act (42 U.S.C. 1395l(a)) are each amended by strik17 ing ‘‘subsection (h)(1),’’ and inserting ‘‘subsection

18 (h)(1) or section 1834(d)(1)(B)(i),’’.

19 (B) Section 1833(a)(1) of such Act (42 U.S.C.

20 1395l(a)(1)) is amended—

21 (i) by striking ‘‘and (P)’’ and inserting

22 ‘‘(P)’’; and

23 (ii) by striking the semicolon at the end

24 and inserting the following: ‘‘, and (Q) with re25 spect to services for the early detection of pros-
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1 tate cancer (as defined in section 1861(oo))

2 (other than prostate-specific antigen tests), the

3 amounts paid shall be the amounts described in

4 section 1834(d)(1);’’.

5 (C) Section 1833(a) of such Act (42 U.S.C.

6 1395l(a)) is amended—

7 (i) by striking ‘‘and’’ at the end of para8 graph (6);

9 (ii) by striking the period at the end of

10 paragraph (7) and inserting ‘‘; and’’; and

11 (iii) by adding at the end the following new

12 paragraph:

13 ‘‘(8) in the case of services for the early detec14 tion of prostate cancer (as defined in section

15 1861(oo)) (other than prostate-specific antigen

16 tests), the amounts described in section

17 1834(d)(1).’’.

18 (D) Section 1833(h)(1)(A) of such Act (42

19 U.S.C. 1395l(h)(1)(A)) is amended by striking ‘‘The

20 Secretary’’ and inserting ‘‘Subject to section

21 1834(d), the Secretary’’.

22 (E) Section 1862(a) of such Act (42 U.S.C.

23 1395y(a)) is amended—

24 (i) in paragraph (1)—
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1 (I) in subparagraph (E), by striking

2 ‘‘and’’ at the end,

3 (II) in subparagraph (F), by striking

4 the semicolon at the end and inserting ‘‘,

5 and’’, and

6 (III) by adding at the end the follow7 ing new subparagraph:

8 ‘‘(G) in the case of services for the early detec9 tion of prostate cancer (as defined in section

10 1861(oo)), which are performed more frequently

11 than is covered under section 1834(d)(2);’’; and

12 (ii) in paragraph (7), by striking ‘‘para13 graph (1)(B) or under paragraph (1)(F)’’ and

14 inserting ‘‘subparagraphs (B), (F), or (G) of

15 paragraph (1)’’.

16 (b) COVERAGE OF CERTAIN DRUG TREATMENTS.—

17 Section 1861(s)(2) of the Social Security Act (42 U.S.C.

18 1395x(s)(2)), as amended by subsection (a)(1), is further

19 amended—

20 (1) by striking ‘‘and’’ at the end of subpara21 graph (P);

22 (2) by adding ‘‘and’’ at the end of subpara23 graph (Q); and

24 (3) by adding at the end the following new sub25 paragraph:
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1 ‘‘(R) an oral drug prescribed for the treatment

2 of prostate cancer, if the use of the drug for such

3 purpose is a medically accepted indication under

4 subsection (t)(2);’’.

5 (c) EFFECTIVE DATE.—The amendments made by

6 this section shall apply to services provided on or after

7 January 1, 1996, without regard to whether or not the

8 Secretary has established fee schedules under section

9 1834(d)(3) of the Social Security Act (as added by sub10 section (a)(3)) or promulgated other regulations to carry

11 out such amendments by that date.

12 SEC. 3. EARLY DETECTION AND TREATMENT OF PROSTATE

13 CANCER IN VETERANS.

14 (a) PREVENTIVE HEALTH SERVICES.—Section

15 1701(9) of title 38, United States Code is amended—

16 (1) by redesignating subparagraphs (J) and (K)

17 as subparagraphs (K) and (L), respectively; and

18 (2) by inserting after subparagraph (I) the fol19 lowing new subparagraph (J):

20 ‘‘(J) tests for the early detection and diagnosis

21 of prostate cancer;’’.

22 (b) COVERAGE OF SERVICES FOR EARLY DETECTION

23 AND TREATMENT OF PROSTATE CANCER.—
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1 (1) IN GENERAL.—Chapter 17 of such title is

2 amended by inserting after section 1724 the follow3 ing new section:

4 ‘‘§ 1725. Prostate cancer detection and treatment

5 ‘‘(a) The Secretary shall include in the medical serv6 ices furnished to veterans under this chapter—

7 ‘‘(1) services for the early detection and treat8 ment of prostate cancer;

9 ‘‘(2) information on the early detection and

10 treatment of prostate cancer; and

11 ‘‘(3) counseling regarding prostate cancer.

12 ‘‘(b) Based on the best available medical evidence, the

13 Secretary shall implement a schedule for early detection

14 of prostate cancer for veterans confined to hospitals or

15 other institutions.

16 ‘‘(c) For the purposes of this section—

17 ‘‘(1) services for the early detection of prostate

18 cancer are procedures provided to a male for the

19 purpose of the early detection of prostate cancer, in20 cluding digital rectal examinations, prostate-specific

21 antigen blood tests, and transrectal ultrasonography;

22 and

23 ‘‘(2) services for treatment of prostate cancer

24 may include the furnishing of drugs approved by the
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1 Food and Drug Administration for the treatment of

2 prostate cancer.

3 ‘‘(d) The Secretary may carry out research and re4 search training in the diagnosis and treatment of prostate

5 cancer based upon the prostate cancer services provided

6 under this section and may develop guidelines outlining

7 effective treatment regimens for prostate cancer.’’.

8 (2) CLERICAL AMENDMENT.—The table of sec9 tions at the beginning of such chapter is amended

10 by inserting after the item relating to section 1724

11 the following new item:

‘‘1725. Prostate cancer detection and treatment.’’.

12 SEC. 4. RESEARCH AND EDUCATION REGARDING PROS13 TATE CANCER; CERTAIN PROGRAMS OF PUB14 LIC HEALTH SERVICE.

15 (a) NATIONAL INSTITUTES OF HEALTH.—Section

16 417B(c) of the Public Health Service Act (42 U.S.C.

17 286a–8(c)) is amended in the first sentence by striking

18 ‘‘$72,000,000’’ and all that follows and inserting the fol19 lowing: ‘‘$86,000,000 for fiscal year 1996, $100,000,000

20 for fiscal year 1997, $115,000,000 for fiscal year 1998,

21 and $130,000,000 for fiscal year 1999.’’.

22 (b) AGENCY FOR HEALTH CARE POLICY AND RE23 SEARCH.—Section 902 of the Public Health Service Act

24 (42 U.S.C. 299a) is amended by adding at the end the

25 following subsection:
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1 ‘‘(f) ACTIVITIES REGARDING PROSTATE CANCER.—

2 The Administrator shall, with respect to prostate cancer—

3 ‘‘(1) conduct and support research on the out4 comes, effectiveness, and appropriateness of health

5 services and procedures; and

6 ‘‘(2) in carrying out section 912(a), provide for

7 the development, periodic review, and updating of

8 clinically relevant guidelines, standards of quality,

9 performance measures, and medical review criteria.’’.

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