```

[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H. Con. Res. 341 Introduced in House (IH)]

106th CONGRESS
  2d Session
H. CON. RES. 341

 Expressing the sense of Congress regarding the guaranteed coverage of 
medically appropriate actinic keratoses treatment and removal under the 
                           Medicare Program.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              May 25, 2000

  Mr. Foley submitted the following concurrent resolution; which was 
  referred to the Committee on Ways and Means, and in addition to the 
 Committee on Commerce, 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

_______________________________________________________________________

                         CONCURRENT RESOLUTION

 
 Expressing the sense of Congress regarding the guaranteed coverage of 
medically appropriate actinic keratoses treatment and removal under the 
                           Medicare Program.

Whereas the American Academy of Dermatology and the American Cancer Society 
        estimate that 1.3 million new cases of skin cancer will be diagnosed in 
        the coming year, amounting to half of all cancer diagnoses. Further, 
        every minute two Americans will develop skin cancer this year;
Whereas the annual cancer report card issued by the National Cancer Institute 
        and the Centers for Disease Control and Prevention showed that the 
        overall cancer incidence rate is in decline in all but two cancers, skin 
        cancer and non-Hodgkins Lymphoma;
Whereas actinic keratosis is the beginning of the continuum of an invasive 
        squamous cell carcinoma and occur primarily on the sun-exposed areas of 
        the skin;
Whereas the mutation in the P-53 gene in an invasive squamous cell carcinoma is 
        identical to the mutation found in actinic keratoses;
Whereas it is impossible to accurately predict in which patient or lesion an 
        actinic keratosis will progress into an invasive squamous cell 
        carcinoma; Therefore, all actinic keratoses should be treated;
Whereas treatment of actinic keratosis avoids the potentially more extensive and 
        expensive treatment of a subsequent invasive squamous cell carcinoma;
Whereas treatment and removal of actinic keratosis lesions varies depending on 
        the presenting conditions of the beneficiary and, therefore, the 
        treating physician, in consultation with the beneficiary, must determine 
        what course of treatment is clinically appropriate;
Whereas surgical removal of actinic keratoses lesions is the clinical standard 
        of medical care because it produces the most positive outcomes in the 
        majority of cases presented by beneficiaries;
Whereas the Medicare Carriers Manual states that a Local Medical Review Policy 
        must be based on the strongest evidence available, including scientific 
        data or research studies published in peer-reviewed medical journals, 
        the consensus of expert medical opinion, or medical option derived from 
        consultations with medical associations or other health care experts;
Whereas Local Medical Review Policies promulgated by Medicare carriers in a 
        number of states do not reflect the consensus of expert medical opinion 
        or the accepted standard of care for actinic keratoses treatment and 
        removal, thereby directly interfering with the physician-to-patient 
        relationship;
Whereas these diverse Local Medical Review Policies for actinic keratoses 
        treatment and removal are creating confusion for beneficiaries, 
        participating physicians, and carriers alike; and
Whereas the Medicare statute prohibits any Federal officer or employee from 
        exercising ``any supervision or control over the practice of medicine or 
        the manner in which medical services are provided . . .'': Now, 
        therefore, be it
    Resolved by the House of Representatives (the Senate concurring), 
That it is the sense of Congress that the Medicare program should cover 
the treatment and removal of actinic keratoses based on the appropriate 
standard of care as determined by a beneficiary's treating physician, 
in consultation with the beneficiary.
                                 <all>
```