```

[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1511 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1511

  To amend titles XVIII and XIX of the Social Security Act to improve 
  awareness and access to colorectal cancer screening tests under the 
        Medicare and Medicaid programs, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             July 23, 2009

Mr. Cardin (for himself and Mr. Graham) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
  To amend titles XVIII and XIX of the Social Security Act to improve 
  awareness and access to colorectal cancer screening tests under the 
        Medicare and Medicaid programs, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Supporting ColoRectal Examination 
and Education Now (SCREEN) Act of 2009''.

SEC. 2. FINDINGS AND SENSE OF CONGRESS.

    (a) Findings.--Congress makes the following findings:
            (1) A majority of the deaths and costs associated with 
        colorectal cancer, the second leading cause of cancer deaths in 
        the United States, are avoidable through timely preventive 
        screening, including colonoscopy.
            (2) The United States Preventive Services Task Force 
        provides its only grade ``A'' recommendation of cancer 
        screenings for colorectal interventions.
            (3) Colorectal cancer screening test rates are far too low, 
        with only 50 percent of recommended populations receiving 
        colorectal cancer screening tests, and rates of such screening 
        tests among minorities and those without insurance lag 
        considerably.
            (4) The colorectal cancer screening benefit under the 
        Medicare Program under title XVIII of the Social Security Act 
        is severely underutilized.
            (5) Numerous barriers for patients, communities, and health 
        care providers detrimentally affect the utilization of 
        colorectal cancer screening tests. Such barriers include 
        patient knowledge, coinsurance burdens, restrictions on 
        Medicare coverage for an office visit prior to a screening 
        colonoscopy, and reductions in Medicare reimbursement.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) if legislation to provide health insurance coverage, 
        public or private, to persons under the age of 65, is enacted, 
        coverage of colorectal cancer screening tests and the 
        provisions of this Act should be included as part of any basic 
        benefit package required under such legislation; and
            (2) Congress, Federal agencies, State and local 
        governments, health care providers, and patient groups should 
        make a concerted and sustained effort to increase the rate of 
        colorectal cancer screening tests.

SEC. 3. COMMUNITY AND PATIENT INTERVENTIONS.

    (a) Grant Program To Increase Colorectal Cancer Awareness, 
Screening, and Treatment.--
            (1) Definitions.--In this subsection:
                    (A) Colorectal cancer screening tests.--The term 
                ``colorectal cancer screening test'' has the meaning 
                given such term in section 1861(pp)(1) of the Social 
                Security Act (42 U.S.C. 1395x(pp)(1)).
                    (B) Indian tribe.--The term ``Indian tribe'' has 
                the meaning given such term in section 4 of the Indian 
                Self-Determination and Education Assistance Act (25 
                U.S.C. 450b).
                    (C) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services, acting through 
                the Director of the Centers for Disease Control and 
                Prevention.
                    (D) State.--The term ``State'' means--
                            (i) a State; and
                            (ii) the District of Columbia.
            (2) Grants authorized.--The Secretary is authorized to make 
        grants to States and Indian tribes for colorectal health 
        programs. Such programs may include the following:
                    (A) Provide colorectal cancer screening tests, 
                including colonoscopy, to individuals who are over 50 
                years of age or who are determined to be at high risk 
                for such cancer.
                    (B) Provide case management and referrals for 
                medical treatment for individuals who are provided 
                colorectal cancer screening tests under the program.
                    (C) Programs to ensure that individuals who are 
                provided colorectal cancer screening tests under the 
                program receive the full continuum of follow up and 
                cancer care, as appropriate.
                    (D) Activities to improve the education, training, 
                and skills of health professionals in the detection and 
                treatment of colorectal cancer.
                    (E) The development and dissemination of public 
                information and education programs--
                            (i) for the detection and treatment of 
                        colorectal cancer; and
                            (ii) promoting the benefits of receiving 
                        colorectal cancer screening tests through the 
                        program.
            (3) Priority.--In making grants under paragraph (2), the 
        Secretary shall give priority to States and Indian tribes that 
        will use grant funds to provide colorectal cancer screening 
        tests to low-income individuals who lack adequate health 
        insurance coverage with respect to such screening.
            (4) Existing funding authority.--The Secretary shall make a 
        grant under this section under an existing funding authority.
    (b) Beneficiary Reminders for Increasing Colorectal Cancer 
Screening Tests.--
            (1) Definitions.--In this subsection:
                    (A) Colorectal cancer screening tests.--The term 
                ``colorectal cancer screening test'' has the meaning 
                given such term in section 1861(pp)(1) of the Social 
                Security Act (42 U.S.C. 1395x(pp)(1)).
                    (B) Medicare beneficiary.--The term ``Medicare 
                beneficiary'' means an individual entitled to, or 
                enrolled for, benefits under part A of title XVIII of 
                the Social Security Act and enrolled for benefits under 
                part B of such title.
                    (C) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.
            (2) Annual notification under the medicare program.--The 
        Secretary shall establish a program under which all Medicare 
        beneficiaries are notified annually about the coverage of 
        colorectal cancer screening tests under the Medicare program 
        under title XVIII of the Social Security Act. Under the 
        program, such notification--
                    (A) may be provided through direct mail or direct 
                electronic communications; and
                    (B) may accompany other information currently 
                provided to such beneficiaries, including marketing 
                materials or information provided to enrollees by 
                Medicare Advantage organizations under section 
                1852(c)(1) of the Social Security Act (42 U.S.C. 1395w-
                22) and information provided by PDP sponsors under 
                section 1860D-4(a)(1) of such Act (42 U.S.C. 1395w-
                104(a)(1)).
            (3) State plan amendment under medicaid.--
                    (A) In general.--Section 1902(a) of the Social 
                Security Act (42 U.S.C. 1396a(a)), as amended by 
                section 5006(e)(2)(A) of division B of the American 
                Recovery and Reinvestment Act of 2009 (Public Law 111-
                5), is amended--
                            (i) in paragraph (72), by striking ``and'' 
                        at the end;
                            (ii) in paragraph (73)(B), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by inserting after paragraph (73), 
                        the following new paragraph:
            ``(74) if the State has elected to provide medical 
        assistance described in section 1905(a)(13) and such assistance 
        includes colorectal cancer screening tests, provide for the 
        establishment of a program under which individuals at risk for 
        colon cancer, including minorities who are identified as at 
        high-risk for colon cancer, who are over an age that the 
        Secretary determines appropriate (based on the recommendations 
        of appropriate entities, including the United States Preventive 
        Services Task Force and appropriate medical specialty 
        societies) are provided a notification of the availability of 
        medical assistance for colorectal cancer screening tests and a 
        reminder regarding the benefits of such tests.''.
                    (B) Effective date.--
                            (i) In general.--Except as provided in 
                        clause (ii), the amendments made by this 
                        paragraph take effect on January 1, 2011.
                            (ii) Extension of effective date for state 
                        law amendment.--In the case of a State plan 
                        under title XIX of the Social Security Act (42 
                        U.S.C. 1396 et seq.) which the Secretary of 
                        Health and Human Services determines requires 
                        State legislation in order for the plan to meet 
                        the additional requirements imposed by the 
                        amendments made by this paragraph, the State 
                        plan shall not be regarded as failing to comply 
                        with the requirements of such title solely on 
                        the basis of its failure to meet these 
                        additional requirements before the first day of 
                        the first calendar quarter beginning after the 
                        close of the first regular session of the State 
                        legislature that begins after the date of 
                        enactment of this Act. For purposes of the 
                        previous sentence, in the case of a State that 
                        has a 2-year legislative session, each year of 
                        the session is considered to be a separate 
                        regular session of the State legislature.

SEC. 4. ELIMINATION OF COINSURANCE FOR COLORECTAL CANCER SCREENING 
              TESTS.

    (a) In General.--Section 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and'' before ``(W)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (X) with respect to colorectal cancer 
        screening tests (as defined in subsection (pp)), the amount 
        paid shall be 100 percent of the lesser of the actual charge 
        for the services or the amount determined under the fee 
        schedule that applies to such tests under this part''.
    (b) Conforming Amendments.--
            (1) Screening sigmoidoscopies and colonoscopies.--Section 
        1834(d) of the Social Security Act (42 U.S.C. 1395m(d)) is 
        amended--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A), by inserting ``, 
                        except that payment for such tests under such 
                        section shall be 100 percent of the payment 
                        determined under such section for such tests'' 
                        before the period at the end; and
                            (ii) in subparagraph (C)--
                                    (I) by striking clause (ii); and
                                    (II) in clause (i)--
                                            (aa) by striking ``(i) In 
                                        general.--Notwithstanding'' and 
                                        inserting ``Notwithstanding'';
                                            (bb) by redesignating 
                                        subclauses (I) and (II) as 
                                        clauses (i) and (ii), 
                                        respectively, and moving such 
                                        clauses and the flush matter 
                                        following such clauses 2 ems to 
                                        the left; and
                                            (cc) in the flush matter 
                                        following clause (ii), as so 
                                        redesignated, by inserting 
                                        ``100 percent of'' after 
                                        ``based on''; and
                    (B) in paragraph (3)--
                            (i) in subparagraph (A), by inserting ``, 
                        except that payment for such tests under such 
                        section shall be 100 percent of the payment 
                        determined under such section for such tests'' 
                        before the period at the end; and
                            (ii) in subparagraph (C)--
                                    (I) by striking clause (ii); and
                                    (II) in clause (i)--
                                            (aa) by striking ``(i) In 
                                        general.--Notwithstanding'' and 
                                        inserting ``Notwithstanding''; 
                                        and
                                            (bb) by inserting ``100 
                                        percent of'' after ``based 
                                        on''.
            (2) Outpatient hospital settings.--Section 1833(t) of the 
        Social Security Act (42 U.S.C. 1395l(t)) is amended--
                    (A) in paragraph (4)(C), by striking ``paragraph 
                (8)(C)'' and inserting ``subparagraphs (C) and (F) of 
                paragraph (8)''; and
                    (B) in paragraph (8), by adding at the end the 
                following new subparagraph:
                    ``(F) No copayment for colorectal cancer screening 
                tests.--The copayment amount that would otherwise apply 
                under this subsection to colorectal cancer screening 
                tests (as defined in section 1861(pp)) shall be reduced 
                to zero.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2010.

SEC. 5. MEDICARE ADVANTAGE REPORTING REQUIREMENTS.

    (a) In General.--Section 1857(e) of the Social Security Act (42 
U.S.C. 1395w-27(e)) is amended by adding at the end the following new 
paragraph:
            ``(4) Annual reporting regarding colorectal cancer 
        screening tests.--
                    ``(A) In general.--Not later than 6 months after 
                the date of enactment of this paragraph and annually 
                thereafter, contract under this section with an MA 
                organization shall require the organization to submit 
                to the Secretary an annual report on the following:
                            ``(i) The coverage of colorectal cancer 
                        screening tests (as defined in section 
                        1861(pp)) under each MA plan offered by the 
                        organization, including the level of any 
                        coinsurance or copayments applicable for 
                        enrollees under the plan.
                            ``(ii) Any educational outreach the 
                        organization provides to enrollees, providers 
                        of services, and suppliers with respect to such 
                        tests.
                            ``(iii) Any pay-for-performance incentives 
                        under MA plans offered by the organization for 
                        providers of services and suppliers with 
                        respect to such tests, or any other financial-
                        sharing program with providers of services and 
                        suppliers with respect to such tests.
                            ``(iv) The total number of enrollees 
                        furnished such tests during the preceding year, 
                        listed according to the specific test 
                        furnished, the type of facility in which the 
                        test was furnished, and the gender and race of 
                        the enrollees to whom such tests were 
                        furnished.
                    ``(B) Report to congress and public availability.--
                            ``(i) Report.--The Secretary shall submit 
                        to Congress an annual report containing 
                        information submitted in the annual reports 
                        under subparagraph (A).
                            ``(ii) Public availability.--The Secretary 
                        shall make such information available to the 
                        public, including by posting such information 
                        on the Internet website of the Centers for 
                        Medicare & Medicaid Services.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to contracts entered into on or after January 1, 2011.

SEC. 6. PROVIDER INTERVENTIONS.

    (a) In General.--Section 1834(d) of the Social Security Act (42 
U.S.C. 1395m(d)) is amended by adding at the end the following new 
paragraph:
            ``(4) Preventive service payment modified for certain 
        colorectal cancer screening tests.--
                    ``(A) National minimum standards.--The Secretary, 
                in consultation with the Institute of Medicine, shall 
                establish a national minimum standard for basic 
                knowledge, training, continuing education, and 
                documentation for suppliers who furnish colorectal 
                cancer screening tests (as defined in subsection (pp)). 
                For purposes of this paragraph, a supplier shall be 
                deemed to meet such national minimum standards if the 
                supplier is certified in gastroenterology by the 
                American Board of Internal Medicine.
                    ``(B) Preventive service payment modifier.--
                            ``(i) Determination of rate goals.--The 
                        Secretary, in consultation with the United 
                        States Preventive Services Task Force, the 
                        Institute of Medicine Colorectal Cancer Working 
                        Group, and other clinical advisors as 
                        determined appropriate by the Secretary, shall 
                        determine age-based goal rates for colorectal 
                        cancer screening tests (as so defined) to be 
                        met or exceeded for beneficiaries under this 
                        part not later than July 1, 2010. Such age-
                        based goal rates shall be consistent with the 
                        rates of screening for beneficiaries with 
                        respect to other cancer screening tests (such 
                        as screening mammography and cervical cancer 
                        screening).
                            ``(ii) Establishment of preventive service 
                        modifier for qualified colorectal cancer 
                        screening tests.--
                                    ``(I) In general.--The Secretary 
                                shall establish an upward preventive 
                                service payment modifier for qualifying 
                                colorectal cancer screening tests 
                                furnished on or after January 1, 2010, 
                                which reflects the annual determination 
                                by the Secretary of the appropriate 
                                amount of additional payment (not less 
                                than 10 percent of the amount of 
                                payment otherwise provided) sufficient 
                                to increase the rate of colorectal 
                                cancer screening tests furnished under 
                                this part to the goal rates determined 
                                under clause (i). The Secretary shall 
                                update such modified on an annual 
                                basis, taking into consideration the 
                                rate of colorectal cancer screening 
                                tests furnished under this part during 
                                the preceding year and such goal rates.
                                    ``(II) Qualifying colorectal cancer 
                                screening tests.--For purposes of 
                                subclause (I), the term `qualifying 
                                colorectal cancer screening tests' 
                                means a colorectal cancer screening 
                                test furnished by a supplier who meets 
                                the national minimum standards 
                                established under subparagraph (A) (as 
                                determined by the Secretary).''.
    (b) Outpatient Settings.--Section 1833(t) of the Social Security 
Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following 
new paragraph:
            ``(18) In general.--
                    ``(A) National minimum standards.--The Secretary, 
                in consultation with the Institute of Medicine, shall 
                establish a national minimum standard for basic 
                knowledge, training, continuing education, and 
                documentation for hospitals in outpatient settings 
                which furnish colorectal cancer screening tests (as 
                defined in subsection (pp)). For purposes of this 
                paragraph, a hospital shall be deemed to meet such 
                national minimum standards if the hospital is certified 
                by the Joint Commission on the Accreditation of 
                Healthcare Organizations, the Accreditation Association 
                for Ambulatory Health Care, or other accreditation body 
                designated by the Secretary.
                    ``(B) Preventive service payment modifier.--
                            ``(i) Determination of rate goals.--The 
                        Secretary, in consultation with the United 
                        States Preventive Services Task Force, the 
                        Institute of Medicine Colorectal Cancer Working 
                        Group, and other clinical advisors as 
                        determined appropriate by the Secretary, shall 
                        determine age-based goal rates for colorectal 
                        cancer screening tests (as so defined) to be 
                        met or exceeded for beneficiaries under this 
                        part not later than July 1, 2010. Such age-
                        based goal rates shall be consistent with the 
                        rates of screening for beneficiaries with 
                        respect to other cancer screening tests (such 
                        as screening mammography and cervical cancer 
                        screening).
                            ``(ii) Establishment of preventive service 
                        modifier for qualified colorectal cancer 
                        screening tests.--
                                    ``(I) In general.--The Secretary 
                                shall establish an upward preventive 
                                service payment modifier for qualifying 
                                colorectal cancer screening tests 
                                furnished on or after January 1, 2010, 
                                which reflects the annual determination 
                                by the Secretary of the appropriate 
                                amount of additional payment (not less 
                                than 10 percent of the amount of 
                                payment otherwise provided) sufficient 
                                to increase the rate of colorectal 
                                cancer screening tests furnished under 
                                this part to the goal rates determined 
                                under clause (i). The Secretary shall 
                                update such modifier on an annual 
                                basis, taking into consideration the 
                                rate of colorectal cancer screening 
                                tests furnished under this part during 
                                the preceding year and such goal rates.
                                    ``(II) Qualifying colorectal cancer 
                                screening tests.--For purposes of 
                                subclause (I), the term `qualifying 
                                colorectal cancer screening tests' 
                                means a colorectal cancer screening 
                                test furnished by a hospital in an 
                                outpatient setting which meets the 
                                national minimum standards established 
                                under subparagraph (A) (as determined 
                                by the Secretary).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2010.

SEC. 7. COVERAGE FOR AN OFFICE VISIT OR CONSULTATION PRIOR TO A 
              QUALIFYING SCREENING COLONOSCOPY.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (DD), by striking ``and'' at the end;
            (2) in subparagraph (EE), by inserting ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
                    ``(FF) an outpatient office visit or consultation 
                for the purpose of beneficiary education, assuring 
                selection of the proper screening test, and securing 
                information relating to the procedure and sedation of 
                the beneficiary, prior to a colorectal cancer screening 
                test consisting of a screening colonoscopy or in 
                conjunction with the beneficiary's decision to obtain 
                such a screening, regardless of whether such screening 
                is medically indicated with respect to the 
                beneficiary;''.
    (b) Payment.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)), as amended by section 4, is 
        amended--
                    (A) by striking ``and'' before ``(W)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (Y) with respect to an 
                outpatient office visit or consultation under section 
                1861(s)(2)(BB), the amounts paid shall be 80 percent of 
                the lesser of the actual charge or the amount 
                established under section 1848''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``(2)(FF),'' after ``(2)(EE),''.
            (3) Requirement for establishment of payment amount under 
        physician fee schedule.--Section 1834(d) of the Social Security 
        Act (42 U.S.C. 1395m(d)), as amended by section 6, is amended 
        by adding at the end the following new paragraph:
            ``(5) Payment for outpatient office visit or consultation 
        prior to screening colonoscopy.--With respect to an outpatient 
        office visit or consultation under section 1861(s)(2)(BB), 
        payment under section 1848 shall be consistent with the payment 
        amounts for CPT codes 99203 and 99243.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2010.
                                 <all>
```