II 

114TH CONGRESS 

1ST SESSION S. 1079 

To amend titles XI and XVIII of the Social Security Act and title XXVII 

of the Public Health Service Act to improve coverage for colorectal 

screening tests under Medicare and private health insurance coverage, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 23, 2015 

Mr. CARDIN introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend titles XI and XVIII of the Social Security Act 

and title XXVII of the Public Health Service Act to 

improve coverage for colorectal screening tests under 

Medicare and private health insurance coverage, and for 

other purposes. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Supporting Colorectal Examination and Education Now 

6 Act of 2015’’ or the ‘‘SCREEN Act of 2015’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Maintaining calendar year 2015 Medicare reimbursement rates for 

colonoscopy procedures for providers participating in colorectal 

cancer screening quality improvement registry. 

Sec. 4. Eliminating Medicare beneficiary cost-sharing for certain colorectal cancer screenings, colorectal cancer screenings with therapeutic effect, and follow-up diagnostic colorectal cancer screenings covered under Medicare. 

Sec. 5. Medicare demonstration project to evaluate the effectiveness of a preoperative visit prior to screening colonoscopy and hepatitis C 

screening. 

Sec. 6. Budget neutrality. 

3 SEC. 2. FINDINGS. 

4 Congress finds the following: 

5 (1) Colorectal cancer is the second leading 

6 cause of cancer death among men and women com7 bined in the United States. 

8 (2) In 2015, more than 130,000 Americans will 

9 be diagnosed with colorectal cancer, and nearly 

10 50,000 Americans are expected to die from it. 

11 (3) Approximately 60 percent of colorectal can12 cer cases and 70 percent of colorectal cancer deaths 

13 occur in those aged 65 and older. 

14 (4) Colorectal cancer screening colonoscopies 

15 allow for the detection and removal of polyps before 

16 they progress to colorectal cancer, as well as early 

17 detection of colorectal cancer when treatment can be 

18 most effective. 


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1 (5) According to a 2012 study published in the 

2 New England Journal of Medicine, removing precan3 cerous polyps through colonoscopy could reduce the 

4 number of colorectal cancer deaths by 53 percent. 

5 (6) Although colorectal cancer is highly prevent6 able with appropriate screening, one in three adults 

7 between the ages of 50 and 75 years are not up to 

8 date with recommended colorectal cancer screening. 

9 (7) Over 200 organizations have committed to 

10 eliminating colorectal cancer as a major health prob11 lem in the United States and are working toward a 

12 shared goal of screening 80 percent of eligible Amer13 icans by 2018. 

14 (8) Hepatitis C is a liver disease that causes in15 flammation of the liver and results from infection 

16 with the Hepatitis C virus. Chronic Hepatitis C in17 fection can lead to serious health problems, including 

18 liver damage, cirrhosis, and liver cancer. It is the 

19 leading cause of liver transplants in the United 

20 States. 

21 (9) According to the Centers for Disease Con22 trol and Prevention (CDC), more than 75 percent of 

23 adults infected with the Hepatitis C virus in the 

24 United States were born between 1945 and 1965. 


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1 (10) The CDC estimates that up to 75 percent 

2 of individuals with Hepatitis C do not know that 

3 they are infected. 

4 (11) The CDC and the United States Preven5 tive Services Task Force (USPSTF) recommend a 

6 one-time screening for Hepatitis C for all individuals 

7 born between 1945 and 1965. 

8 (12) A recent study suggests that offering Hep9 atitis C screening to patients in connection with 

10 screening colonoscopies may be an effective means of 

11 increasing Hepatitis C screening rates among indi12 viduals born between 1945 and 1965. 

13 SEC. 3. MAINTAINING CALENDAR YEAR 2015 MEDICARE RE14 IMBURSEMENT RATES FOR COLONOSCOPY 

15 PROCEDURES FOR PROVIDERS PARTICI16 PATING IN COLORECTAL CANCER SCREEN17 ING QUALITY IMPROVEMENT REGISTRY. 

18 Section 1834(d)(3) of the Social Security Act (42 

19 U.S.C. 1395m(d)(3)) is amended by adding at the end the 

20 following new subparagraph: 

21 ‘‘(F) MAINTAINING CALENDAR YEAR 2015

22 REIMBURSEMENT RATES FOR QUALIFYING CAN23 CER SCREENING TESTS FURNISHED BY QUALI24 FYING PROVIDERS.— 


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1 ‘‘(i) IN GENERAL.—With respect to a 

2 qualifying cancer screening test furnished 

3 during each of 2016, 2017, and 2018, by 

4 a qualifying provider, the amount of pay5 ment to such provider for such test under 

6 section 1833 or section 1848 shall be equal 

7 to the amount of payment for such test 

8 under such section 1833 or 1848 during 

9 2015. 

10 ‘‘(ii) QUALIFYING CANCER SCREENING

11 TEST.—For purposes of this subparagraph, 

12 the term ‘qualifying cancer screening test’ 

13 means an optical screening colonoscopy (as 

14 described in section 1861(pp)(1)(C)). 

15 ‘‘(iii) QUALIFYING PROVIDER DE16 FINED.—For purposes of this subpara17 graph, the term ‘qualifying provider’ 

18 means, with respect to a qualifying cancer 

19 screening test, an individual or entity— 

20 ‘‘(I) that is eligible for payment 

21 for such test under section 1833 or 

22 section 1848; and 

23 ‘‘(II) that— 

24 ‘‘(aa) participates in a na25 tionally recognized quality imVerDate Sep 11 2014 03:50 May 06, 2015 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1079.IS S1079

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1 provement registry with respect 

2 to such test; and 

3 ‘‘(bb) demonstrates, to the 

4 satisfaction of the Secretary, 

5 based on the information in such 

6 registry, that the tests were pro7 vided by such individual or entity 

8 in accordance with accepted out9 comes-based quality measures.’’. 

10 SEC. 4. ELIMINATING MEDICARE BENEFICIARY COST-SHAR11 ING FOR CERTAIN COLORECTAL CANCER 

12 SCREENINGS, COLORECTAL CANCER 

13 SCREENINGS WITH THERAPEUTIC EFFECT, 

14 AND FOLLOW-UP DIAGNOSTIC COLORECTAL 

15 CANCER SCREENINGS COVERED UNDER 

16 MEDICARE. 

17 (a) WAIVER OF COST-SHARING.—Section 

18 1833(a)(1)(Y) of the Social Security Act (42 U.S.C. 

19 1395l(a)(1)(Y)) is amended by inserting ‘‘, including 

20 colorectal cancer screening tests covered under this part 

21 described in section 1861(pp)(1)(C) (regardless of the 

22 code that is billed for the establishment of a diagnosis as 

23 a result of the screening test, for the removal of tissue 

24 or other matter during the screening test, or for a follow25 up procedure that is furnished in connection with, or as 


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1 a result of, the initial screening test)’’ after ‘‘or popu2 lation’’. 

3 (b) WAIVER OF APPLICATION OF DEDUCTIBLE.— 

4 Section 1833(b) of the Social Security Act (42 U.S.C. 

5 1395l(b)) is amended— 

6 (1) in paragraph (1) of the first sentence, by 

7 striking ‘‘individual.’’ and inserting ‘‘individual, in8 cluding colorectal cancer screening tests covered 

9 under this part described in section 

10 1861(pp)(1)(C)’’; and 

11 (2) by striking the last sentence and inserting 

12 the following: ‘‘Subsection (a)(1)(Y) and paragraph 

13 (1) of the first sentence of this subsection shall 

14 apply with respect to a colorectal cancer screening 

15 test covered under this part described in section 

16 1861(pp)(1)(C), regardless of the code that is billed 

17 for the establishment of a diagnosis as a result of 

18 the screening test, for the removal of tissue or other 

19 matter during the screening test, or for a follow-up 

20 procedure that is furnished in connection with, or as 

21 a result of, the initial screening test.’’ 

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

23 this section shall apply to tests and procedures performed 

24 on or after January 1, 2016. 


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1 SEC. 5. MEDICARE DEMONSTRATION PROJECT TO EVALU2 ATE THE EFFECTIVENESS OF A PRE-OPERA3 TIVE VISIT PRIOR TO SCREENING COLONOS4 COPY AND HEPATITIS C SCREENING. 

5 Section 1115A(b)(2) of the Social Security Act (42 

6 U.S.C. 1315a(b)(2)) is amended— 

7 (1) in the last sentence of subparagraph (A), by 

8 inserting ‘‘, and shall include the model described in 

9 subparagraph (D)’’ before the period at the end; and 

10 (2) by adding at the end the following new sub11 paragraph: 

12 ‘‘(D) MEDICARE DEMONSTRATION

13 PROJECT TO EVALUATE THE EFFECTIVENESS

14 OF A PRE-OPERATIVE VISIT PRIOR TO SCREEN15 ING COLONOSCOPY AND HEPATITIS C SCREEN16 ING.— 

17 ‘‘(i) IN GENERAL.—The model de18 scribed in this subparagraph is a dem19 onstration project under title XVIII to 

20 evaluate the effectiveness of a pre-operative 

21 visit with the provider performing the pro22 cedure prior to screening colonoscopy to— 

23 ‘‘(I) ease any patient concern or 

24 fears with respect to the procedure 

25 and answer any questions relating to 

26 the screening; 


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1 ‘‘(II) ensure quality examinations 

2 and avoid unnecessary repeat exami3 nations by educating individuals on 

4 the importance of following pre-proce5 dure instructions, such as bowel prep6 aration, and addressing the individ7 ual’s family history of or predisposi8 tion to colorectal cancer; and 

9 ‘‘(III) increase Hepatitis C Virus 

10 (HCV) screening rates among Medi11 care beneficiaries by educating indi12 viduals about the importance of such 

13 screening during the pre-operative 

14 visit and having the pre-operative visit 

15 fulfill the referral requirement for 

16 such screening under title XVIII, al17 lowing patients to be screened for 

18 colorectal cancer and HCV at the 

19 same time. 

20 ‘‘(ii) CONSULTATION.—The Secretary 

21 shall consult with stakeholders who would 

22 be providing the pre-operative visit under 

23 the model described in this subparagraph 

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1 cluding payment for services furnished 

2 under the model.’’. 

3 SEC. 6. BUDGET NEUTRALITY. 

4 (a) ADJUSTMENT OF PHYSICIAN FEE SCHEDULE

5 CONVERSION FACTOR.—The Secretary of Health and 

6 Human Services (in this section referred to as the ‘‘Sec7 retary’’) shall reduce the conversion factor established 

8 under subsection (d) of section 1848 of the Social Security 

9 Act (42 U.S.C. 1395w–4) for each year (beginning with 

10 2016) to the extent necessary to reduce expenditures 

11 under such section for items and services furnished during 

12 the year in the aggregate by the net offset amount deter13 mined under subsection (c)(5) attributable to such section 

14 for the year. 

15 (b) ADJUSTMENT OF HOPD CONVERSION FAC16 TOR.—The Secretary shall reduce the conversion factor es17 tablished under paragraph (3)(C) of section 1833(t) of the 

18 Social Security Act (42 U.S.C. 1395l(t)) for each year (be19 ginning with 2016) to the extent necessary to reduce ex20 penditures under such section for items and services fur21 nished during the year in the aggregate by the net offset 

22 amount determined under subsection (c)(5) attributable to 

23 such section for the year. 

24 (c) DETERMINATIONS RELATING TO EXPENDI25 TURES.—For purposes of this section, before the beginVerDate Sep 11 2014 03:50 May 06, 2015 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1079.IS S1079

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1 ning of each year (beginning with 2016) at the time con2 version factors described in subsections (a) and (b) are 

3 established for the year, the Secretary shall determine— 

4 (1) the amount of the gross additional expendi5 tures under title XVIII of the Social Security Act 

6 (42 U.S.C. 1395 et seq.) estimated to result from 

7 the implementation of sections 3 and 4 for items 

8 and services furnished during the year; 

9 (2) the amount of any offsetting reductions in 

10 expenditures under such title (such as reductions in 

11 payments for inpatient hospital services) for such 

12 year attributable to the implementation of such sec13 tions; 

14 (3) the amount (if any) by which the amount 

15 of the gross additional expenditures determined 

16 under paragraph (1) for the year exceeds the 

17 amount of offsetting reductions determined under 

18 paragraph (2) for the year; 

19 (4) of the gross additional expenditures deter20 mined under paragraph (1) for the year that are at21 tributable to expenditures under sections 1848 and 

22 1833(t) of such Act, the ratio of such expenditures 

23 that are attributable to each respective section; and 


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1 (5) with respect to section 1848 and section 

2 1833(t) of such Act, a net offset amount for the 

3 year equal to the product of— 

4 (A) the amount of the net additional ex5 penditures for the year determined under para6 graph (3); and 

7 (B) the ratio determined under paragraph 

8 (4) attributable to the respective section. 

Æ 


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