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[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 691 Introduced in Senate (IS)]

104th CONGRESS
  1st Session
                                 S. 691

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 SENATE OF THE UNITED STATES

                April 6 (legislative day, April 5), 1995

  Mr. Shelby (for himself, Mr. Stevens, Mr. Inouye, Mr. Thurmond, Mr. 
  Heflin, and Mr. Mack) introduced the following bill; which was read 
             twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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 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.

    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 ``Prostate Cancer Diagnosis and 
Treatment Act of 1995''.

SEC. 2. MEDICARE COVERAGE OF EARLY DETECTION OF PROSTATE CANCER AND 
              CERTAIN DRUG TREATMENTS.

    (a) Coverage of Early Detection Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)), as amended by section 13553(a) of 
        the Omnibus Budget Reconciliation Act of 1993 (hereafter in 
        this Act referred to as ``OBRA-1993''), is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (P);
                    (B) by adding ``and'' at the end of subparagraph 
                (Q); and
                    (C) by adding at the end the following new 
                subparagraph: ``(R) services for early detection of 
                prostate cancer (as defined in subsection (ll));''.
            (2) Services described.--Section 1861 of such Act (42 
        U.S.C. 1395x) is amended--
                    (A) by redesignating the subsection (jj) inserted 
                by section 4156(a)(2) of the Omnibus Budget 
                Reconciliation Act of 1990 as subsection (kk); and
                    (B) by inserting after such subsection the 
                following new subsection:

           ``Services for Early Detection of Prostate Cancer

    ``(ll) The term `services for early detection of prostate cancer' 
means the following procedures provided to a man for the purpose of 
early detection of prostate cancer:
            ``(1) Digital rectal examination.
            ``(2) Prostate-specific antigen blood test.
            ``(3) Transrectal ultrasonography.
            ``(4) Such other procedures as the Secretary may designate 
        as appropriate for early detection of prostate cancer.''.
            (3) Payment amounts; limitations on frequency of 
        coverage.--Section 1834 of such Act (42 U.S.C. 1395m) is 
        amended by inserting after subsection (c) the following new 
        subsection:
    ``(d) Payment Amounts and Frequency Limits for Services for Early 
Detection of Prostate Cancer.--
            ``(1) In general.--Notwithstanding any other provision of 
        this part, with respect to expenses incurred for services for 
        early detection of prostate cancer (as defined in section 
        1861(ll))--
                    ``(A) payment may be made only for services 
                provided consistent with the frequency permitted under 
                paragraph (2); and
                    ``(B) the amount of the payment under this part 
                shall be equal to 80 percent of the lesser of the 
                actual charge for the service or--
                            ``(i) in the case of services for early 
                        detection of prostate cancer consisting of a 
                        prostate-specific antigen blood test, the fee 
                        schedule amount established for the service 
                        under section 1833(h) (relating to payments for 
                        clinical diagnostic laboratory tests); or
                            ``(ii) in the case of any other services 
                        for early detection of prostate cancer, the 
                        amount provided under the fee schedule 
                        established by the Secretary under paragraph 
                        (3) (subject to the deductible established 
                        under section 1833(b)).
            ``(2) Frequency covered.--
                    ``(A) In general.--Subject to subparagraph (B) and 
                to revision by the Secretary under subparagraph (C), no 
                payment may be made under this part for a service 
                provided to an individual for the purpose of early 
                detection of prostate cancer--
                            ``(i) if the individual is under 50 years 
                        of age; or
                            ``(ii) if the service is provided within 
                        the 11 months after a previous prostate cancer 
                        detection service.
                    ``(B) Exception for high risk individuals.--payment 
                may be made under this part for a service for early 
                detection of prostate cancer provided to an individual 
                more frequently than the limit established under 
                subparagraph (A)(ii) if the individual is at a high 
                risk of developing prostate cancer (as determined 
                pursuant to factors identified by the Secretary).
                    ``(C) Revision by secretary.--
                            ``(i) Review.--The Secretary, in 
                        consultation with the Director of the National 
                        Cancer Institute, shall review periodically the 
                        appropriate frequency for performing services 
                        for early detection of prostate cancer based on 
                        age and such other factors as the Secretary 
                        believes to be pertinent.
                            ``(ii) Revision of frequency.--The 
                        Secretary, taking into consideration the review 
                        made under clause (i), may revise from time to 
                        time the frequency with which such services may 
                        be paid for under this subsection, but no such 
                        revision shall apply to services performed 
                        before January 1, 1998.
            ``(3) Establishment of fee schedule.--
                    ``(A) In general.--The Secretary shall establish 
                fee schedules (on such geographic basis as the 
                Secretary considers appropriate) for payment for 
                services for early detection of prostate cancer under 
                this part (other than prostate-specific antigen blood 
                tests), effective for services furnished after the 
                expiration of the 90-day period beginning on the date 
                the Secretary establishes the fee schedules.
                    ``(B) Factors considered.--In establishing fee 
                schedules under subparagraph (A), the Secretary shall 
                take into consideration variations in the cost of 
                furnishing such services among geographic areas and 
                among different sites where services are furnished, 
                together with such other factors as may be appropriate 
                to assure that payment amounts are equitable.
            ``(4) Limiting charges of nonparticipating physicians.--
                    ``(A) In general.--In the case of a service 
                provided to an individual for the purpose of early 
                detection of prostate cancer for which payment may be 
                made under this part, if a nonparticipating physician 
                or supplier provides the procedure to an individual 
                enrolled under this part, the physician or supplier may 
                not charge the individual more than the limiting charge 
                (as defined in section 1848(g)(2)).
                    ``(B) Enforcement.--If a physician or supplier 
                knowingly and willfully imposes a charge in violation 
                of subparagraph (A), the Secretary may apply sanctions 
                against such physician or supplier in accordance with 
                section 1842(j)(2).''.
            (4) Conforming amendments.--(A) Paragraphs (1)(D) and 
        (2)(D) of section 1833(a) of such Act (42 U.S.C. 13951(a)) are 
        each amended by striking ``subsection (h)(1),'' and inserting 
        ``subsection (h)(1) or section 1834(d)(1)(B)(i),''.
            (B) Section 1833(a)(1) of such Act (42 U.S.C. 13951(a)(1)), 
        as amended by section 13544(b)(2) of OBRA-1993, is amended--
                    (i) by striking ``and (P)'' and insert ``(P)''; and
                    (ii) by striking the semicolon at the end and 
                inserting the following: ``, and (Q) with respect to 
                services for early detection of prostate cancer (as 
                defined in section 1861(ll)) (other than prostate-
                specific antigen tests), the amounts paid shall be the 
                amounts described in section 1834(d)(1);''.
            (C) Section 1833(a) of such Act (42 U.S.C. 13951(a)) is 
        amended--
                    (i) by striking ``and'' at the end of paragraph 
                (6);
                    (ii) by striking the period at the end of paragraph 
                (7) and inserting ``; and''; and
                    (iii) by adding at the end the following new 
                paragraph:
            ``(8) in the case of services for early detection of 
        prostate cancer (as defined in section 1861(ll)) (other than 
        prostate-specific antigen tests), the amounts described in 
        section 1834(d)(1).''.
            (D) Section 1833(h)(1)(A) of such Act (42 U.S.C. 
        13951(h)(1)(A)) is amended by striking ``The Secretary'' and 
        inserting ``Subject to section 1834(d), the Secretary''.
            (E) Section 1861(s)(2)(O) of such Act (42 U.S.C. 
        1395x(s)(2)(O)) is amended by striking ``(jj)'' and inserting 
        ``(kk)''.
            (F) Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is 
        amended--
                    (i) in paragraph (1)--
                            (I) in subparagraph (E), by striking 
                        ``and'' at the end,
                            (II) in subparagraph (F), by striking the 
                        semicolon at the end and inserting ``, and'', 
                        and
                            (III) by adding at the end the following 
                        new subparagraph:
            ``(G) In the case of services (as defined in section 
        1861(ll)) provided to an individual for the purpose of early 
        detection of prostate cancer, which are performed more 
        frequently than is covered under section 1834(d)(2);''; and
                    (ii) in paragraph (7), by striking ``paragraph 
                (1)(B) or under paragraph (1)(F)'' and inserting 
                ``subparagraphs (B), (F), or (G) of paragraph (1)''.
    (b) Coverage of Certain Drug Treatments.--Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by subsection 
(a)(1), is further amended--
            (1) by striking ``and'' at the end of subparagraph (Q);
            (2) by adding ``and'' at the end of subparagraph (R); and
            (3) by adding at the end the following new subparagraph:
            ``(S) an oral drug prescribed for the treatment of prostate 
        cancer, if the use of the drug for such purpose is a medically 
        accepted indication under subsection (t)(2);''.
    (c) Effective Date.--The amendments made by Section 1 shall apply 
to services provided on or after January 1, 1996, without regard to 
whether or not the Secretary has established fee schedules under 
section 1834(d)(3) of the Social Security Act (as added by subsection 
(a)(3)) or promulgated other regulations to carry out such amendments 
by that date.

SEC. 3. COVERAGE OF SERVICES FOR EARLY DETECTION AND TREATMENT OF 
              PROSTATE CANCER IN VETERANS.

    (a) Prostate Cancer Early Detection and Diagnosis Defined as 
Preventive Health Services.--Section 1701(9) of title 38, United States 
Code is amended--
            (1) by redesignating subparagraphs (J) and (K) as 
        subparagraphs (K) and (L), respectively; and
            (2) by inserting after subparagraph (I) the following new 
        subparagraph (J):
            ``(J) early detection and diagnostic tests approved for 
        prostate cancer,''.
    (b) Coverage of Early Detection and Treatment Services for Prostate 
Cancer.--
            (1) In general.--Chapter 17 of title 38, United States 
        Code, is amended by inserting after section 1724 a new section 
        as follows:
``Sec. 1725. Early Detection and Treatment of Prostate Cancer
    ``(a) The Secretary shall include in the medical services made 
available to veterans under this chapter appropriate services for early 
detection, counseling, treatment, and information on prostate cancer. 
Based on the best available medical evidence, the Secretary shall 
develop and implement an appropriate schedule for early detection of 
prostate cancer for those veterans confined to hospitals or other 
institutions.
    ``(b) for the purposes of this section--
            ``(1) appropriate service for early detection of prostate 
        cancer means procedures provided to a man for the purpose of 
        early detection of prostate cancer, including digital rectal 
        examinations, prostate-specific antigen blood tests, and 
        transactual ultrasonography; and
            ``(2) appropriate prostate cancer treatment includes drugs 
        approved by the Food and Drug Administration for the treatment 
        of prostate cancer.
    ``(c) The Secretary may carry out research and research training in 
the diagnosis and treatment of prostate cancer based upon the prostate 
cancer services provided under this section and may develop guidelines 
outlining effective treatment regimens for prostate cancer.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 1724 the following new item:

``1725. Early Detection and Treatment of Prostate Cancer.''.

SEC. 4. RESEARCH AND EDUCATION REGARDING PROSTATE CANCER; CERTAIN 
              PROGRAMS OF PUBLIC HEALTH SERVICE.

    (a) National Institutes of Health.--Section 417B(c) of the Public 
Health Service Act (42 U.S.C. 285a-8(c)) is amended in the first 
sentence by striking ``72,000,000'' and all that follows and inserting 
the following: ``$86,000,000 for fiscal year 1996, $100,000,000 for 
fiscal year 1997, $115,000,000 for fiscal year 1998, and $130,000,000 
for fiscal year 1999.''.
    (b) Agency for Health Care Policy and Research.--Section 902 of the 
Public Health Service Act (42 U.S.C. 299a) is amended by adding at the 
end the following subsection:
    ``(f) Activities Regarding Prostate Cancer.--The Administrator 
shall, with respect to prostate cancer--
            ``(1) conduct and support research on the outcomes, 
        effectiveness, and appropriateness of health services and 
        procedures; and
            ``(2) in carrying out section 912(a), provide for the 
        development, periodic review, and updating of clinically 
        relevant guidelines, standards of quality, performance 
        measures, and medical review criteria.''.
                                 <all>
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