I 

109TH CONGRESS 

1ST SESSION H. R. 1632

To amend title XVIII of the Social Security Act to improve patient access 

to, and utilization of, the colorectal cancer screening benefit under the 

Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 14, 2005

Mr. ENGLISH of Pennsylvania (for himself, Mr. CARDIN, Ms. HART, Mr. WILSON of South Carolina, Mr. TOWNS, Mr. SESSIONS, Mr. PICKERING, Mr. 

PETERSON of Minnesota, Mr. CLYBURN, Mr. MCNULTY, Mr. ISRAEL, and 

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

Committee on Energy and Commerce, and in addition to the Committee 

on Ways and Means, 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 improve 

patient access to, and utilization of, the colorectal cancer 

screening benefit under the Medicare Program.

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 ‘‘Colon Cancer Screen 

5 for Life Act of 2005’’. 
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1 SEC. 2. SENSE OF CONGRESS. 

2 It is the sense of Congress that—

3 (1) colorectal cancer screening tests (as defined 

4 in section 1861(pp)(1) of the Social Security Act (42 

5 U.S.C. 1395x(pp)(1)) covered under the medicare 

6 program have been severely underutilized, with the 

7 Comptroller General of the United States reporting 

8 in 2000 that since coverage of such tests was imple9 mented, the percentage of beneficiaries under the 

10 medicare program receiving either a screening or a 

11 diagnostic colonoscopy has increased by only 1 per12 cent; 

13 (2) in recognition of the need to improve rates 

14 of colorectal cancer screening in the medicare pro15 gram, Congress enacted provisions in the Medicare 

16 Prescription Drug, Improvement, and Modernization 

17 Act of 2003 to require physicians to provide a refer18 ral for colorectal cancer screening as part of the new 

19 initial preventive physical examination, beginning 

20 January 1, 2005; 

21 (3) the Centers for Medicare & Medicaid Serv22 ices should encourage health care providers to use 

23 more effective screening and diagnostic health care 

24 technologies in the area of colorectal cancer screen25 ing; 
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1 (4) in recent years, the Centers for Medicare & 

2 Medicaid Services has subjected colorectal cancer 

3 screening tests to some of the largest reimbursement 

4 reductions under the medicare program; 

5 (5) unlike other preventive screening tests cov6 ered under the medicare program, health care pro7 viders must consult with beneficiaries prior to fur8 nishing a screening colonoscopy in order to—

9 (A) ascertain the medical and family his10 tory of the beneficiary; and 

11 (B) inform the beneficiary of preparatory 

12 steps that must be taken prior to the procedure; 

13 and 

14 (6) reimbursement under the medicare program 

15 is not currently available for the consultations de16 scribed in paragraph (5) despite the fact that reim17 bursement is provided under such program for simi18 lar consultations prior to a diagnostic colonoscopy. 

19 SEC. 3. INCREASE IN PART B REIMBURSEMENT FOR 

20 COLORECTAL CANCER SCREENING AND DI21 AGNOSTIC TESTS. 

22 (a) IN GENERAL.—Section 1834(d) of the Social Se23 curity Act (42 U.S.C. 1395m(d)) is amended by adding 

24 at the end the following new paragraph: 
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1 ‘‘(4) ENHANCED PART B PAYMENT FOR

2 COLORECTAL CANCER SCREENING AND DIAGNOSTIC

3 TESTS.—

4 ‘‘(A) NONFACILITY RATES.—Notwith5 standing paragraphs (2)(A) and (3)(A), the 

6 Secretary shall establish national minimum pay7 ment amounts for CPT codes 45378, 45380, 

8 and 45385, and HCPCS codes G0105 and 

9 GO121 for items and services furnished on or 

10 after January 1, 2006, which reflect a 10-per11 cent increase above the relative value units in 

12 effect as the nonfacility rates for such codes on 

13 December 31, 2005, with such revised payment 

14 level to apply to items and services performed 

15 in a nonfacility setting. 

16 ‘‘(B) FACILITY RATES.—Notwithstanding 

17 paragraphs (2)(A) and (3)(A), the Secretary 

18 shall establish national minimum payment 

19 amounts for CPT codes 45378, 45380, and 

20 45385, and HCPCS codes G0105 and GO121 

21 for items and services furnished on or after 

22 January 1, 2006, which reflect a 30-percent in23 crease above the relative value units in effect as 

24 the facility rates for such codes on December 

25 31, 2005, with such revised payment level to 
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1 apply to items and services performed in a facil2 ity setting. 

3 ‘‘(C) ANNUAL ADJUSTMENTS.—In the case 

4 of items and services furnished on or after Jan5 uary 1, 2006, the payment rates described in 

6 subparagraphs (A) and (B) shall, subject to the 

7 minimum payment amounts established in such 

8 subparagraphs, be adjusted annually as pro9 vided in section 1848.’’. 

10 (b) NO EFFECT ON HOPD PAYMENTS.—The Sec11 retary of Health and Human Services shall not take into 

12 account the provisions of section 1834(d)(4) of the Social 

13 Security Act, as added by subsection (a), in determining 

14 the amount of payment for any covered OPD service under 

15 the prospective payment system for hospitals outpatient 

16 department services under section 1833(t) of such Act (42 

17 U.S.C. 1395l(t)). 

18 SEC. 4. MEDICARE COVERAGE OF OFFICE VISIT OR CON19 SULTATION PRIOR TO A SCREENING 

20 COLONOSCOPY OR IN CONJUNCTION WITH A 

21 BENEFICIARY’S DECISION TO OBTAIN SUCH A 

22 SCREENING. 

23 (a) COVERAGE.—Section 1861(s)(2) of the Social Se24 curity Act (42 U.S.C. 1395x(s)(2)) is amended—
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1 (1) in subparagraph (Y), by striking ‘‘and’’ at 

2 the end; 

3 (2) in subparagraph (Z), by inserting ‘‘and’’ at 

4 the end; and 

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(AA) an outpatient office visit or con8 sultation for the purpose of beneficiary edu9 cation, assuring selection of the proper screen10 ing test, and securing information relating to 

11 the procedure and sedation of the beneficiary, 

12 prior to a colorectal cancer screening test con13 sisting of a screening colonoscopy or in conjunc14 tion with the beneficiary’s decision to obtain 

15 such a screening, regardless of whether such 

16 screening is medically indicated with respect to 

17 the beneficiary;’’. 

18 (b) PAYMENT.—

19 (1) IN GENERAL.—Section 1833(a)(1) of the 

20 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

21 amended—

22 (A) by striking ‘‘and’’ before ‘‘(V)’’; and 

23 (B) by inserting before the semicolon at 

24 the end the following: ‘‘, and (W) with respect 

25 to an outpatient office visit or consultation 
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1 under section 1861(s)(2)(AA), the amounts 

2 paid shall be 80 percent of the lesser of the ac3 tual charge or the amount established under 

4 section 1848’’. 

5 (2) PAYMENT UNDER PHYSICIAN FEE SCHED6 ULE.—Section 1848(j)(3) of the Social Security Act 

7 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

8 ‘‘(2)(AA),’’ after ’’(2)(W),’’. 

9 (3) REQUIREMENT FOR ESTABLISHMENT OF

10 PAYMENT AMOUNT UNDER PHYSICIAN FEE SCHED11 ULE.—Section 1834(d) of the Social Security Act 

12 (42 U.S.C. 1395m(d)), as amended by section 3, is 

13 amended by adding at the end the following new 

14 paragraph: 

15 ‘‘(5) PAYMENT FOR OUTPATIENT OFFICE VISIT

16 OR CONSULTATION PRIOR TO SCREENING

17 COLONOSCOPY.—With respect to an outpatient office 

18 visit or consultation under section 1861(s)(2)(AA), 

19 payment under section 1848 shall be consistent with 

20 the payment amounts for CPT codes 99203 and 

21 99243.’’. 

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

23 this section shall apply to items and services provided on 

24 or after January 1, 2006. 
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1 SEC. 5. WAIVER OF DEDUCTIBLE FOR COLORECTAL CAN2 CER SCREENING TESTS. 

3 (a) IN GENERAL.—The first sentence of section 

4 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) 

5 is amended—

6 (1) by striking ‘‘and’’ before ‘‘(6)’’; and 

7 (2) by inserting before the period at the end the 

8 following: ‘‘, and (7) such deductible shall not apply 

9 with respect to colorectal cancer screening tests (as 

10 described in section 1861(pp)(1))’’. 

11 (b) CONFORMING AMENDMENTS.—Paragraphs 

12 (2)(C)(ii) and (3)(C)(ii) of section 1834(d) of the Social 

13 Security Act (42 U.S.C. 1395m(d)) are each amended—

14 (1) by striking ‘‘DEDUCTIBLE AND’’ in the 

15 heading; and 

16 (2) in subclause (I), by striking ‘‘deductible or’’ 

17 each place it appears. 

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

19 this section shall apply to items and services furnished on 

20 or after January 1, 2006.

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