I 

114TH CONGRESS 

1ST SESSION H. R. 2035 

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 HOUSE OF REPRESENTATIVES 

APRIL 27, 2015 

Mr. NEAL 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 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 

3 precancerous polyps through colonoscopy could re4 duce the number of colorectal cancer deaths by 53 

5 percent. 

6 (6) Although colorectal cancer is highly prevent7 able with appropriate screening, one in three adults 

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

9 date with recommended colorectal cancer screening. 

10 (7) Over 200 organizations have committed to 

11 eliminating colorectal cancer as a major health prob12 lem in the United States and are working toward a 

13 shared goal of screening 80 percent of eligible Amer14 icans by 2018. 

15 (8) Hepatitis C is a liver disease that causes in16 flammation of the liver and results from infection 

17 with the Hepatitis C virus. Chronic Hepatitis C in18 fection can lead to serious health problems, including 

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

20 leading cause of liver transplants in the United 

21 States. 

22 (9) According to the Centers for Disease Con23 trol and Prevention (CDC), more than 75 percent of 

24 adults infected with the Hepatitis C virus in the 

25 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— 

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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 

4 COLONOSCOPY AND HEPATITIS C SCREEN5 ING. 

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

7 U.S.C. 1315a(b)(2)) is amended— 

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

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

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

11 (2) by adding at the end the following new sub12 paragraph: 

13 ‘‘(D) MEDICARE DEMONSTRATION

14 PROJECT TO EVALUATE THE EFFECTIVENESS

15 OF A PRE-OPERATIVE VISIT PRIOR TO SCREEN16 ING COLONOSCOPY AND HEPATITIS C SCREEN17 ING.— 

18 ‘‘(i) IN GENERAL.—The model de19 scribed in this subparagraph is a dem20 onstration project under title XVIII to 

21 evaluate the effectiveness of a pre-operative 

22 visit with the provider performing the pro23 cedure prior to screening colonoscopy to— 

24 ‘‘(I) ease any patient concern or 

25 fears with respect to the procedure 


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1 and answer any questions relating to 

2 the screening; 

3 ‘‘(II) ensure quality examinations 

4 and avoid unnecessary repeat exami5 nations by educating individuals on 

6 the importance of following pre-proce7 dure instructions, such as bowel prep8 aration, and addressing the individ9 ual’s family history of or predisposi10 tion to colorectal cancer; and 

11 ‘‘(III) increase Hepatitis C Virus 

12 (HCV) screening rates among Medi13 care beneficiaries by educating indi14 viduals about the importance of such 

15 screening during the pre-operative 

16 visit and having the pre-operative visit 

17 fulfill the referral requirement for 

18 such screening under title XVIII, al19 lowing patients to be screened for 

20 colorectal cancer and HCV at the 

21 same time. 

22 ‘‘(ii) CONSULTATION.—The Secretary 

23 shall consult with stakeholders who would 

24 be providing the pre-operative visit under 

25 the model described in this subparagraph 


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1 on the implementation of such model, in2 cluding payment for services furnished 

3 under the model.’’. 

4 SEC. 6. BUDGET NEUTRALITY. 

5 (a) ADJUSTMENT OF PHYSICIAN FEE SCHEDULE

6 CONVERSION FACTOR.—The Secretary of Health and 

7 Human Services (in this section referred to as the ‘‘Sec8 retary’’) shall reduce the conversion factor established 

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

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

11 2016) to the extent necessary to reduce expenditures 

12 under such section for items and services furnished during 

13 the year in the aggregate by the net offset amount deter14 mined under subsection (c)(5) attributable to such section 

15 for the year. 

16 (b) ADJUSTMENT OF HOPD CONVERSION FAC17 TOR.—The Secretary shall reduce the conversion factor es18 tablished under paragraph (3)(C) of section 1833(t) of the 

19 Social Security Act (42 U.S.C. 1395l(t)) for each year (be20 ginning with 2016) to the extent necessary to reduce ex21 penditures under such section for items and services fur22 nished during the year in the aggregate by the net offset 

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

24 such section for the year. 


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1 (c) DETERMINATIONS RELATING TO EXPENDI2 TURES.—For purposes of this section, before the begin3 ning of each year (beginning with 2016) at the time con4 version factors described in subsections (a) and (b) are 

5 established for the year, the Secretary shall determine— 

6 (1) the amount of the gross additional expendi7 tures under title XVIII of the Social Security Act 

8 (42 U.S.C. 1395 et seq.) estimated to result from 

9 the implementation of sections 3 and 4 for items 

10 and services furnished during the year; 

11 (2) the amount of any offsetting reductions in 

12 expenditures under such title (such as reductions in 

13 payments for inpatient hospital services) for such 

14 year attributable to the implementation of such sec15 tions; 

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

17 of the gross additional expenditures determined 

18 under paragraph (1) for the year exceeds the 

19 amount of offsetting reductions determined under 

20 paragraph (2) for the year; 

21 (4) the amount of the gross additional expendi22 tures determined under paragraph (1) for the year 

23 that are attributable to expenditures under sections 

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1 penditures that are attributable to each respective 

2 section; and 

3 (5) with respect to section 1848 and section 

4 1833(t) of such Act, a net offset amount for the 

5 year equal to the product of— 

6 (A) the amount of the net additional ex7 penditures for the year determined under para8 graph (3); and 

9 (B) the ratio determined under paragraph 

10 (4) attributable to the respective section. 

Æ 


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