I 

113TH CONGRESS 

1ST SESSION H. R. 1320 

To amend title XVIII of the Social Security Act to improve coverage for 

colorectal screening tests under Medicare, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 21, 2013 

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 title XVIII of the Social Security Act to improve 

coverage for colorectal screening tests under Medicare, 

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 2013’’ or the ‘‘SCREEN Act of 2013’’. 

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

8 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Temporary increase in payment rate for certain cancer screening tests. 

Sec. 4. Waiving Medicare cost-sharing for colorectal cancer screening with 

therapeutic effect. 

Sec. 5. Medicare coverage for an office visit or consultation prior to a qualifying 

screening colonoscopy. 

Sec. 6. Budget neutrality. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Colon cancer is the third most common 

4 cause of cancer-related deaths and the second most 

5 common cancer for both men and women. 

6 (2) According to the American Cancer Society, 

7 over 50,000 people will die this year from colon can8 cer. 

9 (3) Colorectal cancer is highly treatable with 

10 appropriate screening. According to the American 

11 Cancer Society (2010 Facts & Figures), the 5-year 

12 survival rate is 90 percent for those individuals who 

13 are diagnosed at an early stage of the cancer. How14 ever, less than 40 percent of colon cancer cases are 

15 diagnosed at an early stage. 

16 (4) The Centers for Disease Control and Pre17 vention recently estimated that approximately 2,000 

18 deaths could be avoided if colonoscopy screening 

19 rates rose by just 10 percent. 

20 (5) Colonoscopies allow for simultaneous 

21 colorectal cancer screenings and detection and the 


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1 removal of precancerous polyps, thus preventing can2 cer from developing. 

3 (6) The U.S. Preventive Services Task Force 

4 provides an ‘‘A’’ rating for colorectal cancer 

5 screenings. 

6 (7) The Centers for Disease Control and Pre7 vention’s colorectal cancer control program has set a 

8 target of screening 80 percent of eligible adults in 

9 certain States by 2014. The American Cancer Soci10 ety and other patient advocacy groups have a target 

11 rate of 75 percent. 

12 (8) Only between 52 and 58 percent of Medi13 care beneficiaries have had any colorectal cancer 

14 screening test, despite Medicare coverage for such 

15 tests. 

16 (9) Only 49.3 percent of Medicare beneficiaries 

17 who are 50 to 80 years old receive colorectal cancer 

18 screenings within recommended intervals. 

19 (10) The Centers for Medicare & Medicaid 

20 Services notes that there is ‘‘clearly an opportunity 

21 to improve colorectal cancer screening rates in the 

22 Medicare population’’. 

23 (11) A January 2011 study by the Colon Can24 cer Alliance concludes that most Americans over the 

25 age of 50— 


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1 (A) wish a health care provider was able to 

2 sit down with them to discuss a colonoscopy be3 fore undergoing the test; and 

4 (B) forgo a colonoscopy due to fear of the 

5 procedure. 

6 (12) In February 2010, the National Institutes 

7 of Health hosted a conference on colorectal cancer 

8 screening and cited patient awareness and fears as 

9 barriers to increasing colorectal cancer screening 

10 rates. 

11 (13) According to the Medicare Payment Advi12 sory Commission, colonoscopy is one of the most 

13 common procedures performed in the ambulatory 

14 surgical centers (ASCs) and ‘‘the decline in payment 

15 rate for the highest volume procedures is especially 

16 a strong concern for ASCs that focus on gastro17 enterology’’. 

18 (14) An Institute of Medicine study on 

19 colorectal cancer screening cited the inadequate re20 imbursement for preventive care services as one of 

21 the constraints limiting colorectal cancer screening 

22 rates. 

23 (15) Colorectal cancer screening by colonoscopy 

24 has been demonstrated to reduce Medicare costs 

25 over the long-term. 


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1 SEC. 3. TEMPORARY INCREASE IN PAYMENT RATE FOR 

2 CERTAIN CANCER SCREENING TESTS. 

3 (a) IN GENERAL.—With respect to a qualifying can4 cer screening test furnished during the 5-year period be5 ginning on January 1, 2014, by a qualifying provider, the 

6 amount otherwise payable under section 1833 or section 

7 1848 of the Social Security Act (42 U.S.C. 1395l, 1395w– 

8 4) to such provider for such test shall be increased by 10 

9 percent. 

10 (b) QUALIFYING CANCER SCREENING TEST.— 

11 (1) IN GENERAL.—For purposes of this section, 

12 subject to paragraph (2), the term ‘‘qualifying can13 cer screening test’’ means, with respect to a Medi14 care beneficiary, a cancer screening test that has in 

15 effect with respect to such beneficiary a rating of ‘A’ 

16 in the current recommendations of the United States 

17 Preventive Services Task Force. 

18 (2) TERMINATION WHEN HIGH UTILIZATION

19 RATE REACHED.—If the Secretary of Health and 

20 Human Services determines that a cancer screening 

21 test described in paragraph (1) has a utilization rate 

22 of at least 75 percent of the Medicare beneficiaries 

23 for whom such screening has such a recommenda24 tion, effective as of the first day of the year after 

25 the year in which such determination is made, the 


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1 cancer screening test shall not be a qualifying cancer 

2 screening test. 

3 (c) QUALIFYING PROVIDER DEFINED.—For purposes 

4 of this section, the term ‘‘qualifying provider’’ means, with 

5 respect to a qualifying cancer screening test, an individual 

6 or entity— 

7 (1) that is eligible for payment for such test 

8 under section 1833 or section 1848 of the Social Se9 curity Act (42 U.S.C. 1395l, 1395w–4); and 

10 (2) that— 

11 (A) participates in a nationally recognized 

12 quality improvement registry with respect to 

13 such test; and 

14 (B) demonstrates, to the satisfaction of the 

15 Secretary, based on the information in such 

16 registry, that the tests were provided by such 

17 individual or entity in accordance with accepted 

18 outcomes-based quality measures. 

19 SEC. 4. WAIVING MEDICARE COST-SHARING FOR 

20 COLORECTAL CANCER SCREENING WITH 

21 THERAPEUTIC EFFECT. 

22 (a) IN GENERAL.—Section 1833(a)(1)(Y) of the So23 cial Security Act (42 U.S.C. 1395l(a)(1)(Y)) is amended 

24 by inserting ‘‘, including tests and procedures described 


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1 in the last sentence of subsection (b),’’ after ‘‘section 

2 1861(ddd)(3)’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 this section shall apply to tests and procedures performed 

5 on or after January 1, 2014. 

6 SEC. 5. MEDICARE COVERAGE FOR AN OFFICE VISIT OR 

7 CONSULTATION PRIOR TO A QUALIFYING 

8 SCREENING COLONOSCOPY. 

9 (a) COVERAGE.—Section 1861(s)(2) of the Social Se10 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

11 (1) in subparagraph (EE), by striking ‘‘and’’ at 

12 the end; 

13 (2) in subparagraph (FF), by inserting ‘‘and’’ 

14 at the end; and 

15 (3) by adding at the end the following new sub16 paragraph: 

17 ‘‘(GG) prior to a colorectal cancer screening 

18 test consisting of a screening colonoscopy or in con19 junction with an individual’s decision regarding the 

20 performance of such a test on the individual, an out21 patient office visit or consultation for the purpose of 

22 beneficiary education, assuring selection of the prop23 er screening test, and securing information relating 

24 to the procedure and the sedation of the indi25 vidual;’’. 


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1 (b) PAYMENT.— 

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

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

4 amended— 

5 (A) by striking ‘‘and’’ before ‘‘(Z)’’; and 

6 (B) by inserting before the semicolon at 

7 the end the following: ‘‘, and (AA) with respect 

8 to an outpatient office visit or consultation 

9 under section 1861(s)(2)(GG), the amounts 

10 paid shall be 80 percent of the lesser of the ac11 tual charge or the amount established under 

12 section 1848’’. 

13 (2) PAYMENT UNDER PHYSICIAN FEE SCHED14 ULE.—Section 1848(j)(3) of the Social Security Act 

15 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

16 ‘‘(2)(GG),’’ after ‘‘(2)(FF) (including administration 

17 of the health risk assessment),’’. 

18 (3) REQUIREMENT FOR ESTABLISHMENT OF

19 PAYMENT AMOUNT UNDER PHYSICIAN FEE SCHED20 ULE.—Section 1834(d) of the Social Security Act 

21 (42 U.S.C. 1395m(d)) is amended by adding at the 

22 end the following new paragraph: 

23 ‘‘(4) PAYMENT FOR OUTPATIENT OFFICE VISIT

24 OR CONSULTATION PRIOR TO SCREENING

25 COLONOSCOPY.—With respect to an outpatient office 


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1 visit or consultation under section 1861(s)(2)(GG), 

2 payment under section 1848 shall be consistent with 

3 the payment amounts for CPT codes 99201, 99202, 

4 99203, 99204, 99211, 99212, 99213, 99214, and 

5 99215 (as in effect as of the date of the enactment 

6 of this paragraph or any successors to such codes).’’. 

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

8 this section shall apply to items and services furnished on 

9 or after January 1, 2014. 

10 SEC. 6. BUDGET NEUTRALITY. 

11 (a) ADJUSTMENT OF PHYSICIAN FEE SCHEDULE

12 CONVERSION FACTOR.—The Secretary of Health and 

13 Human Services (in this section referred to as the ‘‘Sec14 retary’’) shall reduce the conversion factor established 

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

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

17 2014) to the extent necessary to reduce expenditures 

18 under such section for items and services furnished during 

19 the year in the aggregate by the net offset amount deter20 mined under subsection (c)(5) attributable to such section 

21 for the year. 

22 (b) ADJUSTMENT OF HOPD CONVERSION FAC23 TOR.—The Secretary shall reduce the conversion factor es24 tablished under paragraph (3)(C) of section 1833(t) of the 

25 Social Security Act (42 U.S.C. 1395l(t)) for each year (beVerDate Mar 15 2010 00:24 Mar 28, 2013 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1320.IH H1320

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1 ginning with 2014) to the extent necessary to reduce ex2 penditures under such section for items and services fur3 nished during the year in the aggregate by the net offset 

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

5 such section for the year. 

6 (c) DETERMINATIONS RELATING TO EXPENDI7 TURES.—For purposes of this section, before the begin8 ning of each year (beginning with 2014) at the time con9 version factors described in subsection (a) and (b) are es10 tablished for the year, the Secretary shall determine— 

11 (1) the amount of the gross additional expendi12 tures under title XVIII of the Social Security Act 

13 (42 U.S.C. 1395 et seq.) estimated to result from 

14 the implementation of sections 3, 4, and 5 for items 

15 and services furnished during the year; 

16 (2) the amount of any offsetting reductions in 

17 expenditures under such title (such as reductions in 

18 payments for inpatient hospital services) for such 

19 year attributable to the implementation of such sec20 tions; 

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

22 of the gross additional expenditures determined 

23 under paragraph (1) for the year exceeds the 

24 amount of offsetting reductions determined under 

25 paragraph (2) for the year; 


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1 (4) of the gross additional expenditures deter2 mined under paragraph (1) for the year that are at3 tributable to expenditures under sections 1848 and 

4 1833(t) of such Act (42 U.S.C. 1395w–4, 1395l(t)), 

5 the ratio of such expenditures that are attributable 

6 to each respective section; and 

7 (5) with respect to section 1848 and section 

8 1833(t) of such Act (42 U.S.C. 1395w–4, 1395l(t)), 

9 a net offset amount for the year equal to the prod10 uct of— 

11 (A) the amount of the net additional ex12 penditures for the year determined under para13 graph (3); and 

14 (B) the ratio determined under paragraph 

15 (4) attributable to the respective section. 

Æ 


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