I 

112TH CONGRESS 

1ST SESSION H. R. 3198 

To amend title 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 

OCTOBER 13, 2011 

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 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 2011’’ or the ‘‘SCREEN Act of 2011’’. 


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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. 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. 

Sec. 7. Expansion of coverage of activities related to recommended preventive 

health services under private health insurance. 

3 SEC. 2. FINDINGS. 

4 Congress finds the following: 

5 (1) Colon cancer is the third most common 

6 cause of cancer-related deaths and the second most 

7 common cancer for both men and women. 

8 (2) According to the American Cancer Society, 

9 over 50,000 people will die this year from colon can10 cer. 

11 (3) Colorectal cancer is highly treatable with 

12 appropriate screening. According to the American 

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

14 survival rate is 90 percent for those individuals who 

15 are diagnosed at an early stage of the cancer. How16 ever, less than 40 percent of colon cancer cases are 

17 diagnosed at an early stage. 

18 (4) The Centers for Disease Control and Pre19 vention recently estimated that approximately 2,000 


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1 deaths could be avoided if colonoscopy screening 

2 rates rose by just 10 percent. 

3 (5) Colonoscopies allow for simultaneous 

4 colorectal cancer screenings and detection and the 

5 removal of precancerous polyps, thus preventing can6 cer from developing. 

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

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

9 screenings. 

10 (7) The Centers for Disease Control and Pre11 vention’s colorectal cancer control program has set a 

12 target of screening 80 percent of eligible adults in 

13 certain States by 2014. The American Cancer Soci14 ety and other patient advocacy groups have a target 

15 rate of 75 percent. 

16 (8) Only between 52 and 58 percent of Medi17 care beneficiaries have had any colorectal cancer 

18 screening test, despite Medicare coverage for such 

19 tests. 

20 (9) Only 49.3 percent of Medicare beneficiaries 

21 who are 50 to 80 years old receive colorectal cancer 

22 screenings within recommended intervals. 

23 (10) The Centers for Medicare & Medicaid 

24 Services notes that there is ‘‘clearly an opportunity 


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1 to improve colorectal cancer screening rates in the 

2 Medicare population’’. 

3 (11) A January 2011 study by the Colon Can4 cer Alliance concludes that most Americans over the 

5 age of 50— 

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

7 sit down with them to discuss a colonoscopy be8 fore undergoing the test; and 

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

10 procedure. 

11 (12) In February 2010, the National Institutes 

12 of Health hosted a conference on colorectal cancer 

13 screening and cited patient awareness and fears as 

14 barriers to increasing colorectal cancer screening 

15 rates. 

16 (13) According to the Medicare Payment Advi17 sory Commission, colonoscopy is one of the most 

18 common procedures performed in the ambulatory 

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

20 rate for the highest volume procedures is especially 

21 a strong concern for ASCs that focus on gastro22 enterology’’. 

23 (14) An Institute of Medicine study on 

24 colorectal cancer screening cited the inadequate re25 imbursement for preventive care services as one of 


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1 the constraints limiting colorectal cancer screening 

2 rates. 

3 (15) Colorectal cancer screening by colonoscopy 

4 has been demonstrated to reduce Medicare costs 

5 over the long-term. 

6 SEC. 3. TEMPORARY INCREASE IN PAYMENT RATE FOR 

7 CERTAIN CANCER SCREENING TESTS. 

8 (a) IN GENERAL.—With respect to a qualifying can9 cer screening test furnished during the 5-year period be10 ginning on January 1, 2013, by a qualifying provider, the 

11 amount otherwise payable under section 1833 or section 

12 1848 of the Social Security Act (42 U.S.C. 1395l, 1395w– 

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

14 percent. 

15 (b) QUALIFYING CANCER SCREENING TEST.— 

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

17 subject to paragraph (2), the term ‘‘qualifying can18 cer screening test’’ means, with respect to a Medi19 care beneficiary, a cancer screening test that has in 

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

21 in the current recommendations of the United States 

22 Preventive Services Task Force. 

23 (2) TERMINATION WHEN HIGH UTILIZATION

24 RATE REACHED.—If the Secretary determines that a 

25 cancer screening test described in paragraph (1) has 


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1 a utilization rate of at least 75 percent of the Medi2 care beneficiaries for whom such screening has such 

3 a recommendation, effective as of the first day of the 

4 year after the year in which such determination is 

5 made, the cancer screening test shall not be a quali6 fying cancer screening test. 

7 (c) QUALIFYING PROVIDER DEFINED.—For purposes 

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

9 respect to a qualifying cancer screening test, an individual 

10 or entity— 

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

12 under section 1833 or section 1848 of the Social Se13 curity Act; and 

14 (2) that— 

15 (A) participates in a nationally recognized 

16 quality improvement registry with respect to 

17 such test; and 

18 (B) demonstrates, to the satisfaction of the 

19 Secretary, based on the information in such 

20 registry, that the tests were provided by such 

21 individual or entity in accordance with accepted 

22 outcomes-based quality measures. 


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1 SEC. 4. WAIVING MEDICARE COST-SHARING FOR 

2 COLORECTAL CANCER SCREENING WITH 

3 THERAPEUTIC EFFECT. 

4 (a) IN GENERAL.—Section 1833(a)(1)(Y) of the So5 cial Security Act (42 U.S.C. 1395l(a)(1)(Y)) is amended 

6 by inserting ‘‘, including tests and procedures described 

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

8 1861(ddd)(3)’’. 

9 (b) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply to tests and procedures performed 

11 on or after January 1, 2013. 

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

13 CONSULTATION PRIOR TO A QUALIFYING 

14 SCREENING COLONOSCOPY. 

15 (a) COVERAGE.—Section 1861(s)(2) of the Social Se16 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

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

18 the end; 

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

20 at the end; and 

21 (3) by adding at the end the following new sub22 paragraph: 

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

24 test consisting of a screening colonoscopy or in con25 junction with an individual’s decision regarding the 

26 performance of such a test on the individual, an outVerDate Mar 15 2010 23:44 Oct 14, 2011 Jkt 019060 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3198.IH H3198

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1 patient office visit or consultation for the purpose of 

2 beneficiary education, assuring selection of the prop3 er screening test, and securing information relating 

4 to the procedure and the sedation of the indi5 vidual;’’. 

6 (b) PAYMENT.— 

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

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

9 amended— 

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

11 (B) by inserting before the semicolon at 

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

13 to an outpatient office visit or consultation 

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

15 paid shall be 80 percent of the lesser of the ac16 tual charge or the amount established under 

17 section 1848’’. 

18 (2) PAYMENT UNDER PHYSICIAN FEE SCHED19 ULE.—Section 1848(j)(3) of the Social Security Act 

20 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

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

22 of the health risk assessment),’’. 

23 (3) REQUIREMENT FOR ESTABLISHMENT OF

24 PAYMENT AMOUNT UNDER PHYSICIAN FEE SCHED25 ULE.—Section 1834(d) of the Social Security Act 


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1 (42 U.S.C. 1395m(d)) is amended by adding at the 

2 end the following new paragraph: 

3 ‘‘(4) PAYMENT FOR OUTPATIENT OFFICE VISIT

4 OR CONSULTATION PRIOR TO SCREENING

5 COLONOSCOPY.—With respect to an outpatient office 

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

7 payment under section 1848 shall be consistent with 

8 the payment amounts for CPT codes 99201, 99202, 

9 99203, 99204, 99211, 99212, 99213, 99214, and 

10 99215 (as in effect as of the date of the enactment 

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

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

13 this section shall apply to items and services furnished on 

14 or after January 1, 2013. 

15 SEC. 6. BUDGET NEUTRALITY. 

16 (a) ADJUSTMENT OF PHYSICIAN FEE SCHEDULE

17 CONVERSION FACTOR.—The Secretary of Health and 

18 Human Services (in this section referred to as the ‘‘Sec19 retary’’) shall reduce the conversion factor established 

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

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

22 2013) to the extent necessary to reduce expenditures 

23 under such section for items and services furnished during 

24 the year in the aggregate by the net offset amount deterVerDate Mar 15 2010 23:44 Oct 14, 2011 Jkt 019060 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3198.IH H3198

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1 mined under subsection (c)(5) attributable to such section 

2 for the year. 

3 (b) ADJUSTMENT OF HOPD CONVERSION FAC4 TOR.—The Secretary shall reduce the conversion factor es5 tablished under paragraph (3)(C) of section 1833(t) of the 

6 Social Security Act (42 U.S.C. 1395l(t)) for each year (be7 ginning with 2013) to the extent necessary to reduce ex8 penditures under such section for items and services fur9 nished during the year in the aggregate by the net offset 

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

11 such section for the year. 

12 (c) DETERMINATIONS RELATING TO EXPENDI13 TURES.—For purposes of this section, before the begin14 ning of each year (beginning with 2013) at the time con15 version factors described in subsection (a) and (b) are es16 tablished for the year, the Secretary shall determine— 

17 (1) the amount of the gross additional expendi18 tures under title XVIII of the Social Security Act 

19 (42 U.S.C. 1395 et seq.) estimated to result from 

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

21 and services furnished during the year; 

22 (2) the amount of any offsetting reductions in 

23 expenditures under such title (such as reductions in 

24 payments for inpatient hospital services) for such 


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1 year attributable to the implementation of such sec2 tions; 

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

4 of the gross additional expenditures determined 

5 under paragraph (1) for the year exceeds the 

6 amount of offsetting reductions determined under 

7 paragraph (2) for the year; 

8 (4) of the gross additional expenditures deter9 mined under paragraph (1) for the year that are at10 tributable to expenditures under sections 1848 and 

11 1833(t) of such Act, the ratio of such expenditures 

12 that are attributable to each respective section; and 

13 (5) with respect to section 1848 and section 

14 1833(t) of such Act, a net offset amount for the 

15 year equal to the product of— 

16 (A) the amount of the net additional ex17 penditures for the year determined under para18 graph (3); and 

19 (B) the ratio determined under paragraph 

20 (4) attributable to the respective section. 


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1 SEC. 7. EXPANSION OF COVERAGE OF ACTIVITIES RELATED 

2 TO RECOMMENDED PREVENTIVE HEALTH 

3 SERVICES UNDER PRIVATE HEALTH INSUR4 ANCE. 

5 (a) IN GENERAL.—Section 2713(a)(1) of the Public 

6 Health Service Act (42 U.S.C. 300gg–13(a)(1)) is amend7 ed by inserting ‘‘(including related activities occurring as 

8 part of the same clinical encounter, such as conducting 

9 a biopsy or by removing a lesion or growth)’’ after ‘‘Task 

10 Force’’. 

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

12 subsection (a) shall apply to plan years beginning on or 

13 after January 1, 2013. 

Æ 


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