I 

111TH CONGRESS 

1ST SESSION H. R. 3559 

To amend titles XVIII and XIX of the Social Security Act to improve 

awareness and access to colorectal cancer screening tests under the 

Medicare and Medicaid programs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 14, 2009 

Mr. NEAL of Massachusetts 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 XVIII and XIX of the Social Security Act 

to improve awareness and access to colorectal cancer 

screening tests under the Medicare and Medicaid programs, 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. 

4 This Act may be cited as the ‘‘Supporting ColoRectal 

5 Examination and Education Now (SCREEN) Act of 

6 2009’’. 


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1 SEC. 2. FINDINGS AND SENSE OF CONGRESS. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) A majority of the deaths and costs associ5 ated with colorectal cancer, the second leading cause 

6 of cancer deaths in the United States, are avoidable 

7 through timely preventive screening, including 

8 colonoscopy. 

9 (2) The United States Preventive Services Task 

10 Force provides its only grade ‘‘A’’ recommendation 

11 of cancer screenings for colorectal interventions. 

12 (3) Colorectal cancer screening test rates are 

13 far too low, with only 50 percent of recommended 

14 populations receiving colorectal cancer screening 

15 tests, and rates of such screening tests among mi16 norities and those without insurance lag consider17 ably. 

18 (4) The colorectal cancer screening benefit 

19 under the Medicare program under title XVIII of 

20 the Social Security Act is severely underutilized. 

21 (5) Numerous barriers for patients, commu22 nities, and health care providers detrimentally affect 

23 the utilization of colorectal cancer screening tests. 

24 Such barriers include patient knowledge, coinsurance 

25 burdens, restrictions on Medicare coverage for an ofVerDate Nov 24 2008 01:59 Sep 15, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3559.IH H3559

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1 fice visit prior to a screening colonoscopy, and reduc2 tions in Medicare reimbursement. 

3 (b) SENSE OF CONGRESS.—It is the sense of Con4 gress that— 

5 (1) if legislation to provide health insurance 

6 coverage, public or private, to persons under the age 

7 of 65, is enacted, coverage of colorectal cancer 

8 screening tests and the provisions of this Act should 

9 be included as part of any basic benefit package re10 quired under such legislation; and 

11 (2) Congress, Federal agencies, State and local 

12 governments, health care providers, and patient 

13 groups should make a concerted and sustained effort 

14 to increase the rate of colorectal cancer screening 

15 tests. 

16 SEC. 3. COMMUNITY AND PATIENT INTERVENTIONS. 

17 (a) GRANT PROGRAM TO INCREASE COLORECTAL

18 CANCER AWARENESS, SCREENING, AND TREATMENT.— 

19 (1) DEFINITIONS.—In this subsection: 

20 (A) COLORECTAL CANCER SCREENING

21 TESTS.—The term ‘‘colorectal cancer screening 

22 test’’ has the meaning given such term in sec23 tion 1861(pp)(1) of the Social Security Act (42 

24 U.S.C. 1395x(pp)(1)). 


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1 (B) INDIAN TRIBE.—The term ‘‘Indian 

2 tribe’’ has the meaning given such term in sec3 tion 4 of the Indian Self-Determination and 

4 Education Assistance Act (25 U.S.C. 450b). 

5 (C) SECRETARY.—The term ‘‘Secretary’’ 

6 means the Secretary of Health and Human 

7 Services, acting through the Director of the 

8 Centers for Disease Control and Prevention. 

9 (D) STATE.—The term ‘‘State’’ means— 

10 (i) a State; and 

11 (ii) the District of Columbia. 

12 (2) GRANTS AUTHORIZED.—The Secretary is 

13 authorized to make grants to States and Indian 

14 tribes for colorectal health programs. Such a pro15 gram may include the following: 

16 (A) The provision of colorectal cancer 

17 screening tests, including colonoscopy, to indi18 viduals who are over 50 years of age or who are 

19 determined to be at high risk for such cancer. 

20 (B) The provision of case management and 

21 referrals for medical treatment for individuals 

22 who are provided colorectal cancer screening 

23 tests under the program. 

24 (C) Programs to ensure that individuals 

25 who are provided colorectal cancer screening 


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1 tests under the program receive the full con2 tinuum of follow-up and cancer care, as appro3 priate. 

4 (D) Activities to improve the education, 

5 training, and skills of health professionals in 

6 the detection and treatment of colorectal can7 cer. 

8 (E) The development and dissemination of 

9 public information and education programs— 

10 (i) for the detection and treatment of 

11 colorectal cancer; and 

12 (ii) promoting the benefits of receiving 

13 colorectal cancer screening tests through 

14 the program. 

15 (3) PRIORITY.—In making grants under para16 graph (2), the Secretary shall give priority to States 

17 and Indian tribes that will use grant funds to pro18 vide colorectal cancer screening tests to low-income 

19 individuals who lack adequate health insurance cov20 erage with respect to such screening. 

21 (4) EXISTING FUNDING AUTHORITY.—The Sec22 retary shall make a grant under this section under 

23 an existing funding authority. 

24 (b) BENEFICIARY REMINDERS FOR INCREASING

25 COLORECTAL CANCER SCREENING TESTS.— 


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1 (1) DEFINITIONS.—In this subsection: 

2 (A) COLORECTAL CANCER SCREENING

3 TESTS.—The term ‘‘colorectal cancer screening 

4 test’’ has the meaning given such term in sec5 tion 1861(pp)(1) of the Social Security Act (42 

6 U.S.C. 1395x(pp)(1)). 

7 (B) MEDICARE BENEFICIARY.—The term 

8 ‘‘Medicare beneficiary’’ means an individual en9 titled to, or enrolled for, benefits under part A 

10 of title XVIII of the Social Security Act and en11 rolled for benefits under part B of such title. 

12 (C) SECRETARY.—The term ‘‘Secretary’’ 

13 means the Secretary of Health and Human 

14 Services. 

15 (2) ANNUAL NOTIFICATION UNDER THE MEDI16 CARE PROGRAM.—The Secretary shall establish a 

17 program under which all Medicare beneficiaries are 

18 notified annually about the coverage of colorectal 

19 cancer screening tests under the Medicare program 

20 under title XVIII of the Social Security Act. Under 

21 the program, such notification— 

22 (A) may be provided through direct mail or 

23 direct electronic communications; and 

24 (B) may accompany other information cur25 rently provided to such beneficiaries, including 


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1 marketing materials or information provided to 

2 enrollees by Medicare Advantage organizations 

3 under section 1852(c)(1) of the Social Security 

4 Act (42 U.S.C. 1395w–22) and information 

5 provided by PDP sponsors under section 

6 1860D–4(a)(1) of such Act (42 U.S.C. 1395w– 

7 104(a)(1)). 

8 (3) STATE PLAN AMENDMENT UNDER MED9 ICAID.— 

10 (A) IN GENERAL.—Section 1902(a) of the 

11 Social Security Act (42 U.S.C. 1396a(a)), as 

12 amended by section 5006(e)(2)(A) of division B 

13 of the American Recovery and Reinvestment 

14 Act of 2009 (Public Law 111–5), is amended— 

15 (i) in paragraph (72), by striking 

16 ‘‘and’’ at the end; 

17 (ii) in paragraph (73)(B), by striking 

18 the period at the end and inserting ‘‘; 

19 and’’; and 

20 (iii) by inserting after paragraph (73), 

21 the following new paragraph: 

22 ‘‘(74) if the State has elected to provide medical 

23 assistance described in section 1905(a)(13) and such 

24 assistance includes colorectal cancer screening tests, 

25 provide for the establishment of a program under 


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1 which individuals at risk for colon cancer, including 

2 minorities who are identified as at high-risk for 

3 colon cancer, who are over an age that the Secretary 

4 determines appropriate (based on the recommenda5 tions of appropriate entities, including the United 

6 States Preventive Services Task Force and appro7 priate medical specialty societies) are provided a no8 tification of the availability of medical assistance for 

9 colorectal cancer screening tests and a reminder re10 garding the benefits of such tests.’’. 

11 (B) EFFECTIVE DATE.— 

12 (i) IN GENERAL.—Except as provided 

13 in clause (ii), the amendments made by 

14 this paragraph take effect on January 1, 

15 2011. 

16 (ii) EXTENSION OF EFFECTIVE DATE

17 FOR STATE LAW AMENDMENT.—In the 

18 case of a State plan under title XIX of the 

19 Social Security Act (42 U.S.C. 1396 et 

20 seq.) which the Secretary of Health and 

21 Human Services determines requires State 

22 legislation in order for the plan to meet the 

23 additional requirements imposed by the 

24 amendments made by this paragraph, the 

25 State plan shall not be regarded as failing 


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1 to comply with the requirements of such 

2 title solely on the basis of its failure to 

3 meet these additional requirements before 

4 the first day of the first calendar quarter 

5 beginning after the close of the first reg6 ular session of the State legislature that 

7 begins after the date of enactment of this 

8 Act. For purposes of the previous sentence, 

9 in the case of a State that has a 2-year 

10 legislative session, each year of the session 

11 is considered to be a separate regular ses12 sion of the State legislature. 

13 SEC. 4. ELIMINATION OF COINSURANCE FOR COLORECTAL 

14 CANCER SCREENING TESTS. 

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

16 Security Act (42 U.S.C. 1395l(a)(1)) is amended— 

17 (1) by striking ‘‘and’’ before ‘‘(W)’’; and 

18 (2) by inserting before the semicolon at the end 

19 the following: ‘‘, and (X) with respect to colorectal 

20 cancer screening tests (as defined in subsection 

21 (pp)), the amount paid shall be 100 percent of the 

22 lesser of the actual charge for the services or the 

23 amount determined under the fee schedule that ap24 plies to such tests under this part’’. 

25 (b) CONFORMING AMENDMENTS.— 


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1 (1) SCREENING SIGMOIDOSCOPIES AND

2 COLONOSCOPIES.—Section 1834(d) of the Social Se3 curity Act (42 U.S.C. 1395m(d)) is amended— 

4 (A) in paragraph (2)— 

5 (i) in subparagraph (A), by inserting 

6 ‘‘, except that payment for such tests 

7 under such section shall be 100 percent of 

8 the payment determined under such sec9 tion for such tests’’ before the period at 

10 the end; and 

11 (ii) in subparagraph (C)— 

12 (I) by striking clause (ii); and 

13 (II) in clause (i)— 

14 (aa) by striking ‘‘(i) IN GEN15 ERAL.—Notwithstanding’’ and 

16 inserting ‘‘Notwithstanding’’; 

17 (bb) by redesignating sub18 clauses (I) and (II) as clauses (i) 

19 and (ii), respectively, and moving 

20 such clauses and the flush matter 

21 following such clauses 2 ems to 

22 the left; and 

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1 nated, by inserting ‘‘100 percent 

2 of’’ after ‘‘based on’’; and 

3 (B) in paragraph (3)— 

4 (i) in subparagraph (A), by inserting 

5 ‘‘, except that payment for such tests 

6 under such section shall be 100 percent of 

7 the payment determined under such sec8 tion for such tests’’ before the period at 

9 the end; and 

10 (ii) in subparagraph (C)— 

11 (I) by striking clause (ii); and 

12 (II) in clause (i)— 

13 (aa) by striking ‘‘(i) IN GEN14 ERAL.—Notwithstanding’’ and 

15 inserting ‘‘Notwithstanding’’; and 

16 (bb) by inserting ‘‘100 per17 cent of’’ after ‘‘based on’’. 

18 (2) OUTPATIENT HOSPITAL SETTINGS.—Section 

19 1833(t) of the Social Security Act (42 U.S.C. 

20 1395l(t)) is amended— 

21 (A) in paragraph (4)(C), by striking 

22 ‘‘paragraph (8)(C)’’ and inserting ‘‘subpara23 graphs (C) and (F) of paragraph (8)’’; and 

24 (B) in paragraph (8), by adding at the end 

25 the following new subparagraph: 


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1 ‘‘(F) NO COPAYMENT FOR COLORECTAL

2 CANCER SCREENING TESTS.—The copayment 

3 amount that would otherwise apply under this 

4 subsection to colorectal cancer screening tests 

5 (as defined in section 1861(pp)) shall be re6 duced to zero.’’. 

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

8 this section shall apply to items and services furnished on 

9 or after January 1, 2010. 

10 SEC. 5. MEDICARE ADVANTAGE REPORTING REQUIRE11 MENTS. 

12 (a) IN GENERAL.—Section 1857(e) of the Social Se13 curity Act (42 U.S.C. 1395w–27(e)) is amended by adding 

14 at the end the following new paragraph: 

15 ‘‘(4) ANNUAL REPORTING REGARDING

16 COLORECTAL CANCER SCREENING TESTS.— 

17 ‘‘(A) IN GENERAL.—Not later than 6 

18 months after the date of enactment of this 

19 paragraph and annually thereafter, a contract 

20 under this section with an MA organization 

21 shall require the organization to submit to the 

22 Secretary an annual report on the following: 

23 ‘‘(i) The coverage of colorectal cancer 

24 screening tests (as defined in section 

25 1861(pp)) under each MA plan offered by 


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1 the organization, including the level of any 

2 coinsurance or copayments applicable for 

3 enrollees under the plan. 

4 ‘‘(ii) Any educational outreach the or5 ganization provides to enrollees, providers 

6 of services, and suppliers with respect to 

7 such tests. 

8 ‘‘(iii) Any pay-for-performance incen9 tives under MA plans offered by the orga10 nization for providers of services and sup11 pliers with respect to such tests, or any 

12 other financial-sharing program with pro13 viders of services and suppliers with re14 spect to such tests. 

15 ‘‘(iv) The total number of enrollees 

16 furnished such tests during the preceding 

17 year, listed according to the specific test 

18 furnished, the type of facility in which the 

19 test was furnished, and the gender and 

20 race of the enrollees to whom such tests 

21 were furnished. 

22 ‘‘(B) REPORT TO CONGRESS AND PUBLIC

23 AVAILABILITY.— 

24 ‘‘(i) REPORT.—The Secretary shall 

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1 taining information submitted in the cor2 responding annual report under subpara3 graph (A). 

4 ‘‘(ii) PUBLIC AVAILABILITY.—The 

5 Secretary shall make such information 

6 available to the public, including by posting 

7 such information on the Internet website of 

8 the Centers for Medicare & Medicaid Serv9 ices.’’. 

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

11 this section shall apply to contracts entered into on or 

12 after January 1, 2011. 

13 SEC. 6. PROVIDER INTERVENTIONS. 

14 (a) IN GENERAL.—Section 1834(d) of the Social Se15 curity Act (42 U.S.C. 1395m(d)) is amended by adding 

16 at the end the following new paragraph: 

17 ‘‘(4) PREVENTIVE SERVICE PAYMENT MODIFIED

18 FOR CERTAIN COLORECTAL CANCER SCREENING

19 TESTS.— 

20 ‘‘(A) NATIONAL MINIMUM STANDARDS.— 

21 The Secretary, in consultation with the Insti22 tute of Medicine, shall establish a national min23 imum standard for basic knowledge, training, 

24 continuing education, and documentation for 

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1 ing tests (as defined in subsection (pp)). For 

2 purposes of this paragraph, a supplier shall be 

3 deemed to meet such national minimum stand4 ards if the supplier is certified in gastro5 enterology by the American Board of Internal 

6 Medicine. 

7 ‘‘(B) PREVENTIVE SERVICE PAYMENT

8 MODIFIER.— 

9 ‘‘(i) DETERMINATION OF RATE

10 GOALS.—The Secretary, in consultation 

11 with the United States Preventive Services 

12 Task Force, the Institute of Medicine 

13 Colorectal Cancer Working Group, and 

14 other clinical advisors as determined ap15 propriate by the Secretary, shall determine 

16 age-based goal rates for colorectal cancer 

17 screening tests (as so defined) to be met or 

18 exceeded for beneficiaries under this part 

19 not later than July 1, 2010. Such age20 based goal rates shall be consistent with 

21 the rates of screening for beneficiaries with 

22 respect to other cancer screening tests 

23 (such as screening mammography and cer24 vical cancer screening). 


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1 ‘‘(ii) ESTABLISHMENT OF PREVEN2 TIVE SERVICE MODIFIER FOR QUALIFIED

3 COLORECTAL CANCER SCREENING

4 TESTS.— 

5 ‘‘(I) IN GENERAL.—The Sec6 retary shall establish an upward pre7 ventive service payment modifier for 

8 qualifying colorectal cancer screening 

9 tests furnished on or after January 1, 

10 2010, which reflects the annual deter11 mination by the Secretary of the ap12 propriate amount of additional pay13 ment (not less than 10 percent of the 

14 amount of payment otherwise pro15 vided) sufficient to increase the rate 

16 of colorectal cancer screening tests 

17 furnished under this part to the goal 

18 rates determined under clause (i). The 

19 Secretary shall update such modifier 

20 on an annual basis, taking into con21 sideration the rate of colorectal cancer 

22 screening tests furnished under this 

23 part during the preceding year and 

24 such goal rates. 


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1 ‘‘(II) QUALIFYING COLORECTAL

2 CANCER SCREENING TESTS.—For 

3 purposes of subclause (I), the term 

4 ‘qualifying colorectal cancer screening 

5 tests’ means a colorectal cancer 

6 screening test furnished by a supplier 

7 who meets the national minimum 

8 standards established under subpara9 graph (A) (as determined by the Sec10 retary).’’. 

11 (b) OUTPATIENT SETTINGS.—Section 1833(t) of the 

12 Social Security Act (42 U.S.C. 1395l(t)) is amended by 

13 adding at the end the following new paragraph: 

14 ‘‘(18) IN GENERAL.— 

15 ‘‘(A) NATIONAL MINIMUM STANDARDS.— 

16 The Secretary, in consultation with the Insti17 tute of Medicine, shall establish a national min18 imum standard for basic knowledge, training, 

19 continuing education, and documentation for 

20 hospitals in outpatient settings which furnish 

21 colorectal cancer screening tests (as defined in 

22 subsection (pp)). For purposes of this para23 graph, a hospital shall be deemed to meet such 

24 national minimum standards if the hospital is 

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1 creditation of Healthcare Organizations, the Ac2 creditation Association for Ambulatory Health 

3 Care, or other accreditation body designated by 

4 the Secretary. 

5 ‘‘(B) PREVENTIVE SERVICE PAYMENT

6 MODIFIER.— 

7 ‘‘(i) DETERMINATION OF RATE

8 GOALS.—The Secretary, in consultation 

9 with the United States Preventive Services 

10 Task Force, the Institute of Medicine 

11 Colorectal Cancer Working Group, and 

12 other clinical advisors as determined ap13 propriate by the Secretary, shall determine 

14 age-based goal rates for colorectal cancer 

15 screening tests (as so defined) to be met or 

16 exceeded for beneficiaries under this part 

17 not later than July 1, 2010. Such age18 based goal rates shall be consistent with 

19 the rates of screening for beneficiaries with 

20 respect to other cancer screening tests 

21 (such as screening mammography and cer22 vical cancer screening). 

23 ‘‘(ii) ESTABLISHMENT OF PREVEN24 TIVE SERVICE MODIFIER FOR QUALIFIED


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1 COLORECTAL CANCER SCREENING

2 TESTS.— 

3 ‘‘(I) IN GENERAL.—The Sec4 retary shall establish an upward pre5 ventive service payment modifier for 

6 qualifying colorectal cancer screening 

7 tests furnished on or after January 1, 

8 2010, which reflects the annual deter9 mination by the Secretary of the ap10 propriate amount of additional pay11 ment (not less than 10 percent of the 

12 amount of payment otherwise pro13 vided) sufficient to increase the rate 

14 of colorectal cancer screening tests 

15 furnished under this part to the goal 

16 rates determined under clause (i). The 

17 Secretary shall update such modifier 

18 on an annual basis, taking into con19 sideration the rate of colorectal cancer 

20 screening tests furnished under this 

21 part during the preceding year and 

22 such goal rates. 

23 ‘‘(II) QUALIFYING COLORECTAL

24 CANCER SCREENING TESTS.—For 

25 purposes of subclause (I), the term 


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1 ‘qualifying colorectal cancer screening 

2 tests’ means a colorectal cancer 

3 screening test furnished by a hospital 

4 in an outpatient setting which meets 

5 the national minimum standards es6 tablished under subparagraph (A) (as 

7 determined by the Secretary).’’. 

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

9 this section shall apply to items and services furnished on 

10 or after January 1, 2010. 

11 SEC. 7. COVERAGE FOR AN OFFICE VISIT OR CONSULTA12 TION PRIOR TO A QUALIFYING SCREENING 

13 COLONOSCOPY. 

14 (a) COVERAGE.—Section 1861(s)(2) of the Social Se15 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

16 (1) in subparagraph (DD), by striking ‘‘and’’ at 

17 the end; 

18 (2) in subparagraph (EE), by inserting ‘‘and’’ 

19 at the end; and 

20 (3) by adding at the end the following new sub21 paragraph: 

22 ‘‘(FF) an outpatient office visit or consultation 

23 for the purpose of beneficiary education, assuring se24 lection of the proper screening test, and securing in25 formation relating to the procedure and sedation of 


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1 the beneficiary, prior to a colorectal cancer screening 

2 test consisting of a screening colonoscopy or in con3 junction with the beneficiary’s decision to obtain 

4 such a screening, regardless of whether such screen5 ing is medically indicated with respect to the bene6 ficiary;’’. 

7 (b) PAYMENT.— 

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

9 Social Security Act (42 U.S.C. 1395l(a)(1)), as 

10 amended by section 4, is amended— 

11 (A) by striking ‘‘and’’ before ‘‘(W)’’; and 

12 (B) by inserting before the semicolon at 

13 the end the following: ‘‘, and (Y) with respect 

14 to an outpatient office visit or consultation 

15 under section 1861(s)(2)(BB), the amounts 

16 paid shall be 80 percent of the lesser of the ac17 tual charge or the amount established under 

18 section 1848’’. 

19 (2) PAYMENT UNDER PHYSICIAN FEE SCHED20 ULE.—Section 1848(j)(3) of the Social Security Act 

21 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

22 ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’. 

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)), as amended by section 6, is 

2 amended by adding at the end the following new 

3 paragraph: 

4 ‘‘(5) PAYMENT FOR OUTPATIENT OFFICE VISIT

5 OR CONSULTATION PRIOR TO SCREENING

6 COLONOSCOPY.—With respect to an outpatient office 

7 visit or consultation under section 1861(s)(2)(BB), 

8 payment under section 1848 shall be consistent with 

9 the payment amounts for CPT codes 99203 and 

10 99243.’’. 

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

12 this section shall apply to items and services furnished on 

13 or after January 1, 2010. 

Æ 


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