Donald Payne Sr. Colorectal Cancer Detection Act of 2018

To amend title XVIII of the Social Security Act to provide coverage under the Medicare program for FDA-approved qualifying colorectal cancer screening blood-based tests, and for other purposes. 1. Short title This Act may be cited as the Donald Payne Sr. Colorectal Cancer Detection Act of 2018 2. Medicare coverage for FDA-approved qualifying colorectal cancer screening blood-based tests (a) In general Section 1861(pp) of the Social Security Act ( 42 U.S.C. 1395x(pp) (1) in paragraph (1)— (A) by redesignating subparagraph (D) as subparagraph (E); and (B) by inserting after subparagraph (C) the following new subparagraph: (D) Qualifying colorectal cancer screening blood-based test. ; and (2) by adding at the end the following new paragraph: (3) The term qualifying colorectal cancer screening blood-based test . (b) Frequency limits for colorectal cancer screening tests and payment amount for qualifying colorectal cancer screening blood-Based tests Section 1834(d) of the Social Security Act ( 42 U.S.C. 1395m(d) (1) by amending clause (ii) of paragraph (1)(B) to read as follows: (ii) if the test is performed within— (I) the 11 months after a previous screening fecal-occult blood test or a previous qualifying colorectal cancer screening blood-based test; (II) the 35 months after a previous screening flexible sigmoidoscopy or a previous screening colonoscopy with adenoma findings; (III) the 59 months after a previous screening colonoscopy with small polyp findings; or (IV) the 119 months after a previous screening colonoscopy without adenoma findings or small polyp findings. ; (2) in paragraph (2)(E)(ii), by inserting or within the 35 months after a previous screening fecal-occult blood test or previous qualifying colorectal cancer screening blood-based test sigmoidoscopy (3) by amending subparagraph (E) of paragraph (3) to read as follows: (E) Frequency limit No payment may be made under this part for a colorectal cancer screening test consisting of a screening colonoscopy— (i) if the procedure is performed within the 11 months after a previous screening fecal-occult blood test or previous qualifying colorectal cancer screening blood-based test; (ii) for individuals at high risk for colorectal cancer if the procedure is performed within the 23 months after a previous screening colonoscopy; or (iii) for individuals not at high risk for colorectal cancer if the procedure is performed within the 119 months after a previous screening colonoscopy or within the 47 months after a previous screening flexible sigmoidoscopy. ; and (4) by adding at the end the following new paragraph: (4) Qualifying colorectal cancer screening blood-based tests (A) Payment amount The payment amount for colorectal cancer screening tests consisting of qualifying colorectal cancer screening blood-based tests shall be established by the Secretary based on a crosswalk to payment amounts for tests for the diagnosis of inherited colorectal cancer by methylation methods. (B) Frequency limit Paragraph (1)(B) shall apply to colorectal cancer screening tests consisting of qualifying colorectal cancer screening blood-based tests in the same manner as such paragraph applies to colorectal cancer screening tests consisting of fecal-occult blood tests. . (c) Effective date The amendments made by this section shall apply to colorectal cancer screening tests furnished in a year beginning more than 6 months after the date of the enactment of this Act.

Summary: Donald Payne Sr. Colorectal Cancer Detection Act of 2018 This bill provides for Medicare coverage and payment, subject to specified frequency limits, of certain colorectal cancer screening blood-based tests.