Donald Payne Sr. Colorectal Cancer Detection Act of 2019

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 2019 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. (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 2019 This bill provides for Medicare coverage and payment, subject to specified frequency limits, of certain colorectal cancer screening blood-based tests.