the Social Security Act (42 U.S.C. 1395m(c)(2)(A)) is
amended—
(1) in clause (iv), by striking ‘‘but under 65
years of age,’’; and
(2) by striking clause (v).
(b) WAIVER OF DEDUCTIBLE.—The first sentence of
section 1833(b) of such Act (42 U.S.C. 1395l(b)) is
amended—
(1) by striking ‘‘and (4)’’ and inserting ‘‘(4)’’;
and
(2) by striking the period at the end and insert-
ing the following: ‘‘, and (5) such deductible shall
not apply with respect to screening mammography
(as described in section 1861(jj)).’’.
(c) 
CONFORMING
AMENDMENT.—Section
1834(c)(1)(C) of such Act (42 U.S.C. 1395m(c)(1)(C)) is
amended by striking ‘‘, subject to the deductible estab-
lished under section 1833(b),’’.
SEC. 3. SCREENING PAP SMEAR AND PELVIC EXAMS.
(a) COVERAGE OF PELVIC EXAM; INCREASING FRE-
QUENCY
OF
COVERAGE
OF
PAP
SMEAR.—Section
1861(nn) of the Social Security Act (42 U.S.C.
1395x(nn)) is amended—
(1) in the heading, by striking ‘‘Smear’’ and in-
serting ‘‘Smear; Screening Pelvic Exam’’;
(2) by striking ‘‘(nn)’’ and inserting ‘‘(nn)(1)’’;
(3) by striking ‘‘3 years’’ and all that follows
and inserting ‘‘3 years, or during the preceding year
in the case of a woman described in paragraph (3).’’;
and
(4) by adding at the end the following new
paragraphs:
‘‘(2) The term ‘screening pelvic exam’ means a pelvic
examination provided to a woman if the woman involved
has not had such an examination during the preceding 3
years, or during the preceding year in the case of a woman
described in paragraph (3), and includes a clinical breast
examination.
‘‘(3) A woman described in this paragraph is a
woman who—
‘‘(A) is of childbearing age and has not had a
test described in this subsection during each of the
preceding 3 years that did not indicate the presence
of cervical cancer; or
‘‘(B) is at high risk of developing cervical can-
cer (as determined pursuant to factors identified by
the Secretary).’’.
(b) WAIVER OF DEDUCTIBLE.—The first sentence of
section 1833(b) of such Act (42 U.S.C. 1395l(b)), as
amended by section 2(b), is amended—
(1) by striking ‘‘and (5)’’ and inserting ‘‘(5)’’;
and
(2) by striking the period at the end and insert-
ing the following: ‘‘, and (6) such deductible shall
not apply with respect to screening pap smear and
screening pelvic exam (as described in section
1861(nn)).’’.
(c) 
CONFORMING
AMENDMENTS.—(1) 
Section
1861(s)(14) of such Act (42 U.S.C. 1395x(s)(14)) is
amended by inserting ‘‘and screening pelvic exam’’ after
‘‘screening pap smear’’.
(2) Section 1862(a)(1)(F) of such Act (42 U.S.C.
1395y(a)(1)(F)) is amended by inserting ‘‘and screening
pelvic exam’’ after ‘‘screening pap smear’’.
SEC. 4. COVERAGE OF COLORECTAL SCREENING.
(a) IN GENERAL.—
(1) COVERAGE.—Section 1861(s)(2) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)) is amend-
ed—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (N) and subparagraph (O); and
(B) by inserting after subparagraph (O)
the following new subparagraph:
‘‘(P) colorectal cancer screening tests (as de-
fined in subsection (oo)); and’’.
(2) TESTS DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) is amended by adding at the
end the following new subsection:
‘‘Colorectal Cancer Screening Tests
‘‘(oo)(1) The term ‘colorectal cancer screening test’
means any of the following procedures furnished to an in-
dividual for the purpose of early detection of colorectal
cancer:
‘‘(A) Screening fecal-occult blood test.
‘‘(B) Screening flexible sigmoidoscopy.
‘‘(C) In the case of an individual at high risk
for colorectal cancer, screening colonoscopy.
‘‘(D) Screening barium enema, if found by the
Secretary to be an appropriate alternative to screen-
ing flexible sigmoidoscopy under subparagraph (B)
or screening colonoscopy under subparagraph (C).
‘‘(E) For years beginning after 2002, such
other procedures as the Secretary finds appropriate
for the purpose of early detection of colorectal can-
cer, taking into account changes in technology and
standards of medical practice, availability, effective-
ness, costs, and such other factors as the Secretary
considers appropriate.
‘‘(2) In paragraph (1)(C), an ‘individual at high risk
for colorectal cancer’ is an individual who, because of fam-
ily history, prior experience of cancer or precursor neo-
plastic polyps, a history of chronic digestive disease condi-
tion (including inflammatory bowel disease, Crohn’s Dis-
ease, or ulcerative colitis), the presence of any appropriate
recognized gene markers for colorectal cancer, or other
predisposing factors, faces a high risk for colorectal can-
cer.’’.
(3) DEADLINE FOR DECISION ON COVERAGE OF
SCREENING
BARIUM
ENEMA.—Not later than 2
years after the date of the enactment of this Act, the
Secretary of Health and Human Services shall issue
and publish a determination on the treatment of
screening barium enema as a colorectal cancer
screening test under section 1861(oo) of the Social
Security Act (as added by paragraph (2)) as an al-
ternative 
procedure 
to 
a 
screening 
flexible
sigmoidoscopy or screening colonoscopy.
(b) FREQUENCY AND PAYMENT LIMITS.—
(1) IN GENERAL.—Section 1834 of the Social
Security Act (42 U.S.C. 1395m) is amended by in-
serting after subsection (c) the following new sub-
section:
‘‘(d) FREQUENCY
AND
PAYMENT
LIMITS
FOR
COLORECTAL CANCER SCREENING TESTS.—
‘‘(1) 
SCREENING
FECAL-OCCULT
BLOOD
TESTS.—
‘‘(A) PAYMENT LIMIT.—In establishing fee
schedules under section 1833(h) with respect to
colorectal cancer screening tests consisting of
screening fecal-occult blood tests, except as pro-
vided by the Secretary under paragraph (4)(A),
the payment amount established for tests per-
formed—
‘‘(i) in 1996 shall not exceed $5; and
‘‘(ii) in a subsequent year, shall not
exceed the limit on the payment amount
established under this subsection for such
tests for the preceding year, adjusted by
the applicable adjustment under section
1833(h) for tests performed in such year.
‘‘(B) FREQUENCY LIMIT.—Subject to revi-
sion by the Secretary under paragraph (4)(B),
no payment may be made under this part for
colorectal cancer screening test consisting of a
screening fecal-occult blood test—
‘‘(i) if the individual is under 50 years
of age; or
‘‘(ii) if the test is performed within
the 11 months after a previous screening
fecal-occult blood test.
‘‘(2) 
SCREENING
FLEXIBLE
SIGMOIDOSCOPIES.—
‘‘(A) PAYMENT AMOUNT.—The Secretary
shall establish a payment amount under section
1848 with respect to colorectal cancer screening
tests 
consisting 
of 
screening 
flexible
sigmoidoscopies that is consistent with payment
amounts under such section for similar or relat-
ed services, except that such payment amount
shall be established without regard to sub-
section (a)(2)(A) of such section.
‘‘(B) FREQUENCY LIMIT.—Subject to revi-
sion by the Secretary under paragraph (4)(B),
no payment may be made under this part for
a colorectal cancer screening test consisting of
a screening flexible sigmoidoscopy—
‘‘(i) if the individual is under 50 years
of age; or
‘‘(ii) if the procedure is performed
within the 47 months after a previous
screening flexible sigmoidoscopy.
‘‘(3) SCREENING COLONOSCOPY FOR INDIVID-
UALS AT HIGH RISK FOR COLORECTAL CANCER.—
‘‘(A) PAYMENT AMOUNT.—The Secretary
shall establish a payment amount under section
1848 with respect to colorectal cancer screening
test consisting of a screening colonoscopy for
individuals at high risk for colorectal cancer (as
defined in section 1861(oo)(2)) that is consist-
ent with payment amounts under such section
for similar or related services, except that such
payment amount shall be established without
regard to subsection (a)(2)(A) of such section.
‘‘(B) FREQUENCY LIMIT.—Subject to revi-
sion by the Secretary under paragraph (4)(B),
no payment may be made under this part for
a colorectal cancer screening test consisting of
a screening colonoscopy for individuals at high
risk for colorectal cancer if the procedure is
performed within the 23 months after a pre-
vious screening colonoscopy.
‘‘(4) REDUCTIONS IN PAYMENT LIMIT AND RE-
VISION OF FREQUENCY.—
‘‘(A) REDUCTIONS IN PAYMENT LIMIT FOR
SCREENING
FECAL-OCCULT
BLOOD
TESTS.—
The Secretary shall review from time to time
the appropriateness of the amount of the pay-
ment limit established for screening fecal-occult
blood tests under paragraph (1)(A). The Sec-
retary may, with respect to tests performed in
a year after 1998, reduce the amount of such
limit as it applies nationally or in any area to
the amount that the Secretary estimates is re-
quired to assure that such tests of an appro-
priate quality are readily and conveniently
available during the year.
‘‘(B) REVISION OF FREQUENCY.—
‘‘(i) REVIEW.—The Secretary shall re-
view periodically the appropriate frequency
for performing colorectal cancer screening
tests based on age and such other factors
as the Secretary believes to be pertinent.
‘‘(ii) REVISION OF FREQUENCY.—The
Secretary, taking into consideration the re-
view made under clause (i), may revise
from time to time the frequency with
which such tests may be paid for under
this subsection, but no such revision shall
apply to tests performed before January 1,
1999.
in paragraph (2)(B), but only if the physician who is man-
aging the individual’s diabetic condition certifies that such
services are needed under a comprehensive plan of care
related to the individual’s diabetic condition to provide the
individual with necessary skills and knowledge (including
skills related to the self-administration of injectable drugs)
to participate in the management of the individual’s condi-
tion.
‘‘(2) In paragraph (1)—
‘‘(A) a ‘certified provider’ is an individual or
entity that, in addition to providing diabetes out-
patient self-management training services, provides
other items or services for which payment may be
made under this title; and
‘‘(B) an individual or entity meets the quality
standards described in this paragraph if the individ-
ual or entity meets quality standards established by
the Secretary, except that the individual or entity
shall be deemed to have met such standards if the
individual or entity meets applicable standards origi-
nally established by the National Diabetes Advisory
Board and subsequently revised by organizations
who participated in the establishment of standards
by such Board, or is recognized by the American Di-