risk for colorectal cancer provided to an individ-
ual for the purpose of early detection of colon
cancer if the procedure is performed within the
months 
after 
a 
previous 
screening
colonoscopy.
‘‘(C) INDIVIDUAL
AT
HIGH
RISK
DE-
FINED.—In this subsection, an ‘individual at
high risk for colorectal cancer’ is an individual
who, because of family history, prior experience
of cancer or precursor neoplastic polyps, a his-
tory of chronic digestive disease condition (in-
cluding inflammatory bowel disease, Crohn’s
Disease, or ulcerative colitis), the presence of
any appropriate recognized gene markers for
colorectal cancer, or other predisposing factors,
faces a high risk for colorectal cancer.
‘‘(4) REDUCTIONS IN PAYMENT LIMIT AND RE-
VISION OF FREQUENCY.—
‘‘(A) REDUCTIONS IN PAYMENT LIMIT.—
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 screening fecal-occult blood
tests, screening flexible sigmoidoscopies,
and screening colonoscopy based on age
and such other factors as the Secretary be-
lieves 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 and procedures may be
paid for under this subsection, but no such
revision shall apply to tests or procedures
performed before January 1, 1999.
‘‘(5) LIMITING CHARGES OF NONPARTICIPATING
PHYSICIANS.—
‘‘(A) IN
GENERAL.—In the case of a
screening flexible sigmoidoscopy provided to an
individual for the purpose of early detection of
colon cancer or a screening colonoscopy pro-
vided to an individual at high risk for colorectal
cancer for the purpose of early detection of
colon cancer for which payment may be made
under this part, if a nonparticipating physician
provides the procedure to an individual enrolled
under this part, the physician may not charge
the individual more than the limiting charge (as
defined in section 1848(g)(2)).
‘‘(B) ENFORCEMENT.—If a physician or
supplier knowing and willfully imposes a charge
in violation of subparagraph (A), the Secretary
may apply sanctions against such physician or
supplier 
in 
accordance 
with 
section
1842(j)(2).’’.
(b) CONFORMING AMENDMENTS.—(1) Paragraphs
(1)(D) and (2)(D) of section 1833(a) of such Act (42
U.S.C. 1395l(a)) are each amended by striking ‘‘sub-
section (h)(1),’’ and inserting ‘‘subsection (h)(1) or section
1834(d)(1),’’.
(2) Section 1833(h)(1)(A) of such Act (42 U.S.C.
1395l(h)(1)(A)) is amended by striking ‘‘The Secretary’’
and inserting ‘‘Subject to paragraphs (1) and (3)(A) of
section 1834(d), the Secretary’’.
(3) Clauses (i) and (ii) of section 1848(a)(2)(A) of
such Act (42 U.S.C. 1395w–4(a)(2)(A)) are each amended
by striking ‘‘a service’’ and inserting ‘‘a service (other
than a screening flexible sigmoidoscopy provided to an in-
dividual for the purpose of early detection of colon cancer
or a screening colonoscopy provided to an individual at
high risk for colorectal cancer for the purpose of early de-
tection of colon cancer)’’.
(4) Section 1862(a) of such Act (42 U.S.C. 1395y(a))
is amended—
(A) in paragraph (1)—
(i) in subparagraph (E), by striking ‘‘and’’
at the end,
(ii) in subparagraph (F), by striking the
semicolon at the end and inserting ‘‘, and’’, and
(iii) by adding at the end the following new
subparagraph:
‘‘(G) in the case of screening fecal-occult blood
tests, screening flexible sigmoidoscopies, and screen-
ing colonoscopy provided for the purpose of early de-
tection of colon cancer, which are performed more
frequently than is covered under section 1834(d);’’;
and
(B) in paragraph (7), by striking ‘‘paragraph
(1)(B) or under paragraph (1)(F)’’ and inserting
‘‘subparagraphs (B), (F), or (G) of paragraph (1)’’.
SEC. 3. EFFECTIVE DATE.
The amendments made by section 2 shall apply to
screening fecal-occult blood tests, screening flexible
sigmoidoscopies, and screening colonoscopy performed on
or after January 1, 1996.
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