I
105TH CONGRESS
1ST SESSION
H. R. 448
To amend title XVIII of the Social Security Act to provide for coverage
of early detection of prostate cancer and certain drug treatment services
under part B of the Medicare program, to amend chapter 17 of title
38, United States Code, to provide for coverage of such early detection
and treatment services under the programs of the Department of Veter-
ans Affairs, and to expand research and education programs of the
National Institutes of Health and the Public Health Service relating
to prostate cancer.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 9, 1997
Mr. BACHUS introduced the following bill; which was referred to the Commit-
tee on Commerce, and in addition to the Committees on Ways and
Means, and Veterans’ Affairs, 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 title XVIII of the Social Security Act to provide
for coverage of early detection of prostate cancer and
certain drug treatment services under part B of the
Medicare program, to amend chapter 17 of title 38,
United States Code, to provide for coverage of such
early detection and treatment services under the pro-
grams of the Department of Veterans Affairs, and to
expand research and education programs of the National
Institutes of Health and the Public Health Service relat-
ing to prostate cancer.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Prostate Cancer Diag-
nosis and Treatment Act of 1997’’.
SEC. 2. MEDICARE COVERAGE OF PROSTATE CANCER
SCREENING AND CERTAIN DRUG TREAT-
MENTS.
(a) COVERAGE OF SCREENING SERVICES.—
(1) IN
GENERAL.—Section 1861(s)(2) of the
Social Security Act (42 U.S.C. 1395x(s)(2)) is
amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (N);
(B) by striking ‘‘and’’ at the end of sub-
paragraph (O); and
(C) by inserting after subparagraph (O)
the following new subparagraph:
‘‘(P) services for the early detection of prostate
cancer (as defined in subsection (oo)); and’’.
(2) SERVICES
DESCRIBED.—Section 1861 of
such Act (42 U.S.C. 1395x) is amended by adding
at the end the following new subsection:
‘‘SERVICES FOR THE EARLY DETECTION OF PROSTATE
CANCER
‘‘(oo) The term ‘services for the early detection of
prostate cancer’ means the following procedures provided
to a man for the purpose of early detection of prostate
cancer:
‘‘(1) Digital rectal examination.
‘‘(2) Prostate-specific antigen blood test.
‘‘(3) Transrectal ultrasonography.
‘‘(4) Such other procedures as the Secretary
may designate as appropriate for early detection of
prostate cancer.’’.
(3) PAYMENT AMOUNTS; LIMITATIONS ON FRE-
QUENCY OF COVERAGE.—Section 1834 of such Act
(42 U.S.C. 1395m) is amended by inserting after
subsection (c) the following new subsection:
‘‘(d) PAYMENT AMOUNTS AND FREQUENCY LIMITS
FOR SERVICES FOR THE EARLY DETECTION OF PROS-
TATE CANCER.—
‘‘(1) IN GENERAL.—Notwithstanding any other
provision of this part, with respect to expenses in-
curred for services for the early detection of prostate
cancer (as defined in section 1861(oo))—
‘‘(A) payment may be made only for serv-
ices provided consistent with the frequency per-
mitted under paragraph (2); and
‘‘(B) the amount of the payment under
this part shall be equal to 80 percent of the
lesser of the actual charge for the service or—
‘‘(i) in the case of a service for the
early detection of prostate cancer consist-
ing of a prostate-specific antigen blood
test, the fee schedule amount established
for the service under section 1833(h) (re-
lating to payments for clinical diagnostic
laboratory tests); or
‘‘(ii) in the case of any other service
for the early detection of prostate cancer,
the amount provided under the fee sched-
ule established by the Secretary under
paragraph (3) (subject to the deductible
established under section 1833(b)).
‘‘(2) FREQUENCY COVERED.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B) and to revision by the Secretary
under subparagraph (C), no payment may be
made under this part for a service for the early
detection of prostate cancer provided to an indi-
vidual—
‘‘(i) if the individual is under 50 years
of age; or
‘‘(ii) if the service is provided within
the 11 months after a previous service for
the early detection of prostate cancer.
‘‘(B) EXCEPTION FOR HIGH RISK INDIVID-
UALS.—Payment may be made under this part
for a service for the early detection of prostate
cancer provided to an individual more fre-
quently than the limit established under sub-
paragraph (A)(ii) if the individual is at a high
risk of developing prostate cancer (as deter-
mined pursuant to factors identified by the Sec-
retary).
‘‘(C) REVISION BY SECRETARY.—
‘‘(i) REVIEW.—The Secretary, in con-
sultation with the Director of the National
Cancer Institute, shall review periodically
the appropriate frequency for performing
services for the early detection of prostate
cancer 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 services may be paid for under
this subsection, but no such revision shall
apply to services performed before January
1, 2000.
‘‘(3) ESTABLISHMENT OF FEE SCHEDULE.—
‘‘(A) IN
GENERAL.—The Secretary shall
establish fee schedules (on such geographic
basis as the Secretary considers appropriate)
for payment for services for the early detection
of prostate cancer under this part (other than
prostate-specific antigen blood tests), effective
for services furnished after the expiration of the
90-day period beginning on the date the Sec-
retary establishes the fee schedules.
‘‘(B) FACTORS
CONSIDERED.—In estab-
lishing fee schedules under subparagraph (A),
the Secretary shall take into consideration vari-
ations in the cost of furnishing such services
among geographic areas and among different
sites where services are furnished, together with
such other factors as may be appropriate to as-
sure that payment amounts are equitable.
‘‘(4) LIMITING CHARGES OF NONPARTICIPATING
PHYSICIANS.—In the case of a service for the early
detection of prostate cancer for which payment may
be made under this part, if a nonparticipating physi-
cian or nonparticipating supplier or other person (as
defined in section 1842(i)(2)) who does not accept
payment on an assignment-related basis provides the
service to an individual enrolled under this part, sec-
tion 1848(g)(1) shall apply to the service in the
same manner as such section applies to a physician’s
service.’’.
(4) CONFORMING
AMENDMENTS.—(A) Para-
graphs (1)(D) and (2)(D) of section 1833(a) of such
Act (42 U.S.C. 1395l(a)) are each amended by strik-
ing ‘‘subsection (h)(1),’’ and inserting ‘‘subsection
(h)(1) or section 1834(d)(1)(B)(i),’’.
(B) Section 1833(a)(1) of such Act (42 U.S.C.
1395l(a)(1)) is amended—
(i) by striking ‘‘and (P)’’ and inserting
‘‘(P)’’; and
(ii) by striking the semicolon at the end
and inserting the following: ‘‘, and (Q) with re-
spect to services for the early detection of pros-
tate cancer (as defined in section 1861(oo))
(other than prostate-specific antigen tests), the
amounts paid shall be the amounts described in
section 1834(d)(1);’’.
(C) Section 1833(a) of such Act (42 U.S.C.
1395l(a)) is amended—
(i) by striking ‘‘and’’ at the end of para-
graph (6);
(ii) by striking the period at the end of
paragraph (7) and inserting ‘‘; and’’; and
(iii) by adding at the end the following new
paragraph:
‘‘(8) in the case of services for the early detec-
tion of prostate cancer (as defined in section
1861(oo)) (other than prostate-specific antigen
tests), 
the 
amounts 
described 
in 
section
1834(d)(1).’’.
(D) 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 section
1834(d), the Secretary’’.
(E) Section 1862(a) of such Act (42 U.S.C.
1395y(a)) is amended—
(i) 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 follow-
ing new subparagraph:
‘‘(G) in the case of services for the early detec-
tion of prostate cancer (as defined in section
1861(oo)), which are performed more frequently
than is covered under section 1834(d)(2);’’; and
(ii) in paragraph (7), by striking ‘‘para-
graph (1)(B) or under paragraph (1)(F)’’ and
inserting ‘‘subparagraphs (B), (F), or (G) of
paragraph (1)’’.
(b) COVERAGE OF CERTAIN DRUG TREATMENTS.—
Section 1861(s)(2) of the Social Security Act (42 U.S.C.
1395x(s)(2)), as amended by subsection (a)(1), is further
amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (P);