I 
114TH CONGRESS 
1ST SESSION H. R. 2035 
To amend titles XI and XVIII of the Social Security Act and title XXVII 
of the Public Health Service Act to improve coverage for colorectal 
screening tests under Medicare and private health insurance coverage, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 27, 2015 
Mr. NEAL introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committee on Ways 
and Means, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To amend titles XI and XVIII of the Social Security Act 
and title XXVII of the Public Health Service Act to 
improve coverage for colorectal screening tests under 
Medicare and private health insurance coverage, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Supporting Colorectal Examination and Education Now 
Act of 2015’’ or the ‘‘SCREEN Act of 2015’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. Maintaining calendar year 2015 Medicare reimbursement rates for 
colonoscopy procedures for providers participating in colorectal 
cancer screening quality improvement registry. 
Sec. 4. Eliminating Medicare beneficiary cost-sharing for certain colorectal can-
cer screenings, colorectal cancer screenings with therapeutic ef-
fect, and follow-up diagnostic colorectal cancer screenings cov-
ered under Medicare. 
Sec. 5. Medicare demonstration project to evaluate the effectiveness of a pre- 
operative visit prior to screening colonoscopy and hepatitis C 
screening. 
Sec. 6. Budget neutrality. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Colorectal cancer is the second leading 
cause of cancer death among men and women com-
bined in the United States. 
(2) In 2015, more than 130,000 Americans will 
be diagnosed with colorectal cancer, and nearly 
50,000 Americans are expected to die from it. 
(3) Approximately 60 percent of colorectal can-
cer cases and 70 percent of colorectal cancer deaths 
occur in those aged 65 and older. 
(4) Colorectal cancer screening colonoscopies 
allow for the detection and removal of polyps before 
they progress to colorectal cancer, as well as early 
detection of colorectal cancer when treatment can be 
most effective. 
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(5) According to a 2012 study published in the 
New England Journal of Medicine, removing 
precancerous polyps through colonoscopy could re-
duce the number of colorectal cancer deaths by 53 
percent. 
(6) Although colorectal cancer is highly prevent-
able with appropriate screening, one in three adults 
between the ages of 50 and 75 years are not up to 
date with recommended colorectal cancer screening. 
(7) Over 200 organizations have committed to 
eliminating colorectal cancer as a major health prob-
lem in the United States and are working toward a 
shared goal of screening 80 percent of eligible Amer-
icans by 2018. 
(8) Hepatitis C is a liver disease that causes in-
flammation of the liver and results from infection 
with the Hepatitis C virus. Chronic Hepatitis C in-
fection can lead to serious health problems, including 
liver damage, cirrhosis, and liver cancer. It is the 
leading cause of liver transplants in the United 
States. 
(9) According to the Centers for Disease Con-
trol and Prevention (CDC), more than 75 percent of 
adults infected with the Hepatitis C virus in the 
United States were born between 1945 and 1965. 
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(10) The CDC estimates that up to 75 percent 
of individuals with Hepatitis C do not know that 
they are infected. 
(11) The CDC and the United States Preven-
tive Services Task Force (USPSTF) recommend a 
one-time screening for Hepatitis C for all individuals 
born between 1945 and 1965. 
(12) A recent study suggests that offering Hep-
atitis C screening to patients in connection with 
screening colonoscopies may be an effective means of 
increasing Hepatitis C screening rates among indi-
viduals born between 1945 and 1965. 
SEC. 3. MAINTAINING CALENDAR YEAR 2015 MEDICARE RE-
IMBURSEMENT RATES FOR COLONOSCOPY 
PROCEDURES 
FOR 
PROVIDERS 
PARTICI-
PATING IN COLORECTAL CANCER SCREEN-
ING QUALITY IMPROVEMENT REGISTRY. 
Section 1834(d)(3) of the Social Security Act (42 
U.S.C. 1395m(d)(3)) is amended by adding at the end the 
following new subparagraph: 
‘‘(F) MAINTAINING CALENDAR YEAR 2015 
REIMBURSEMENT RATES FOR QUALIFYING CAN-
CER SCREENING TESTS FURNISHED BY QUALI-
FYING PROVIDERS.— 
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‘‘(i) IN GENERAL.—With respect to a 
qualifying cancer screening test furnished 
during each of 2016, 2017, and 2018, by 
a qualifying provider, the amount of pay-
ment to such provider for such test under 
section 1833 or section 1848 shall be equal 
to the amount of payment for such test 
under such section 1833 or 1848 during 
2015. 
‘‘(ii) QUALIFYING CANCER SCREENING 
TEST.—For purposes of this subparagraph, 
the term ‘qualifying cancer screening test’ 
means an optical screening colonoscopy (as 
described in section 1861(pp)(1)(C)). 
‘‘(iii) 
QUALIFYING
PROVIDER
DE-
FINED.—For purposes of this subpara-
graph, the term ‘qualifying provider’ 
means, with respect to a qualifying cancer 
screening test, an individual or entity— 
‘‘(I) that is eligible for payment 
for such test under section 1833 or 
section 1848; and 
‘‘(II) that— 
‘‘(aa) participates in a na-
tionally recognized quality im-
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provement registry with respect 
to such test; and 
‘‘(bb) demonstrates, to the 
satisfaction of the Secretary, 
based on the information in such 
registry, that the tests were pro-
vided by such individual or entity 
in accordance with accepted out-
comes-based quality measures.’’. 
SEC. 4. ELIMINATING MEDICARE BENEFICIARY COST-SHAR-
ING FOR CERTAIN COLORECTAL CANCER 
SCREENINGS, 
COLORECTAL 
CANCER 
SCREENINGS WITH THERAPEUTIC EFFECT, 
AND FOLLOW-UP DIAGNOSTIC COLORECTAL 
CANCER 
SCREENINGS 
COVERED 
UNDER 
MEDICARE. 
(a) 
WAIVER
OF
COST-SHARING.—Section 
1833(a)(1)(Y) of the Social Security Act (42 U.S.C. 
1395l(a)(1)(Y)) is amended by inserting ‘‘, including 
colorectal cancer screening tests covered under this part 
described in section 1861(pp)(1)(C) (regardless of the 
code that is billed for the establishment of a diagnosis as 
a result of the screening test, for the removal of tissue 
or other matter during the screening test, or for a follow- 
up procedure that is furnished in connection with, or as 
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a result of, the initial screening test)’’ after ‘‘or popu-
lation’’. 
(b) WAIVER OF APPLICATION OF DEDUCTIBLE.— 
Section 1833(b) of the Social Security Act (42 U.S.C. 
1395l(b)) is amended— 
(1) in paragraph (1) of the first sentence, by 
striking ‘‘individual.’’ and inserting ‘‘individual, in-
cluding colorectal cancer screening tests covered 
under 
this 
part 
described 
in 
section 
1861(pp)(1)(C)’’; and 
(2) by striking the last sentence and inserting 
the following: ‘‘Subsection (a)(1)(Y) and paragraph 
(1) of the first sentence of this subsection shall 
apply with respect to a colorectal cancer screening 
test covered under this part described in section 
1861(pp)(1)(C), regardless of the code that is billed 
for the establishment of a diagnosis as a result of 
the screening test, for the removal of tissue or other 
matter during the screening test, or for a follow-up 
procedure that is furnished in connection with, or as 
a result of, the initial screening test.’’ 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to tests and procedures performed 
on or after January 1, 2016. 
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SEC. 5. MEDICARE DEMONSTRATION PROJECT TO EVALU-
ATE THE EFFECTIVENESS OF A PRE-OPERA-
TIVE 
VISIT 
PRIOR 
TO 
SCREENING 
COLONOSCOPY AND HEPATITIS C SCREEN-
ING. 
Section 1115A(b)(2) of the Social Security Act (42 
U.S.C. 1315a(b)(2)) is amended— 
(1) in the last sentence of subparagraph (A), by 
inserting ‘‘, and shall include the model described in 
subparagraph (D)’’ before the period at the end; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) 
MEDICARE
DEMONSTRATION 
PROJECT TO EVALUATE THE EFFECTIVENESS 
OF A PRE-OPERATIVE VISIT PRIOR TO SCREEN-
ING COLONOSCOPY AND HEPATITIS C SCREEN-
ING.— 
‘‘(i) IN
GENERAL.—The model de-
scribed in this subparagraph is a dem-
onstration project under title XVIII to 
evaluate the effectiveness of a pre-operative 
visit with the provider performing the pro-
cedure prior to screening colonoscopy to— 
‘‘(I) ease any patient concern or 
fears with respect to the procedure 
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and answer any questions relating to 
the screening; 
‘‘(II) ensure quality examinations 
and avoid unnecessary repeat exami-
nations by educating individuals on 
the importance of following pre-proce-
dure instructions, such as bowel prep-
aration, and addressing the individ-
ual’s family history of or predisposi-
tion to colorectal cancer; and 
‘‘(III) increase Hepatitis C Virus 
(HCV) screening rates among Medi-
care beneficiaries by educating indi-
viduals about the importance of such 
screening during the pre-operative 
visit and having the pre-operative visit 
fulfill the referral requirement for 
such screening under title XVIII, al-
lowing patients to be screened for 
colorectal cancer and HCV at the 
same time. 
‘‘(ii) CONSULTATION.—The Secretary 
shall consult with stakeholders who would 
be providing the pre-operative visit under 
the model described in this subparagraph 
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on the implementation of such model, in-
cluding payment for services furnished 
under the model.’’. 
SEC. 6. BUDGET NEUTRALITY. 
(a) ADJUSTMENT
OF PHYSICIAN FEE SCHEDULE 
CONVERSION FACTOR.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall reduce the conversion factor established 
under subsection (d) of section 1848 of the Social Security 
Act (42 U.S.C. 1395w–4) for each year (beginning with 
2016) to the extent necessary to reduce expenditures 
under such section for items and services furnished during 
the year in the aggregate by the net offset amount deter-
mined under subsection (c)(5) attributable to such section 
for the year. 
(b) ADJUSTMENT
OF HOPD CONVERSION FAC-
TOR.—The Secretary shall reduce the conversion factor es-
tablished under paragraph (3)(C) of section 1833(t) of the 
Social Security Act (42 U.S.C. 1395l(t)) for each year (be-
ginning with 2016) to the extent necessary to reduce ex-
penditures under such section for items and services fur-
nished during the year in the aggregate by the net offset 
amount determined under subsection (c)(5) attributable to 
such section for the year. 
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(c) DETERMINATIONS
RELATING
TO
EXPENDI-
TURES.—For purposes of this section, before the begin-
ning of each year (beginning with 2016) at the time con-
version factors described in subsections (a) and (b) are 
established for the year, the Secretary shall determine— 
(1) the amount of the gross additional expendi-
tures under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.) estimated to result from 
the implementation of sections 3 and 4 for items 
and services furnished during the year; 
(2) the amount of any offsetting reductions in 
expenditures under such title (such as reductions in 
payments for inpatient hospital services) for such 
year attributable to the implementation of such sec-
tions; 
(3) the amount (if any) by which the amount 
of the gross additional expenditures determined 
under paragraph (1) for the year exceeds the 
amount of offsetting reductions determined under 
paragraph (2) for the year; 
(4) the amount of the gross additional expendi-
tures determined under paragraph (1) for the year 
that are attributable to expenditures under sections 
1848 and 1833(t) of such Act, the ratio of such ex-
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penditures that are attributable to each respective 
section; and 
(5) with respect to section 1848 and section 
1833(t) of such Act, a net offset amount for the 
year equal to the product of— 
(A) the amount of the net additional ex-
penditures for the year determined under para-
graph (3); and 
(B) the ratio determined under paragraph 
(4) attributable to the respective section. 
Æ 
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