I
105TH CONGRESS
1ST SESSION
H. R. 1128
To amend title XVIII of the Social Security Act to provide for coverage
of periodic colorectal screening services under part B of the Medicare
Program.
IN THE HOUSE OF REPRESENTATIVES
MARCH 19, 1997
Mr. HASTINGS of Florida (for himself, Ms. SLAUGHTER, Mr. EVANS, Ms.
NORTON, Ms. PELOSI, Mr. OBERSTAR, Ms. HARMAN, Mr. CLEMENT,
Mrs. MEEK of Florida, Mr. FOGLIETTA, Mr. FLAKE, Mr. SISISKY, Mr.
GORDON, Ms. CHRISTIAN-GREEN, and Mr. SKEEN) introduced the follow-
ing bill; which was referred to the Committee on Commerce, and in addi-
tion to the Committee on Ways and Means, for a period to be subse-
quently 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 periodic colorectal screening services
under part B of the Medicare Program.
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 ‘‘Colorectal Cancer
Screening Act of 1997’’.
SEC. 2. MEDICARE COVERAGE OF COLORECTAL SCREEN-
ING SERVICES.
(a) IN GENERAL.—Section 1834 of the Social Secu-
rity Act (42 U.S.C. 1395m) is amended by inserting after
subsection (d) the following new subsection:
‘‘(e) FREQUENCY
AND
PAYMENT
LIMITS
FOR
COLORECTAL SCREENING PROCEDURES.—
‘‘(1) 
SCREENING
FECAL-OCCULT
BLOOD
TESTS.—
‘‘(A) PAYMENT LIMIT.—In establishing fee
schedules under section 1833(h) with respect to
screening fecal-occult blood tests provided for
the purpose of early detection of colon cancer,
except as provided by the Secretary under para-
graph (3)(A), the payment amount established
for tests performed—
‘‘(i) in 1998 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) LIMITING
COVERAGE
FOR
NON-EL-
DERLY TO HIGH-RISK INDIVIDUALS.—No pay-
ment may be made under this part for a screen-
ing fecal-occult blood test provided for the pur-
pose of early detection of colon cancer to an in-
dividual who is under 65 years of age unless the
individual is at high risk for colorectal cancer
(as determined in accordance with criteria es-
tablished by the Secretary).
‘‘(C) FREQUENCY LIMITS.—Subject to re-
vision by the Secretary under paragraph (3)(B),
no payment may be made under this part for
a screening fecal-occult blood test provided to
an individual for the purpose of early detection
of colon cancer if the test is performed—
‘‘(i) in the case of an individual under
65 years of age, more frequently than is
provided in a periodicity schedule estab-
lished by the Secretary for purposes of this
subparagraph; or
‘‘(ii) in the case of any other individ-
ual, within the 11 months after a previous
screening fecal-occult blood test.
‘‘(2) PERIODIC COLORECTAL SCREENING PRO-
CEDURES FOR INDIVIDUALS NOT AT HIGH RISK FOR
COLORECTAL CANCER.—
‘‘(A) PAYMENT AMOUNT.—The Secretary
shall establish a payment amount under section
1848 with respect to periodic colorectal screen-
ing procedures provided for the purpose of early
detection of colon cancer that is consistent 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. The Sec-
retary shall establish a single payment amount
for periodic colorectal screening procedures,
which shall be based on the cost of a flexible
sigmoidoscopy or barium enema procedure, as
the Secretary determines appropriate.
‘‘(B) LIMITING
COVERAGE
FOR
NON-EL-
DERLY TO HIGH-RISK INDIVIDUALS.—No pay-
ment may be made under this part for a peri-
odic colorectal screening procedure provided for
the purpose of early detection of colon cancer to
an individual who is under 65 years of age un-
less the individual is at high risk for colorectal
cancer (as determined in accordance with cri-
teria established by the Secretary).
‘‘(C) FREQUENCY LIMITS.—Subject to re-
vision by the Secretary under paragraph (4)(B),
no payment may be made under this part for
a periodic colorectal screening procedure pro-
vided to an individual for the purpose of early
detection of colon cancer if the procedure is
performed—
‘‘(i) in the case of an individual under
65 years of age, more frequently than is
provided in a periodicity schedule estab-
lished by the Secretary for purposes of this
subparagraph; or
‘‘(ii) in the case of any other individ-
ual, within the 47 months after a previous
periodic colorectal screening procedure.
‘‘(D) PERIODIC
COLORECTAL
SCREENING
PROCEDURE
DEFINED.—The term ‘periodic
colorectal screening procedure’ means a flexible
sigmoidoscopy, barium enema screening proce-
dure, or other screening procedure for colorectal
cancer, as determined by the Secretary.
‘‘(3) SCREENING
FOR
INDIVIDUALS
AT
HIGH
RISK FOR COLORECTAL CANCER.—
‘‘(A) PAYMENT AMOUNT.—The Secretary
shall establish a payment amount under section
1848 with respect to each eligible procedure for
screening for individuals at high risk for
colorectal cancer (as determined in accordance
with criteria established by the Secretary) pro-
vided for the purpose of early detection of colon
cancer that is consistent with payment amounts
under such section for similar or related serv-
ices, except that such payment amount shall be
established 
without 
regard 
to 
subsection
(a)(2)(A) of such section. The Secretary may
establish a payment amount for a barium
enema procedure pursuant to this paragraph
that is different from the payment amount es-
tablished pursuant to paragraph (2) for a peri-
odic colorectal screening procedure for an indi-
vidual not a high risk for colorectal cancer so
long as the payment amount established pursu-
ant to paragraph (2) is not based on the cost
of a barium enema procedure.
‘‘(B) ELIGIBLE PROCEDURES.—Procedures
eligible for payment under this part for screen-
ing for individuals at high risk for colorectal
cancer for the purpose of early detection of
colorectal cancer shall include a screening
colonoscopy, a barium enema screening proce-
dure, 
or 
other 
screening 
procedures 
for
colorectal cancer as the Secretary determines
appropriate.
‘‘(C) FREQUENCY LIMIT.—Subject to revi-
sion by the Secretary under paragraph (4)(B),
no payment may be made under this part for
a screening procedure for individuals at high
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
23 months after a previous screening procedure.
‘‘(D) FACTORS
CONSIDERED
IN
ESTAB-
LISHING CRITERIA FOR DETERMINING INDIVID-
UALS AT HIGH RISK.—In establishing criteria
for determining whether an individual is at high
risk for colorectal cancer for purposes of this
paragraph, the Secretary shall take into consid-
eration family history, prior experience of can-
cer, a history of chronic digestive disease condi-
tion, and the presence of any appropriate recog-
nized gene markers 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 2002, 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 AND DE-
TERMINATION OF ELIGIBLE PROCEDURES.—
‘‘(i) REVIEW.—The Secretary shall re-
view periodically the appropriate frequency
for performing screening fecal-occult blood
tests, periodic colorectal screening proce-
dures, and screening procedures for indi-
viduals at high risk for colorectal cancer
based on age and such other factors as the
Secretary believes to be pertinent, and
shall review periodically the availability, ef-
fectiveness, and cost of screening proce-
dures for colorectal cancer other than
those specified in this section.
‘‘(ii) REVISION OF FREQUENCY AND
DETERMINATION
OF
ELIGIBLE
PROCE-
DURES.—The Secretary, taking into con-
sideration the review made under clause
(i), may revise from time to time the fre-
quency with which such tests and proce-
dures may be paid for under this sub-
section and may determine that additional
screening procedures shall be considered to
be ‘periodic colorectal screening proce-
dures’ or an eligible procedure for the
screening of individuals at high risk for
colorectal cancer, but no such revision shall
apply to tests or procedures performed be-
fore January 1, 2002.
‘‘(5) LIMITING CHARGES OF NONPARTICIPATING
PHYSICIANS.—
‘‘(A) IN GENERAL.—In the case of a peri-
odic colorectal screening procedure provided to
an individual for the purpose of early detection
of colon cancer or a screening provided 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 in-
dividual more than the limiting charge (as de-
fined 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 the Social Secu-
rity Act (42 U.S.C. 1395l(a)) are each amended by strik-
ing ‘‘subsection (h)(1),’’ and inserting ‘‘subsection (h)(1)
or section 1834(e)(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(e), 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 periodic colorectal screening procedure provided to
an individual for the purpose of early detection of colon
cancer or an eligible screening procedure provided to an
individual at high risk for colorectal cancer for the purpose
of early detection 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, periodic colorectal screening procedures, and
screening procedures provided for the purpose of
early detection of colon cancer, which are performed
more frequently than is covered under section
1834(e);’’; and
(B) in paragraph (7), by striking ‘‘paragraph
(1)(B) or under paragraph (1)(F)’’ and inserting
‘‘subparagraph (B), (F), or (G) of paragraph (1)’’.
SEC. 3. EFFECTIVE DATE.
The amendments made by section 2 shall apply to
services furnished on or after January 1, 1998.
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