(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. Temporary increase in payment rate for certain cancer screening tests. 
Sec. 4. Waiving Medicare cost-sharing for colorectal cancer screening with 
therapeutic effect. 
Sec. 5. Medicare coverage for an office visit or consultation prior to a qualifying 
screening colonoscopy. 
Sec. 6. Budget neutrality. 
Sec. 7. Expansion of coverage of activities related to recommended preventive 
health services under private health insurance. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Colon cancer is the third most common 
cause of cancer-related deaths and the second most 
common cancer for both men and women. 
(2) According to the American Cancer Society, 
over 50,000 people will die this year from colon can-
cer. 
(3) Colorectal cancer is highly treatable with 
appropriate screening. According to the American 
Cancer Society (2010 Facts & Figures), the 5-year 
survival rate is 90 percent for those individuals who 
are diagnosed at an early stage of the cancer. How-
ever, less than 40 percent of colon cancer cases are 
diagnosed at an early stage. 
(4) The Centers for Disease Control and Pre-
vention recently estimated that approximately 2,000 
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deaths could be avoided if colonoscopy screening 
rates rose by just 10 percent. 
(5) 
Colonoscopies 
allow 
for 
simultaneous 
colorectal cancer screenings and detection and the 
removal of precancerous polyps, thus preventing can-
cer from developing. 
(6) The U.S. Preventive Services Task Force 
provides an ‘‘A’’ rating for colorectal cancer 
screenings. 
(7) The Centers for Disease Control and Pre-
vention’s colorectal cancer control program has set a 
target of screening 80 percent of eligible adults in 
certain States by 2014. The American Cancer Soci-
ety and other patient advocacy groups have a target 
rate of 75 percent. 
(8) Only between 52 and 58 percent of Medi-
care beneficiaries have had any colorectal cancer 
screening test, despite Medicare coverage for such 
tests. 
(9) Only 49.3 percent of Medicare beneficiaries 
who are 50 to 80 years old receive colorectal cancer 
screenings within recommended intervals. 
(10) The Centers for Medicare & Medicaid 
Services notes that there is ‘‘clearly an opportunity 
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to improve colorectal cancer screening rates in the 
Medicare population’’. 
(11) A January 2011 study by the Colon Can-
cer Alliance concludes that most Americans over the 
age of 50— 
(A) wish a health care provider was able to 
sit down with them to discuss a colonoscopy be-
fore undergoing the test; and 
(B) forgo a colonoscopy due to fear of the 
procedure. 
(12) In February 2010, the National Institutes 
of Health hosted a conference on colorectal cancer 
screening and cited patient awareness and fears as 
barriers to increasing colorectal cancer screening 
rates. 
(13) According to the Medicare Payment Advi-
sory Commission, colonoscopy is one of the most 
common procedures performed in the ambulatory 
surgical centers (ASCs) and ‘‘the decline in payment 
rate for the highest volume procedures is especially 
a strong concern for ASCs that focus on gastro-
enterology’’. 
(14) An Institute of Medicine study on 
colorectal cancer screening cited the inadequate re-
imbursement for preventive care services as one of 
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the constraints limiting colorectal cancer screening 
rates. 
(15) Colorectal cancer screening by colonoscopy 
has been demonstrated to reduce Medicare costs 
over the long-term. 
SEC. 3. TEMPORARY INCREASE IN PAYMENT RATE FOR 
CERTAIN CANCER SCREENING TESTS. 
(a) IN GENERAL.—With respect to a qualifying can-
cer screening test furnished during the 5-year period be-
ginning on January 1, 2013, by a qualifying provider, the 
amount otherwise payable under section 1833 or section 
1848 of the Social Security Act (42 U.S.C. 1395l, 1395w– 
4) to such provider for such test shall be increased by 10 
percent. 
(b) QUALIFYING CANCER SCREENING TEST.— 
(1) IN GENERAL.—For purposes of this section, 
subject to paragraph (2), the term ‘‘qualifying can-
cer screening test’’ means, with respect to a Medi-
care beneficiary, a cancer screening test that has in 
effect with respect to such beneficiary a rating of ‘A’ 
in the current recommendations of the United States 
Preventive Services Task Force. 
(2) TERMINATION
WHEN
HIGH
UTILIZATION 
RATE REACHED.—If the Secretary determines that a 
cancer screening test described in paragraph (1) has 
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a utilization rate of at least 75 percent of the Medi-
care beneficiaries for whom such screening has such 
a recommendation, effective as of the first day of the 
year after the year in which such determination is 
made, the cancer screening test shall not be a quali-
fying cancer screening test. 
(c) QUALIFYING PROVIDER DEFINED.—For purposes 
of this section, the term ‘‘qualifying provider’’ means, with 
respect to a qualifying cancer screening test, an individual 
or entity— 
(1) that is eligible for payment for such test 
under section 1833 or section 1848 of the Social Se-
curity Act; and 
(2) that— 
(A) participates in a nationally recognized 
quality improvement registry with respect to 
such test; and 
(B) demonstrates, to the satisfaction of the 
Secretary, based on the information in such 
registry, that the tests were provided by such 
individual or entity in accordance with accepted 
outcomes-based quality measures. 
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