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 1994’’.
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)), as
amended by section 13553(a) of the Omnibus Budg-
et Reconciliation Act of 1993 (hereafter in this Act
referred to as ‘‘OBRA–1993’’), is amended—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (P);
(B) by adding ‘‘and’’ at the end of sub-
paragraph (Q); and
(C) by adding at the end the following new
subparagraph:
‘‘(R) prostate cancer screening services (as de-
fined in subsection (ll));’’.
(2) SERVICES
DESCRIBED.—Section 1861 of
such Act (42 U.S.C. 1395x) is amended—
(A) by redesignating the subsection (jj) in-
serted by section 4156(a)(2) of the Omnibus
Budget Reconciliation Act of 1990 as sub-
section (kk); and
(B) by inserting after such subsection the
following new subsection:
‘‘Prostate Cancer Screening Services
‘‘(ll) The term ‘prostate cancer screening services’
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 PROSTATE CANCER SCREENING SERVICES.—
‘‘(1) IN GENERAL.—Notwithstanding any other
provision of this part, with respect to expenses in-
curred for prostate cancer screening services (as de-
fined in section 1861(ll))—
‘‘(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 prostate cancer
screening service consisting of a prostate-
specific antigen blood test, the fee schedule
amount established for the service under
section 1833(h) (relating to payments for
clinical diagnostic laboratory tests); or
‘‘(ii) in the case of any other prostate
cancer screening service, the amount pro-
vided under the fee schedule 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 prostate cancer
screening service provided to an individual for
the purpose of early detection of prostate can-
cer—
‘‘(i) if the individual is under 50 years
of age; or
‘‘(ii) if the service is provided within
the 11 months after a previous prostate
cancer screening service.
‘‘(B) EXCEPTION FOR HIGH RISK INDIVID-
UALS.—Payment may be made under this part
for a prostate cancer screening service provided
to an individual more frequently than the limit
established under subparagraph (A)(ii) if the
individual is at a high risk of developing pros-
tate cancer (as determined pursuant to factors
identified by the Secretary).
‘‘(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
prostate cancer screening services based on
age and such other factors as the Sec-
retary 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, 1998.
‘‘(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 prostate cancer screening serv-
ices under this part (other than prostate-spe-
cific antigen blood tests), effective for services
furnished after the expiration of the 90-day pe-
riod beginning on the date the Secretary estab-
lishes 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.—
‘‘(A) IN GENERAL.—In the case of a pros-
tate cancer screening service provided to an in-
dividual for the purpose of early detection of
prostate cancer for which payment may be
made under this part, if a nonparticipating phy-
sician or supplier provides the procedure to an
individual enrolled under this part, the physi-
cian or supplier 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).’’.
(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)), as amended by section 13544(b)(2) of
OBRA–1993, 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 prostate cancer screening services (as
defined in section 1861(ll)) (other than pros-
tate-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 prostate cancer screening
services (as defined in section 1861(ll)) (other than
prostate-specific antigen tests), the amounts de-
scribed 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 1861(s)(2)(O) of such Act (42
U.S.C. 1395x(s)(2)(O)) is amended by striking
‘‘(jj)’’ and inserting ‘‘(kk)’’.
(F) 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 prostate cancer screening
services (as defined in section 1861(ll)) provided for
the purpose of early detection of prostate cancer,
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 (Q);
(2) by adding ‘‘and’’ at the end of subpara-
graph (R); and
(3) by adding at the end the following new sub-
paragraph:
‘‘(S) an oral drug prescribed for the treatment
of prostate cancer, if the use of the drug for such
purpose is a medically accepted indication under
subsection (t)(2);’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to services provided on or after
January 1, 1995, without regard to whether or not the
Secretary has established fee schedules under section
1834(d)(3) of the Social Security Act (as added by sub-
section (a)(3)) or promulgated other regulations to carry
out such amendments by that date.
SEC. 3. COVERAGE OF PROSTATE CANCER SCREENING AND
TREATMENT SERVICES FOR VETERANS.
(a) PROSTATE CANCER SCREENING AND DIAGNOSIS
DEFINED AS PREVENTIVE HEALTH SERVICE.—Section
1701(9) of title 38, United States Code is amended—
(1) by redesignating subparagraphs (J) and (K)
as subparagraphs (K) and (L), respectively; and
(2) by inserting after subparagraph (I) the fol-
lowing new subparagraph (J):
‘‘(J) screening and diagnostic tests approved
for prostate cancer;’’.
(b) COVERAGE OF PROSTATE CANCER SCREENING
AND TREATMENT.—
(1) IN GENERAL.—Chapter 17 of title 38, Unit-
ed States Code, is amended by inserting after sec-
tion 1724 a new section as follows:
‘‘§ 1725. Prostate cancer screening and treatment
‘‘(a) The Secretary shall include in the medical serv-
ices made available to veterans under this chapter appro-
priate prostate cancer screening, counseling, treatment,
and information. Based on the best available medical evi-
dence, the Secretary shall develop and implement an ap-
propriate prostate cancer screening schedule for those vet-
erans confined to hospitals or other institutions.
‘‘(b) For the purposes of this section—
‘‘(1) appropriate prostate cancer screening
means procedures provided to a man for the purpose
of early detection of prostate cancer, including digi-
tal rectal examinations, prostate-specific antigen
blood tests, and transrectal ultrasonography; and
‘‘(2) appropriate prostate cancer treatment in-
cludes drugs approved by the Food and Drug Ad-
ministration for the treatment of prostate cancer.
‘‘(c) The Secretary may carry out research and re-
search training in the diagnosis and treatment of prostate
cancer based upon the prostate cancer services provided
under this section and may develop guidelines outlining
effective treatment regimens for prostate cancer.’’.
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended
by inserting after the item relating to section 1724
the following new item:
‘‘1725. Prostate cancer screening and treatment.’’.
SEC. 4. RESEARCH AND EDUCATION REGARDING PROS-
TATE CANCER; CERTAIN PROGRAMS OF PUB-
LIC HEALTH SERVICE.
(a) NATIONAL INSTITUTES
OF HEALTH.—Section
417B(c) of the Public Health Service Act (42 U.S.C.
286a–8(c)) is amended in the first sentence by striking
‘‘$72,000,000’’ and all that follows and inserting the fol-
lowing: ‘‘$72,000,000 for fiscal year 1994, $86,000,000
for fiscal year 1995, $100,000,000 for fiscal year 1996,
and such sums as may be necessary for each of the fiscal
years 1997 and 1998.’’.
(b) AGENCY FOR HEALTH CARE POLICY AND RE-
SEARCH.—Section 902 of the Public Health Service Act
(42 U.S.C. 299a) is amended by adding at the end the
following subsection:
‘‘(f) ACTIVITIES REGARDING PROSTATE CANCER.—
The Administrator shall, with respect to prostate cancer—
‘‘(1) conduct and support research on the out-
comes, effectiveness, and appropriateness of health
services and procedures; and
‘‘(2) in carrying out section 912(a), provide for
the development, periodic review, and updating of
clinically relevant guidelines, standards of quality,
performance measures, and medical review criteria.’’.
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