Donald Payne, Sr., Colorectal Cancer Detection Act of 2021
Bill: S.2149 | Sponsor: Sen. Heinrich, Martin (D-NM)
Policy area: Health

Summary:
Donald Payne Sr. Colorectal Cancer Detection Act of 2021
This bill provides for Medicare coverage and payment, subject to specified frequency limits, of certain colorectal cancer screening blood-based tests.

To amend title XVIII of the Social Security Act to provide coverage 
   under the Medicare program for FDA-approved qualifying colorectal 
   cancer screening blood-based tests, to increase participation in 
colorectal cancer screening in under-screened communities of color, to 
   offset the COVID-19 pandemic driven declines in colorectal cancer 
                   screening, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Donald Payne, Sr., Colorectal Cancer 
Detection Act of 2021''.

SEC. 2. MEDICARE COVERAGE FOR FDA-APPROVED QUALIFYING COLORECTAL CANCER 
              SCREENING BLOOD-BASED TESTS.

    (a) In General.--Section 1861(pp) of the Social Security Act (42 
U.S.C. 1395x(pp)) is amended--
            (1) in paragraph (1)--
                    (A) by redesignating subparagraph (D) as 
                subparagraph (E); and
                    (B) by inserting after subparagraph (C) the 
                following new subparagraph:
            ``(D) Qualifying colorectal cancer screening blood-based 
        test.''; and
            (2) by adding at the end the following new paragraph:
    ``(3) The term `qualifying colorectal cancer screening blood-based 
test' means, with respect to a year, a screening blood-based test for 
the early detection of colorectal cancer furnished in the year that was 
marketed or used, as applicable, in accordance with the relevant 
provisions of section 353 of the Public Health Service Act or the 
Federal Food, Drug, and Cosmetic Act more than 6 months before the 
beginning of the year.''.
    (b) Frequency Limits for Colorectal Cancer Screening Tests and 
Payment Amount for Qualifying Colorectal Cancer Screening Blood-Based 
Tests.--Section 1834(d) of the Social Security Act (42 U.S.C. 1395m(d)) 
is amended--
            (1) by amending clause (ii) of paragraph (1)(B) to read as 
        follows:
                            ``(ii) if the test is performed within--
                                    ``(I) the 11 months after a 
                                previous screening fecal-occult blood 
                                test or a previous qualifying 
                                colorectal cancer screening blood-based 
                                test;
                                    ``(II) the 35 months after a 
                                previous screening flexible 
                                sigmoidoscopy or a previous screening 
                                colonoscopy with adenoma findings;
                                    ``(III) the 59 months after a 
                                previous screening colonoscopy with 
                                small polyp findings; or
                                    ``(IV) the 119 months after a 
                                previous screening colonoscopy without 
                                adenoma findings or small polyp 
                                findings.'';
            (2) in paragraph (2)(E)(ii), by inserting ``or within the 
        35 months after a previous screening fecal-occult blood test or 
        previous qualifying colorectal cancer screening blood-based 
        test'' after ``sigmoidoscopy'';
            (3) by amending subparagraph (E) of paragraph (3) to read 
        as follows:
                    ``(E) Frequency limit.--No payment may be made 
                under this part for a colorectal cancer screening test 
                consisting of a screening colonoscopy--
                            ``(i) if the procedure is performed within 
                        the 11 months after a previous screening fecal-
                        occult blood test or previous qualifying 
                        colorectal cancer screening blood-based test;
                            ``(ii) for individuals at high risk for 
                        colorectal cancer if the procedure is performed 
                        within the 23 months after a previous screening 
                        colonoscopy; or
                            ``(iii) for individuals not at high risk 
                        for colorectal cancer if the procedure is 
                        performed within the 119 months after a 
                        previous screening colonoscopy or within the 47 
                        months after a previous screening flexible 
                        sigmoidoscopy.''; and
            (4) by adding at the end the following new paragraph:
            ``(4) Qualifying colorectal cancer screening blood-based 
        tests.--
                    ``(A) Payment amount.--The payment amount for 
                colorectal cancer screening tests consisting of 
                qualifying colorectal cancer screening blood-based 
                tests shall be established by the Secretary.
                    ``(B) Frequency limit.--Paragraph (1)(B) shall 
                apply to colorectal cancer screening tests consisting 
                of qualifying colorectal cancer screening blood-based 
                tests in the same manner as such paragraph applies to 
                colorectal cancer screening tests consisting of fecal-
                occult blood tests.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to colorectal cancer screening tests furnished in a year 
beginning more than 6 months after the date of the enactment of this 
Act.
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