Title: CT Colonography Screening for Colorectal Cancer Act of 2018
Policy area: Health

Summary:
CT Colonography Screening for Colorectal Cancer Act of 2018
This bill alters Medicare requirements in order to: (1) provide Medicare coverage for screening computed tomography colonography (CTC) as a colorectal cancer screening test, and (2) exclude screening CTC from a special Medicare payment rule applicable to certain imaging services.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3465 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 3465

  To amend title XVIII of the Social Security Act to cover screening 
computed tomography colonography as a colorectal cancer screening test 
                      under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 18, 2018

Mr. Inhofe (for himself and Mr. Sanders) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to cover screening 
computed tomography colonography as a colorectal cancer screening test 
                      under the Medicare program.

    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 ``CT Colonography Screening for 
Colorectal Cancer Act of 2018''.

SEC. 2. COVERAGE OF COMPUTED TOMOGRAPHY COLONOGRAPHY SCREENING AS A 
              COLORECTAL CANCER SCREENING TEST UNDER MEDICARE.

    (a) In General.--Section 1861(pp)(1) of the Social Security Act (42 
U.S.C. 1395x(pp)(1)) is amended--
            (1) by redesignating subparagraph (D) as subparagraph (E); 
        and
            (2) by inserting after subparagraph (C) the following new 
        subparagraph:
                    ``(D) Screening computed tomography 
                colonography.''.
    (b) Frequency Limits and Payment.--Section 1834(d) of such Act (42 
U.S.C. 1395m(d)) is amended by adding at the end the following new 
paragraph:
            ``(4) Screening computed tomography colonography.--
                    ``(A) Fee schedule.--With respect to a colorectal 
                cancer screening test consisting of screening computed 
                tomography colonography, subject to subparagraph (B), 
                payment under section 1848 shall be consistent with 
                payment under such section for similar or related 
                services.
                    ``(B) Payment limit.--In the case of screening 
                computed tomography colonography, payment under this 
                part shall not exceed such amount as the Secretary 
                specifies, based upon rates recognized for diagnostic 
                computed tomography colonography.
                    ``(C) Facility payment limit.--Notwithstanding any 
                other provision of this title, in the case of an 
                individual who receives screening computed tomography 
                colonography--
                            ``(i) in computing the amount of any 
                        applicable coinsurance, the computation of such 
                        coinsurance shall be based upon the fee 
                        schedule under which payment is made for the 
                        services; and
                            ``(ii) the amount of such coinsurance shall 
                        not exceed 25 percent of the payment amount 
                        under the fee schedule described in 
                        subparagraph (A).
                    ``(D) Frequency limit.--No payment may be made 
                under this part for a colorectal cancer screening test 
                consisting of a screening computed tomography 
                colonography--
                            ``(i) if the individual is under 50 years 
                        of age; or
                            ``(ii)(I) in the case of individuals at 
                        high risk for colorectal cancer, if the 
                        procedure is performed within the 23 months 
                        after a previous screening computed tomography 
                        colonography or a previous screening 
                        colonoscopy; or
                            ``(II) in the case of an individual who is 
                        not at high risk for colorectal cancer, if the 
                        procedure is performed within the 119 months 
                        after a previous screening colonoscopy or 
                        within the 59 months after a previous screening 
                        flexible sigmoidoscopy or a previous screening 
                        computed tomography colonography.''.
    (c) Conforming Frequency Limits for Other Colorectal Cancer 
Screening Tests.--
            (1) Screening flexible sigmoidoscopy.--Paragraph (2)(E)(ii) 
        of section 1834(d) of the Social Security Act (42 U.S.C. 
        1395m(d)) is amended by inserting ``or screening computed 
        tomography colonography'' after ``previous screening flexible 
        sigmoidoscopy''.
            (2) Screening colonoscopy.--Paragraph (3)(E) of such 
        section is amended--
                    (A) by inserting ``or screening computed tomography 
                colonography'' after ``23 months after a previous 
                screening colonoscopy''; and
                    (B) by inserting ``or screening computed tomography 
                colonography'' after ``screening flexible 
                sigmoidoscopy''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2019.

SEC. 3. EXEMPTION OF SCREENING COMPUTED TOMOGRAPHY COLONOGRAPHY FROM 
              SPECIAL RULE ON PAYMENT FOR IMAGING SERVICES.

    (a) In General.--Section 1848(b)(4)(B) of the Social Security Act 
(42 U.S.C. 1395w-4(b)(4)(B)) is amended by inserting ``and screening 
computed tomography colonography'' after ``diagnostic and screening 
mammography''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services furnished on or after January 1, 2019.

SEC. 4. REPORTS ON THE STATUS OF COVERING COMPUTED TOMOGRAPHY 
              COLONOGRAPHY AS A COLORECTAL CANCER SCREENING TEST UNDER 
              MEDICARE.

    (a) Preliminary Report.--Not later than 90 days after the date of 
the enactment of this Act, the Secretary of Health and Human Services 
shall submit a preliminary report to Congress on the status of coverage 
of computed tomography colonography as a colorectal cancer screening 
test under the Medicare program under title XVIII of the Social 
Security Act, including the extent to which such coverage as required 
by the amendments made by sections 2 and 3 has been implemented.
    (b) Annual Report.--Not later than September 30 of each fiscal year 
during the 5-year period beginning with fiscal year 2020, the Secretary 
shall submit to the Congress, a status report on the following:
            (1) The impact of screening computed tomography 
        colonography on the change in colorectal cancer screening 
        compliance of Medicare beneficiaries.
            (2) The various utilization rates with respect to Medicare 
        beneficiaries for each available colorectal cancer screening 
        option before and after the availability of and coverage of 
        screening computed tomography colonography under the Medicare 
        program pursuant to the enactment of this Act, including--
                    (A) by initial CRC screening performed with respect 
                to a Medicare beneficiary per year, including the age 
                of the beneficiary when the initial screening was 
                performed; and
                    (B) by follow-on screening performed, whereby the 
                analysis demonstrates to what extent screening computed 
                tomography colonography was used as a substitute for a 
                previous screening procedure.
            (3) Access to screening computed tomography colonography by 
        Medicare beneficiaries, especially in rural areas or 
        underserved populations, before and after the date of 
        implementation of coverage of such screening benefit under the 
        Medicare program pursuant to the enactment of this Act.
            (4) Recommendations for such legislation and administrative 
        action as the Secretary determines appropriate to implement 
        this Act.
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