Title: Prostate Cancer Misdiagnosis Elimination Act of 2017
Policy area: Health

Summary:
Prostate Cancer Misdiagnosis Elimination Act of 2017
This bill provides for Medicare coverage of a DNA Specimen Provenance Assay clinical diagnostic laboratory test following a positive prostate cancer biopsy.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2557 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 2557

To amend title XVIII of the Social Security Act to provide for coverage 
  under the Medicare program of certain DNA Specimen Provenance Assay 
                 clinical diagnostic laboratory tests.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 19, 2017

Mr. Bucshon (for himself, Mr. Payne, Mr. Carson of Indiana, Mr. Mullin, 
and Mr. Rush) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently 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 
  under the Medicare program of certain DNA Specimen Provenance Assay 
                 clinical diagnostic laboratory tests.

    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 ``Prostate Cancer Misdiagnosis 
Elimination Act of 2017''.

SEC. 2. COVERAGE OF CERTAIN DNA SPECIMEN PROVENANCE ASSAY CLINICAL 
              DIAGNOSTIC LABORATORY TESTS UNDER MEDICARE.

    (a) Coverage.--Section 1862(a)(1) of the Social Security Act (42 
U.S.C. 1395y(a)(1)) is amended--
            (1) in subparagraph (O), by striking ``and'' at the end;
            (2) in subparagraph (P), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
            ``(Q) in the case of a DNA Specimen Provenance Assay 
        clinical diagnostic laboratory test (DSPA test), unless the 
        DSPA test is furnished to an individual enrolled under part B 
        who has had a prostate cancer biopsy the results of which are 
        positive, the DSPA test is furnished with respect to such 
        biopsy, and the DSPA test is ordered by the physician who 
        furnished the prostate cancer biopsy that obtained the specimen 
        tested;''.
    (b) Temporary Payment Amount for Tests Furnished During 2018 
Through 2020 and Related Requirements.--Section 1834A of the Social 
Security Act (42 U.S.C. 1395m-1) is amended--
            (1) in subsection (b)(1)(A), by striking ``and (d)'' and 
        inserting ``, (d), and (j)''; and
            (2) by adding at the end the following new subsection:
    ``(j) DNA Specimen Provenance Assay Clinical Diagnostic Laboratory 
Tests.--
            ``(1) Temporary payment amount for tests furnished during 
        2018 through 2020.--Notwithstanding the payment amount that 
        would otherwise apply under this section, with respect to a DNA 
        Specimen Provenance Assay clinical diagnostic laboratory test 
        furnished on or after January 1, 2018, and before January 1, 
        2021, the payment amount under this section shall be equal to 
        85 percent of the amount determined under the fee schedule 
        under section 1833(h)(1) for 2016 for HCPCS code 81265.
            ``(2) HCPCS code assignment.--The Secretary shall assign an 
        HCPCS code to the DNA Specimen Provenance Assay clinical 
        diagnostic laboratory test.
            ``(3) Ensuring proper billing and payment.--
                    ``(A) Use of modifier to ensure proper payment.--
                The Secretary may use a modifier to facilitate making 
                payment under this section with respect to a DNA 
                Specimen Provenance Assay clinical diagnostic 
                laboratory test.
                    ``(B) Paid claims sample error rate.--
                            ``(i) In general.--The Secretary shall 
                        conduct a post-payment review of a sample of 
                        not less than 50 claims for DNA Specimen 
                        Provenance Assay clinical diagnostic laboratory 
                        tests for which payment is made under this 
                        part. The sample reviewed under the preceding 
                        sentence may be taken from claims paid to more 
                        than one supplier.
                            ``(ii) Posting on internet website.--Not 
                        later than July 1, 2019, the Secretary shall 
                        post on the Internet website of the Centers for 
                        Medicare & Medicaid Services the number of 
                        claims with errors identified based on the 
                        reviews conducted under clause (i).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to DNA Specimen Provenance Assay clinical diagnostic laboratory 
tests furnished on or after January 1, 2018.

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