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Q: SECTION 1. SHORT TITLE.

This Act may be cited as the ''Colorectal Cancer Screening Act of
1995''.

SEC. 2. MEDICARE COVERAGE OF COLORECTAL SCREENING SERVICES.

(a) In General.--Section 1834 of the Social Security Act (42 U.S.C.
1395m) is amended by inserting after subsection (d) the following new
subsection:
''(e) Frequency and Payment Limits for Colorectal Screening
Procedures.--
''(1) Screening fecal-occult blood tests.--
''(A) Payment limit.--In establishing fee schedules
under section 1833(h) with respect to screening fecal-
occult blood tests provided for the purpose of early
detection of colon cancer, except as provided by the
Secretary under paragraph (3)(A), the payment amount
established for tests performed--
''(i) in 1996 shall not exceed $5; and
''(ii) in a subsequent year, shall not
exceed the limit on the payment amount
established under this subsection for such
tests for the preceding year, adjusted by the
applicable adjustment under section 1833(h) for
tests performed in such year.
''(B) Frequency limits.--Subject to revision by the
Secretary under paragraph (3)(B), no payment may be
made under this part for a screening fecal-occult blood
test provided to an individual for the purpose of early
detection of colon cancer if the test is performed--
''(i) on an individual under 50 years of
age; or
''(ii) within the 11 months after a
previous screening fecal-occult blood test.
''(2) Periodic colorectal screening procedures for
individuals not at high risk for colorectal cancer.--
''(A) Payment amount.--The Secretary shall
establish a payment amount under section 1848 with
respect to periodic colorectal screening procedures
provided for the purpose of early detection of colon
cancer that is consistent with payment amounts under
such section for similar or related services, except
that such payment amount shall be established without
regard to subsection (a)(2)(A) of such section. The
Secretary shall establish a single payment amount for
periodic colorectal screening procedures, which shall
be based on the cost of a flexible sigmoidoscopy or
barium enema procedure, as the Secretary determines
appropriate.
''(B) Frequency limits.--Subject to revision by the
Secretary under paragraph (4)(B), no payment may be
made under this part for a periodic colorectal
screening procedure provided to an individual for the
purpose of early detection of colon cancer if the
procedure is performed--
''(i) on an individual under 50 years of
age; or
''(ii) within the 59 months after a
previous periodic colorectal screening
procedure.
''(C) Periodic colorectal screening procedure
defined.--The term 'periodic colorectal screening
procedure' means a flexible sigmoidoscopy, barium enema
screening procedure, or other screening procedure for
colorectal cancer, as determined by the Secretary.
''(3) Screening for individuals at high risk for colorectal
cancer.--
''(A) Payment amount.--The Secretary shall
establish a payment amount under section 1848 with
respect to each eligible procedure for screening for
individuals at high risk for colorectal cancer (as
determined in accordance with criteria established by
the Secretary) provided for the purpose of early
detection of colon cancer that is consistent with
payment amounts under such section for similar or
related services, except that such payment amount shall
be established without regard to subsection (a)(2)(A)
of such section. The Secretary may establish a payment
amount for a barium enema procedure pursuant to this
paragraph that is different from the payment amount
established pursuant to paragraph (2) for a periodic
colorectal screening procedure for an individual not at
high risk for colorectal cancer so long as the payment
amount established pursuant to paragraph (2) is not
based on the cost of a barium enema procedure.
''(B) Eligible procedures.--Procedures eligible for
payment under this part for screening for individuals
at high risk for colorectal cancer for the purpose of
early detection of colorectal cancer shall include a
screening colonoscopy, a barium enema screening
procedure, or other screening procedures for colorectal
cancer as the Secretary determines appropriate.
''(C) Frequency limit.--Subject to revision by the
Secretary under paragraph (4)(B), no payment may be
made under this part for a screening procedure for
individuals at high risk for colorectal cancer provided
to an individual for the purpose of early detection of
colon cancer if the procedure is performed within the
23 months after a previous screening procedure.
''(D) Factors considered in establishing criteria
for determining individuals at high risk.--In
establishing criteria for determining whether an
individual is at high risk for colorectal cancer for
purposes of this paragraph, the Secretary shall take
into consideration family history, prior experience of
cancer or precursor neoplastic polyps, a history of
chronic digestive disease condition (including
inflammatory bowel disease, Crohn's disease, or
ulcerative colitis), the presence of any appropriate
recognized gene markers for colorectal cancer and other
predisposing factors.
''(4) Reductions in payment limit and revision of
frequency.--
''(A) Reductions in payment limit.--The Secretary
shall review from time to time the appropriateness of
the amount of the payment limit established for
screening fecal-occult blood tests under paragraph
(1)(A). The Secretary may, with respect to tests
performed in a year after 1998, reduce the amount of
such limit as it applies nationally or in any area to
the amount that the Secretary estimates is required to
assure that such tests of an appropriate quality are
readily and conveniently available during the year.
''(B) Revision of frequency and determination of
eligible procedures.--
''(i) Review.--The Secretary shall review
periodically the appropriate frequency for
performing screening fecal-occult blood tests,
periodic colorectal screening procedures, and
screening procedures for individuals at high
risk for colorectal cancer based on age and
such other factors as the Secretary believes to
be pertinent, and shall review periodically the
availability, effectiveness, and cost of
screening procedures for colorectal cancer
other than those specified in this section.
''(ii) Revision of frequency and
determination of eligible procedures.--The
Secretary, taking into consideration the review
made under clause (i), may revise from time to
time the frequency with which such tests and
procedures may be paid for under this
subsection and may determine that additional
screening procedures shall be considered to be
'periodic colorectal screening procedures' or
an eligible procedure for the screening of
individuals at high risk for colorectal cancer,
but no such revision shall apply to tests or
procedures performed before January 1, 1999.
''(5) Limiting charges of nonparticipating physicians.--
''(A) In general.--In the case of a periodic
colorectal screening procedure provided to an
individual for the purpose of early detection of colon
cancer or a screening provided to an individual at high
risk for colorectal cancer for the purpose of early
detection of colon cancer for which payment may be made
under this part, if a nonparticipating physician
provides the procedure to an individual enrolled under
this part, the physician 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).''.
(b) Conforming Amendments.--(1) Paragraphs (1)(D) and (2)(D) of
section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) are
each amended by striking ''subsection (h)(1),'' and inserting
''subsection (h)(1) or section 1834(e)(1),''.
(2) Section 1823(h)(1)(A) of such Act (42 U.S.C. 1935l(h)(1)(A)) is
amended by striking ''The Secretary'' and inserting ''Subject to
paragraphs (1) and (3)(A) of section 1834(e), the Secretary''.
(3) Clauses (i) and (ii) of section 1848(a)(2)(A) of such Act (42
U.S.C. 1395w-4(a)(2)(A)) are each amended by striking ''a service'' and
inserting ''a service (other than a periodic colorectal screening
procedure provided to an individual for the purpose of early detection
of colon cancer or an eligible screening procedure provided to an
individual at high risk for colorectal cancer for the purpose of early
detection of colon cancer)''.
(4) Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--
(A) 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 following new
subparagraph:
''(G) in the case of screening fecal-occult blood tests,
periodic colorectal screening procedures, and screening
procedures provided for the purpose of early detection of colon
cancer, which are performed more frequently than is covered
under section 1834(e);''; and
(B) in paragraph (7), by striking ''paragraph (1)(B) or
under paragraph (1)(F)'' and inserting ''subparagraphs (B),
(F), or (G) of paragraph (1)''.

SEC. 3. EFFECTIVE DATE.

The amendments made by section 2 shall apply to services furnished
on or after January 1, 1996.
A:
Colorectal Cancer Screening Act of 1995 - Amends title XVIII (Medicare) of the Social Security Act to prescribe frequency and payment limits under Medicare part B (Supplementary Medical Insurance) for screening fecal-occult blood tests, flexible sigmoidoscopies, barium enemas, and other appropriate screening procedures for colorectal cancer, such as a colonoscopy.