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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Cancer Screening and Prevention
Act''.

SEC. 2. MEDICARE COVERAGE OF COLORECTAL SCREENING.

(a) In General.--Section 1834 of the Social Security Act (42 U.S.C.
1395m) is amended by inserting after subsection (c) the following new
subsection:
''(d) Frequency and Payment Limits for Screening Fecal-Occult Blood
Tests, Screening Flexible Sigmoidoscopies, and Screening Colonoscopy.--
''(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 limit.--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--
''(i) if the individual is under 50 years
of age; or
''(ii) if the test is performed within the
11 months after a previous screening fecal-
occult blood test.
''(2) Screening flexible sigmoid- oscopies.--
''(A) Payment amount.--The Secretary shall
establish a payment amount under section 1848 with
respect to screening flexible sigmoidoscopies 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.
''(B) Frequency limit.--Subject to revision by the
Secretary under paragraph (4)(B), no payment may be
made under this part for a screening flexible
sigmoidoscopy provided to an individual for the purpose
of early detection of colon cancer--
''(i) if the individual is under 50 years
of age; or
''(ii) if the procedure is performed within
the 47 months after a previous screening
flexible sigmoidoscopy.
''(3) Screening colonoscopy for individuals at high risk
for colorectal cancer.--
''(A) Payment amount.--The Secretary shall
establish a payment amount under section 1848 with
respect to screening colonoscopy for individuals at
high risk for colorectal cancer (as defined in
subparagraph (C)) 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.
''(B) Frequency limit.--Subject to revision by the
Secretary under paragraph (4)(B), no payment may be
made under this part for a screening colonoscopy 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 colonoscopy.
''(C) Individual at high risk defined.--In this
subsection, an 'individual at high risk for colorectal
cancer' is an individual who, because of 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, or other predisposing factors, faces
a high risk for colorectal cancer.
''(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.--
''(i) Review.--The Secretary shall review
periodically the appropriate frequency for
performing screening fecal-occult blood tests,
screening flexible sigmoidoscopies, and
screening colonoscopy based on age and such
other factors as the Secretary believes to be
pertinent.
''(ii) Revision of frequency.--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, 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 screening
flexible sigmoidoscopy provided to an individual for
the purpose of early detection of colon cancer or a
screening colonoscopy 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 such Act (42 U.S.C. 1395l(a)) are each amended by
striking ''subsection (h)(1),'' and inserting ''subsection (h)(1) or
section 1834(d)(1),''.
(2) 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
paragraphs (1) and (3)(A) of section 1834(d), 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 screening flexible sigmoidoscopy
provided to an individual for the purpose of early detection of colon
cancer or a screening colonoscopy 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,
screening flexible sigmoidoscopies, and screening colonoscopy
provided for the purpose of early detection of colon cancer,
which are performed more frequently than is covered under
section 1834(d);''; 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 screening fecal-
occult blood tests, screening flexible sigmoidoscopies, and screening
colonoscopy performed on or after January 1, 1996.
Output:
Cancer Screening and Prevention Act - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of various specified colon and colorectal screening tests and corresponding payment and frequency limits.