Donald Payne Sr. Colorectal Cancer Detection Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 1765 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, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 14, 2019 Mr. PAYNE (for himself, Mr. MARCHANT, Ms. SEWELL of Alabama, Ms. ADAMS, Ms. KELLY of Illinois, Ms. WILSON of Florida, Mr. BISHOP of Georgia, Mr. RICHMOND, Ms. MCCOLLUM, Ms. LEE of California, Ms. CLARKE of New York, and Mr. PERRY) 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 subse- quently 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 coverage under the Medicare program for FDA-approved qualifying colorectal cancer screening blood-based tests, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Donald Payne Sr. 4 Colorectal Cancer Detection Act of 2019’’. 5 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1765.IH H1765 kjohnson on DSK79L0C42 with BILLS 2 •HR 1765 IH SEC. 2. MEDICARE COVERAGE FOR FDA-APPROVED QUALI- 1 FYING COLORECTAL CANCER SCREENING 2 BLOOD-BASED TESTS. 3 (a) IN GENERAL.—Section 1861(pp) of the Social Se- 4 curity Act (42 U.S.C. 1395x(pp)) is amended— 5 (1) in paragraph (1)— 6 (A) by redesignating subparagraph (D) as 7 subparagraph (E); and 8 (B) by inserting after subparagraph (C) 9 the following new subparagraph: 10 ‘‘(D) Qualifying colorectal cancer screening 11 blood-based test.’’; and 12 (2) by adding at the end the following new 13 paragraph: 14 ‘‘(3) The term ‘qualifying colorectal cancer screening 15 blood-based test’ means, with respect to a year, a screen- 16 ing blood-based test for the early detection of colorectal 17 cancer furnished in the year that was marketed or used, 18 as applicable, in accordance with the relevant provisions 19 of section 353 of the Public Health Service Act or the 20 Federal Food, Drug, and Cosmetic Act more than 6 21 months before the beginning of the year.’’. 22 (b) FREQUENCY LIMITS FOR COLORECTAL CANCER 23 SCREENING TESTS AND PAYMENT AMOUNT FOR QUALI- 24 FYING COLORECTAL CANCER SCREENING BLOOD-BASED 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1765.IH H1765 kjohnson on DSK79L0C42 with BILLS 3 •HR 1765 IH TESTS.—Section 1834(d) of the Social Security Act (42 1 U.S.C. 1395m(d)) is amended— 2 (1) by amending clause (ii) of paragraph (1)(B) 3 to read as follows: 4 ‘‘(ii) if the test is performed within— 5 ‘‘(I) the 11 months after a pre- 6 vious screening fecal-occult blood test 7 or a previous qualifying colorectal 8 cancer screening blood-based test; 9 ‘‘(II) the 35 months after a pre- 10 vious screening flexible sigmoidoscopy 11 or a previous screening colonoscopy 12 with adenoma findings; 13 ‘‘(III) the 59 months after a pre- 14 vious screening colonoscopy with small 15 polyp findings; or 16 ‘‘(IV) the 119 months after a 17 previous screening colonoscopy with- 18 out adenoma findings or small polyp 19 findings.’’; 20 (2) in paragraph (2)(E)(ii), by inserting ‘‘or 21 within the 35 months after a previous screening 22 fecal-occult blood test or previous qualifying 23 colorectal cancer screening blood-based test’’ after 24 ‘‘sigmoidoscopy’’; 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1765.IH H1765 kjohnson on DSK79L0C42 with BILLS 4 •HR 1765 IH (3) by amending subparagraph (E) of para- 1 graph (3) to read as follows: 2 ‘‘(E) FREQUENCY LIMIT.—No payment 3 may be made under this part for a colorectal 4 cancer screening test consisting of a screening 5 colonoscopy— 6 ‘‘(i) if the procedure is performed 7 within the 11 months after a previous 8 screening fecal-occult blood test or previous 9 qualifying colorectal cancer screening 10 blood-based test; 11 ‘‘(ii) for individuals at high risk for 12 colorectal cancer if the procedure is per- 13 formed within the 23 months after a pre- 14 vious screening colonoscopy; or 15 ‘‘(iii) for individuals not at high risk 16 for colorectal cancer if the procedure is 17 performed within the 119 months after a 18 previous screening colonoscopy or within 19 the 47 months after a previous screening 20 flexible sigmoidoscopy.’’; and 21 (4) by adding at the end the following new 22 paragraph: 23 ‘‘(4) QUALIFYING COLORECTAL CANCER 24 SCREENING BLOOD-BASED TESTS.— 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1765.IH H1765 kjohnson on DSK79L0C42 with BILLS 5 •HR 1765 IH ‘‘(A) PAYMENT AMOUNT.—The payment 1 amount for colorectal cancer screening tests 2 consisting of qualifying colorectal cancer screen- 3 ing blood-based tests shall be established by the 4 Secretary. 5 ‘‘(B) FREQUENCY LIMIT.—Paragraph 6 (1)(B) shall apply to colorectal cancer screening 7 tests consisting of qualifying colorectal cancer 8 screening blood-based tests in the same manner 9 as such paragraph applies to colorectal cancer 10 screening tests consisting of fecal-occult blood 11 tests.’’. 12 (c) EFFECTIVE DATE.—The amendments made by 13 this section shall apply to colorectal cancer screening tests 14 furnished in a year beginning more than 6 months after 15 the date of the enactment of this Act. 16 Æ VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H1765.IH H1765 kjohnson on DSK79L0C42 with BILLS