CT Colonography Screening for Colorectal Cancer Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 1969 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 HOUSE OF REPRESENTATIVES MARCH 28, 2019 Mr. DANNY K. DAVIS of Illinois (for himself and Mr. WENSTRUP) 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 com- mittee concerned 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 pro- gram. 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 ‘‘CT Colonography 4 Screening for Colorectal Cancer Act of 2019’’. 5 VerDate Sep 11 2014 01:38 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1969.IH H1969 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 1969 IH SEC. 2. COVERAGE OF COMPUTED TOMOGRAPHY 1 COLONOGRAPHY SCREENING AS A 2 COLORECTAL CANCER SCREENING TEST 3 UNDER MEDICARE. 4 (a) IN GENERAL.—Section 1861(pp)(1) of the Social 5 Security Act (42 U.S.C. 1395x(pp)(1)) is amended— 6 (1) by redesignating subparagraph (D) as sub- 7 paragraph (E); and 8 (2) by inserting after subparagraph (C) the fol- 9 lowing new subparagraph: 10 ‘‘(D) Screening computed tomography 11 colonography.’’. 12 (b) FREQUENCY LIMITS AND PAYMENT.—Section 13 1834(d) of such Act (42 U.S.C. 1395m(d)) is amended 14 by adding at the end the following new paragraph: 15 ‘‘(4) SCREENING COMPUTED TOMOGRAPHY 16 COLONOGRAPHY.— 17 ‘‘(A) FEE SCHEDULE.—With respect to a 18 colorectal cancer screening test consisting of 19 screening computed tomography colonography, 20 subject to subparagraph (B), payment under 21 section 1848 shall be consistent with payment 22 under such section for similar or related serv- 23 ices. 24 ‘‘(B) PAYMENT LIMIT.—In the case of 25 screening computed tomography colonography, 26 VerDate Sep 11 2014 01:38 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1969.IH H1969 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 1969 IH payment under this part shall not exceed such 1 amount as the Secretary specifies, based upon 2 rates recognized for diagnostic computed to- 3 mography colonography. 4 ‘‘(C) FACILITY PAYMENT LIMIT.—Notwith- 5 standing any other provision of this title, in the 6 case of an individual who receives screening 7 computed tomography colonography— 8 ‘‘(i) in computing the amount of any 9 applicable coinsurance, the computation of 10 such coinsurance shall be based upon the 11 fee schedule under which payment is made 12 for the services; and 13 ‘‘(ii) the amount of such coinsurance 14 shall not exceed 25 percent of the payment 15 amount under the fee schedule described in 16 subparagraph (A). 17 ‘‘(D) FREQUENCY LIMIT.—No payment 18 may be made under this part for a colorectal 19 cancer screening test consisting of a screening 20 computed tomography colonography— 21 ‘‘(i) if the individual is under 50 years 22 of age; or 23 ‘‘(ii)(I) in the case of individuals at 24 high risk for colorectal cancer, if the proce- 25 VerDate Sep 11 2014 01:38 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1969.IH H1969 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 1969 IH dure is performed within the 23 months 1 after a previous screening computed to- 2 mography colonography or a previous 3 screening colonoscopy; or 4 ‘‘(II) in the case of an individual who 5 is not at high risk for colorectal cancer, if 6 the procedure is performed within the 119 7 months after a previous screening 8 colonoscopy or within the 59 months after 9 a previous screening flexible sigmoidoscopy 10 or a previous screening computed tomog- 11 raphy colonography.’’. 12 (c) CONFORMING FREQUENCY LIMITS FOR OTHER 13 COLORECTAL CANCER SCREENING TESTS.— 14 (1) SCREENING FLEXIBLE SIGMOIDOSCOPY.— 15 Paragraph (2)(E)(ii) of section 1834(d) of the Social 16 Security Act (42 U.S.C. 1395m(d)) is amended by 17 inserting ‘‘or screening computed tomography 18 colonography’’ after ‘‘previous screening flexible 19 sigmoidoscopy’’. 20 (2) SCREENING COLONOSCOPY.—Paragraph 21 (3)(E) of such section is amended— 22 (A) by inserting ‘‘or screening computed 23 tomography colonography’’ after ‘‘23 months 24 after a previous screening colonoscopy’’; and 25 VerDate Sep 11 2014 01:38 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1969.IH H1969 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 1969 IH (B) by inserting ‘‘or screening computed 1 tomography colonography’’ after ‘‘screening 2 flexible sigmoidoscopy’’. 3 (d) EFFECTIVE DATE.—The amendments made by 4 this section shall apply to items and services furnished on 5 or after January 1, 2020. 6 SEC. 3. EXEMPTION OF SCREENING COMPUTED TOMOG- 7 RAPHY COLONOGRAPHY FROM SPECIAL 8 RULE ON PAYMENT FOR IMAGING SERVICES. 9 (a) IN GENERAL.—Section 1848(b)(4)(B) of the So- 10 cial Security Act (42 U.S.C. 1395w–4(b)(4)(B)) is amend- 11 ed by inserting ‘‘and screening computed tomography 12 colonography’’ after ‘‘diagnostic and screening mammog- 13 raphy’’. 14 (b) EFFECTIVE DATE.—The amendment made by 15 subsection (a) shall apply to items and services furnished 16 on or after January 1, 2020. 17 SEC. 4. REPORTS ON THE STATUS OF COVERING COM- 18 PUTED TOMOGRAPHY COLONOGRAPHY AS A 19 COLORECTAL CANCER SCREENING TEST 20 UNDER MEDICARE. 21 (a) PRELIMINARY REPORT.—Not later than 90 days 22 after the date of the enactment of this Act, the Secretary 23 of Health and Human Services shall submit a preliminary 24 report to Congress on the status of coverage of computed 25 VerDate Sep 11 2014 01:38 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1969.IH H1969 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 1969 IH tomography colonography as a colorectal cancer screening 1 test under the Medicare program under title XVIII of the 2 Social Security Act, including the extent to which such 3 coverage as required by the amendments made by sections 4 2 and 3 has been implemented. 5 (b) ANNUAL REPORT.—Not later than September 30 6 of each fiscal year during the 5-year period beginning with 7 fiscal year 2021, the Secretary shall submit to the Con- 8 gress, a status report on the following: 9 (1) The impact of screening computed tomog- 10 raphy colonography on the change in colorectal can- 11 cer screening compliance of Medicare beneficiaries. 12 (2) The various utilization rates with respect to 13 Medicare beneficiaries for each available colorectal 14 cancer screening option before and after the avail- 15 ability of and coverage of screening computed to- 16 mography colonography under the Medicare program 17 pursuant to the enactment of this Act, including— 18 (A) by initial CRC screening performed 19 with respect to a Medicare beneficiary per year, 20 including the age of the beneficiary when the 21 initial screening was performed; and 22 (B) by follow-on screening performed, 23 whereby the analysis demonstrates to what ex- 24 tent screening computed tomography 25 VerDate Sep 11 2014 01:38 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1969.IH H1969 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 1969 IH colonography was used as a substitute for a 1 previous screening procedure. 2 (3) Access to screening computed tomography 3 colonography by Medicare beneficiaries, especially in 4 rural areas or underserved populations, before and 5 after the date of implementation of coverage of such 6 screening benefit under the Medicare program pur- 7 suant to the enactment of this Act. 8 (4) Recommendations for such legislation and 9 administrative action as the Secretary determines 10 appropriate to implement this Act. 11 Æ VerDate Sep 11 2014 01:38 Apr 11, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H1969.IH H1969 pamtmann on DSKBFK8HB2PROD with BILLS