What This Bill Does
This bill changes Medicare to pay for blood-based screening tests that detect colorectal cancer early. The bill aims to help communities of color get more colorectal cancer screenings and recover from reduced screening during the COVID-19 pandemic.
Who It Affects
Medicare beneficiaries (people over 65 and some younger people with disabilities or certain conditions who receive Medicare coverage).
Key Provisions
- Medicare will cover FDA-approved blood-based colorectal cancer screening tests that are marketed or used according to federal drug approval laws (Sec. 2(a))
- A person cannot receive Medicare payment for a blood-based colorectal cancer screening test if they had a similar screening test within 11 months prior (Sec. 2(b))
- The amount Medicare pays for these blood-based tests will be determined by the Secretary of Health and Human Services following specific payment rules (Sec. 2(b))
What Changes
Medicare coverage expands to include blood-based colorectal cancer screening tests. Payment rules for these new tests follow the same frequency limits as existing blood-based screening tests.
Important Definitions
"Qualifying colorectal cancer screening blood-based test" means a blood test for early detection of colorectal cancer that meets federal approval and marketing requirements (Sec. 2(a))
Effective Date
The changes apply to colorectal cancer screening tests provided more than 6 months after this bill becomes law (Sec. 2(c))
II
118TH CONGRESS
1ST SESSION
S. 892
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, to increase participation in colorectal cancer
screening in under-screened communities of color, to offset the COVID–
19 pandemic driven declines in colorectal cancer screening, and for other
purposes.
IN THE SENATE OF THE UNITED STATES
MARCH 21, 2023
Mr. HEINRICH introduced the following bill; which was read twice and referred
to the Committee on Finance
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,
to increase participation in colorectal cancer screening
in under-screened communities of color, to offset the
COVID–19 pandemic driven declines in colorectal cancer
screening, 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,
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•S 892 IS
SECTION 1. SHORT TITLE.
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This Act may be cited as the ‘‘Colorectal Cancer De-
2
tection Act’’.
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SEC. 2. MEDICARE COVERAGE FOR FDA-APPROVED QUALI-
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FYING
COLORECTAL
CANCER
SCREENING
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BLOOD-BASED TESTS.
6
(a) IN GENERAL.—Section 1861(pp) of the Social Se-
7
curity Act (42 U.S.C. 1395x(pp)) is amended—
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(1) in paragraph (1)—
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(A) by redesignating subparagraph (D) as
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subparagraph (E); and
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(B) by inserting after subparagraph (C)
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the following new subparagraph:
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‘‘(D) Qualifying colorectal cancer screening
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blood-based test.’’; and
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(2) by adding at the end the following new
16
paragraph:
17
‘‘(3) The term ‘qualifying colorectal cancer screening
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blood-based test’ means a screening blood-based test for
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the early detection of colorectal cancer that is marketed
20
or used, as applicable, in accordance with the relevant pro-
21
visions of section 353 of the Public Health Service Act
22
or the Federal Food, Drug, and Cosmetic Act.’’.
23
(b) FREQUENCY LIMITS FOR COLORECTAL CANCER
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SCREENING TESTS AND PAYMENT AMOUNT FOR QUALI-
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FYING COLORECTAL CANCER SCREENING BLOOD-BASED
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•S 892 IS
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
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the 11 months after a previous screening
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fecal-occult blood test or a previous quali-
7
fying colorectal cancer screening blood-
8
based test.’’;
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(2) in paragraph (2)(E)(ii), by inserting ‘‘or
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within the 35 months after a previous screening
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fecal-occult
blood
test
or
previous
qualifying
12
colorectal cancer screening blood-based test’’ after
13
‘‘sigmoidoscopy’’;
14
(3) by amending subparagraph (E) of para-
15
graph (3) to read as follows:
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‘‘(E) FREQUENCY
LIMIT.—No payment
17
may be made under this part for a colorectal
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cancer screening test consisting of a screening
19
colonoscopy—
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‘‘(i) if the procedure is performed
21
within the 11 months after a previous
22
screening fecal-occult blood test or previous
23
qualifying
colorectal
cancer
screening
24
blood-based test;
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•S 892 IS
‘‘(ii) for individuals at high risk for
1
colorectal cancer if the procedure is per-
2
formed within the 23 months after a pre-
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vious screening colonoscopy; or
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‘‘(iii) for individuals not at high risk
5
for colorectal cancer if the procedure is
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performed within the 119 months after a
7
previous screening colonoscopy or within
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the 47 months after a previous screening
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flexible sigmoidoscopy.’’; and
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(4) by adding at the end the following new
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paragraph:
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‘‘(4)
QUALIFYING
COLORECTAL
CANCER
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SCREENING BLOOD-BASED TESTS.—
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‘‘(A) PAYMENT
AMOUNT.—The payment
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amount for colorectal cancer screening tests
16
consisting of qualifying colorectal cancer screen-
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ing blood-based tests shall be established by the
18
Secretary in accordance with section 1833(h)
19
and section 1834A, as applicable.
20
‘‘(B)
FREQUENCY
LIMIT.—Paragraph
21
(1)(B) shall apply to colorectal cancer screening
22
tests consisting of qualifying colorectal cancer
23
screening blood-based tests in the same manner
24
as such paragraph applies to colorectal cancer
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•S 892 IS
screening tests consisting of fecal-occult blood
1
tests.’’.
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(c) EFFECTIVE DATE.—The amendments made by
3
this section shall apply to colorectal cancer screening tests
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furnished in a year beginning more than 6 months after
5
the date of the enactment of this Act.
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Æ
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