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HR 4879 IH
110th CONGRESS
1st Session
H. R. 4879
To amend title XVIII of the Social Security Act to include screening computed tomography colonography as a colorectal screening test for purposes of coverage under the Medicare Program, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
December 19, 2007
Mrs. CUBIN (for herself and Mr. TOWNS) 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 committee concerned
A BILL
To amend title XVIII of the Social Security Act to include screening computed tomography colonography as a colorectal screening test for purposes of coverage under the Medicare Program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
SEC. 2. SCREENING COMPUTED TOMOGRAPHY COLONOGRAPHY INCLUDED AS A COLORECTAL SCREENING TEST FOR PURPOSES OF COVERAGE UNDER THE MEDICARE PROGRAM.
(a) In General- Section 1861(pp)(1) of the Social Security Act (42 U.S.C. 1395x(pp)(1)) is amended--
(1) by redesignating subparagraph (D) as subparagraph (E); and
(2) by inserting after subparagraph (C) the following new subparagraph:
(b) Frequency Limits and Payment for Screening Computed Tomography Colonography- Section 1834(d) of the Social Security Act (42 U.S.C. 1395m(d)) is amended by adding at the end the following new paragraph:
`(4) SCREENING COMPUTED TOMOGRAPHY COLONOGRAPHY-
`(A) FEE SCHEDULE- With respect to a colorectal cancer screening test consisting of screening computed tomography colonography, payment under section 1848 shall be consistent with payment under such section for similar or related services.
`(B) PAYMENT LIMIT- In the case of screening computed tomography colonography, payment under this part shall not exceed such amount as the Secretary specifies, based upon rates recognized for diagnostic computed tomography colonography.
`(C) FACILITY PAYMENT LIMIT-
`(i) IN GENERAL- Notwithstanding subsections (i)(2)(A) and (t) of section 1833, in the case of screening computed tomography colonography furnished on or after January 1, 2008, that--
`(I) in accordance with regulations, may be performed in an ambulatory surgical center and for which the Secretary permits ambulatory surgical center payments under this part; and
`(II) are performed in an ambulatory surgical center or hospital outpatient department,
payment under this part shall be based on the lesser of the amount under the fee schedule that would apply to such services if they were performed in a hospital outpatient department in an area or the amount under the fee schedule that would apply to such services if they were performed in an ambulatory surgical center in the same area.
`(ii) LIMITATION ON COINSURANCE- Notwithstanding any other provision of this title, in the case of a beneficiary who receives the services described in clause (i)--
`(I) in computing the amount of any applicable copayment, the computation of such coinsurance shall be based upon the fee schedule under which payment is made for the services; and
`(II) the amount of such coinsurance shall not exceed 25 percent of the payment amount under the fee schedule described in subclause (I).
`(D) FREQUENCY LIMIT- No payment may be made under this part for a colorectal cancer screening test consisting of a screening computed tomography colonography--
`(i) if the individual is under 50 years of age; or
`(ii)(I) in the case of individuals at high risk for colorectal cancer, if the procedure is performed within the 23 months after a previous screening computed tomography colonography or a previous screening colonoscopy; or
`(II) in the case of an individual who is not at high risk for colorectal cancer, if the procedure is performed within the 119 months after a previous screening colonoscopy or within the 47 months after a previous screening flexible sigmoidoscopy or a previous screening computed tomography colonography.'.
(c) Conforming Frequency Limits for Other Colorectal Cancer Screening Tests-
(1) SCREENING FLEXIBLE SIGMOIDOSCOPY- Paragraph (2)(E)(ii) of section 1834(d) of the Social Security Act (42 U.S.C. 1395m(d)) is amended by inserting `or screening computed tomography colonography' after `previous screening flexible sigmoidoscopy'.
(2) SCREENING COLONOSCOPY- Paragraph (3)(E) of such section is amended--
(A) by inserting `or screening computed tomography colonography' after `23 months after a previous screening colonoscopy'; and
(B) by inserting `or screening computed tomography colonography' after `screening flexible sigmoidoscopy'.
(d) Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2009.
SEC. 3. EXEMPTION OF SCREENING COMPUTED TOMOGRAPHY COLONOGRAPHY FROM SPECIAL RULE ON IMAGING SERVICES.
(a) In General- Section 1848(b)(4)(B) of the Social Security Act (42 U.S.C. 1395w-4(b)(4)(B)) is amended by inserting `and screening computed tomography colonography' after `diagnostic and screening mammography'.
(b) Effective Date- The amendment made by subsection (a) shall apply to items and services furnished on or after January 1, 2009.
U.S. Congress - Text of H.R.4879 as Introduced in House Virtual Screening for Cancer Act of 2007
