Legislation in Congress aims to eliminate cost sharing for Medicare beneficiaries who have polyps removed during a colonoscopy.
Under the Affordable Care Act, preventive care services – including screening colonoscopy – are covered with no copayment or coinsurance to the patients. Under Medicare, however, colonoscopies are reclassified as therapeutic if polyps are removed during the procedure. In that case, patients must pay coinsurance of 20% of the Medicare-approved charge. Changing the Medicare policy requires action by Congress.
Rep. Charlie Dent (R-Pa.) introduced H.R. 1070, the Removing Barriers to Colorectal Cancer Screening Act, which would waive the cost sharing for Medicare beneficiaries if polyps were removed during a screening colonoscopy. This legislation is strongly supported by the American Gastroenterological Association (AGA), the American Society of Gastrointestinal Endoscopy, the American Cancer Society Cancer Action Network, Fight Colorectal Cancer, Prevent Cancer Foundation, and other patient advocacy groups. At press time, it was cosponsored by 17 Democrats and 3 Republicans.
"For years, the AGA has been working to increase access to colorectal cancer screenings for patients, including removing financial barriers that many patients face when seeking lifesaving colorectal cancer screenings," said Dr. Carla Ginsburg, AGAF, chair of the Public Affairs and Advocacy Committee of the AGA. "The removal of polyps during a screening is an integral part of the screening and we believe that patients should not be responsible for the cost sharing. H.R. 1070 ensures that a screening colonoscopy is fully covered, regardless of the outcome, and that patients will not be responsible for the coinsurance."
Also in March, Sen. Ben Cardin (D-Md.) introduced S.608, the Supporting Colorectal Examination and Education Now (SCREEN) Act. The bill would waive cost sharing for Medicare beneficiaries if polyps were removed during a colonoscopy. The proposed legislation also calls for notifying all Medicare beneficiaries about the screening benefit and would cover a prescreening visit under Medicare.
Rep. Richard Neal (D-Mass.) introduced companion legislation in the House (H.R. 1320).
The SCREEN Act also would give physicians a chance to earn higher payments for providing colonoscopies. The legislation would create a preventive services payment modifier for colorectal cancer screening. Under the bill, physicians could earn incentive payments by meeting national colorectal cancer screening goals and minimum standards for knowledge, training, continuing education, and documentation.
At press time, all three bills had been referred to committee; no other action had been taken.
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