The Patient Protection and Affordable Care Act (PPACA) provides that preventative care services, including a CRC screening colonoscopy, shall be covered by a health benefit plan with no copayment or coinsurance costs to the patients. However, PPACA did not address what happens when a screening colonoscopy procedure becomes a polypectomy. Before PPACA was revised to require health plans to cover polypectomy as part of preventative colonoscopy (see lead story in this newsletter), the procedure was deemed to be “therapeutic,” not “preventative,” and health insurance copays and coinsurances kicked in. The outcome was patients being hit with unexpected colonoscopy costs.
We all celebrated when the Centers for Medicare and Medicaid Services (CMS) issued the new PPACA ruling that changed this policy. However, the CMS ruling does not address Medicare procedures. Under Medicare, colonoscopies are reclassified as therapeutic if polyps are removed during the procedure, and patients must pay coinsurance of 20% of the Medicare-approved charge. Changing the Medicare policy will require action by Congress.
In order to address this inequity, Sen. Ben Cardin (D-MD) recently introduced S. 608, the Supporting Colorectal Examination and Education Now (SCREEN) Act. The bill will waive cost-sharing for Medicare patients when polyps are removed during a colonoscopy.
The SCREEN Act will amend Section 2713(a)(1) of the Public Health Service Act (42 U.S.C. 300gg-13(a)(1)) by inserting: “(including related activities occurring as part of the same clinical encounter, such as conducting a biopsy or by removing a lesion or growth)”.
The proposed legislation also provides for the notification of all Medicare beneficiaries about the screening benefit and will cover a prescreening visit under Medicare. The SCREEN Act provides:
“...prior to a colorectal cancer screening test consisting of a screening colonoscopy or in conjunction with an individual’s decision regarding the performance of such a test on the individual, an outpatient office visit or consultation for the purpose of beneficiary education, assuring selection of the proper screening test, and securing information relating to the procedure and the sedation of the individual.”
A companion bill, H.R. 1320, has been introduced by Rep. Richard Neal (D-Mass.) in the House of Representatives. Finally, the SCREEN Act also would provide physicians the opportunity to earn higher reimbursements 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.
We applaud the actions of Sen. Cardin and Rep. Neal, and urge you to write or phone your lawmakers in Congress to voice your support of these important pieces of legislation.