First introduced in February 2017, the Removing Barriers to Colorectal Cancer Screening Act of 2019 (H.R. 1570/S. 668) aims to waive Medicare coinsurance for colorectal cancer (CRC) screening tests, regardless of the code billed for a resulting diagnosis or procedure. The bill sponsors are: Representatives Donald Payne, Jr. (D-NJ), Rodney Davis (R-IL), Donald McEachin (D-VA), and David McKinley (R-WV) in the House and Senators Sherrod Brown (D-OH), Roger Wicker (R-MS), Ben Cardin (D-MD) and Susan Collins (R-ME) in the Senate.

The bill acknowledges that CRC is largely preventable if polyps are detected early and removed before they become cancerous. But there is a large gap in CRC screening rates in the country, with 60% of CRC cases and 70% of deaths occurring in those 65 and over. In order to improve colonoscopy rates, the bill, if passed, will eliminate any unexpected costs, and remove financial barriers that prevent seniors from being screened.

In a statement supporting H.R. 1570 and S. 668, the American Cancer Society Cancer Action Network (ACS CAN) explains that seniors who set up a screening colonoscopy visit do so assuming there is no cost sharing since it’s a screening procedure. However, detection and removal of a polyp during the screening can result in the enrollee facing a surprise medical bill because removing the polyp changes the colonoscopy to a diagnostic process. Medicare enrollees are responsible for a 20% copay on diagnostic procedures, and this amount may vary based on the procedure and the facility where it was conducted. ACS CAN says that Medicare beneficiaries may be sensitive to such out-of-pocket (OOP) costs, and it may deter them from undergoing screening colonoscopy.

ACS CAN is hopeful that removal of this OOP cost loophole can not only save lives by catching CRC at an earlier stage, but it will also result in savings for Medicare, which is expected to spend $20 billion on CRC treatment in 2020 alone.

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply