Consolidated Appropriations Act of 2020
Sec. 122- Waiving Medicare Coinsurance for Certain Colorectal Cancer Screening Tests
Colorectal cancer is estimated to kill more than 53,000 Americans this year alone. But with recommended screening, this disease is preventable. That’s one of the reasons the Affordable Care Act required that health insurance plans cover screening colonoscopies without cost sharing. But the law created a loophole when it came to Medicare coverage: if a polyp was found and removed, the procedure was no longer considered “screening” and the patient faced an unexpected charge which could amount to hundreds of dollars. The expense created a major barrier to this lifesaving screening for those who are most at risk for colorectal cancer. Since risk increases with age, we knew this loophole could be the difference between life and death.
FWIW the AAFP wrote
CMS for this change:
II.L. Coinsurance for Colorectal Cancer Screening Tests
Colorectal cancer screening tests fall within the scope of Medicare Part B benefits and under the definition of “preventive services.” The Affordable Care Act provides for payment for U.S. Preventive Services Task Force (USPSTF) grade A or B preventive services at 100% of the lesser of the actual charge or the fee schedule amount, thus no beneficiary coinsurance is required. When a flexible sigmoidoscopy or colonoscopy is performed as a diagnostic test, the beneficiary is responsible for Part B coinsurance (normally 20%) associated with the service. CMS has excluded from the definition of “screening test” any flex sigmoidoscopy or colonoscopy that started as a screening test and ended with the need to remove a polyp.
We strongly encourage CMS to work with Congress to assure that a polypectomy resulting from a screening colonoscopy be included in the colorectal cancer screening benefit.
While the AAFP appreciates that CMS has recognized and defined the problem with coinsurance for Medicare beneficiaries regarding screening versus diagnostic flexible sigmoidoscopy and colonoscopy, in most cases, physician practices account for the collection of coinsurance via patient intake forms that acknowledge the patient’s responsibility to pay for additional and non-covered services. Given that, we believe the solution suggested by CMS increases administrative burden to physician offices screening their patients for colon cancer. Requiring these offices to check one more box in the EHR and track documentation of conversations that are necessary only because of inadequate payment policy for clinically recommended tests undermines patient-centered care. Requiring these offices to check one more meaningless box in the EHR and track documentation of conversations that are necessary only because of poor payment policy for these needed screening tests is non-productive and insulting to those practicing good medicine. The true problem to be solved is the financial burden facing the Medicare beneficiaries whose screenings result in a diagnostic procedure through no fault of their own.
From the AMA summary
Waiving Coinsurance of Certain Colorectal Cancer Screening Tests under Medicare. The bill gradually eliminates cost-sharing for Medicare beneficiaries with respect to colorectal cancer screening tests. (Sec. 122)