Medicare Preventive Benefits Act of 1991 : hearing before the Subcommittee on Health of the Committee on Ways and Means, House of Representatives, One Hundred Second Congress, first session, on H.R. 2565, to amend Title XVIII of the Social Security Act ..

132 Pages·1992·7.5 MB·English

by  United States. Congress. House. Committee on Ways and Means. Subcommittee on Health

MEDICARE PREVENTIVE BENEFITS ACT OF 1991
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON WAYS AND MEANS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SECOND CONGRESS
FIRST SESSION
ON
H.R. 2565
TO AMEND TITLE XVIII OF THE SOCIAL SECURITY ACT TO PROVIDE
FOR COVERAGE OF COLORECTAL SCREENING EXAMINATIONS AND
CERTAIN IMMUNIZATIONS UNDER PART B OF THE MEDICARE PRO-
GRAM, AND FOR OTHER PURPOSES
JUNE 20, 1991
Serial 102-43
Printed for the use of the Committee on Ways and Means
U.S. GOVERNMENT PRINTING OFFICE
51-330 WASHINGTON 1992
:
ForsalebytheU.S.GovernmentPrintingOffice
SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402
ISBN 0-16-037381-6
COMMITTEE ON WAYS AND MEANS
DAN ROSTENKOWSKI, Illinois, Chairman
SAM M. GIBBONS, Florida BILL ARCHER, Texas
J.J. PICKLE, Texas GUY VANDER JAGT, Michigan
CHARLES B. RANGEL, New York PHILIP M. CRANE, Illinois
FORTNEY PETE STARK, California DICK SCHULZE, Pennsylvania
ANDY JACOBS, Jr., Indiana BILL GRADISON, Ohio
HAROLD E. FORD, Tennessee BILL THOMAS, California
ED JENKINS, Georgia RAYMOND J. McGRATH, New York
THOMAS J. DOWNEY, New York ROD CHANDLER, Washington
FRANK J. GUARINI, New Jersey E. CLAY SHAW, Jr., Florida
MARTY RUSSO, Illinois DON SUNDQUIST, Tennessee
DON J. PEASE, Ohio NANCY L. JOHNSON, Connecticut
ROBERT T. MATSUI, California JIM RUNNING, Kentucky
BERYL ANTHONY, Jr., Arkansas FRED GRANDY, Iowa
BYRON L. DORGAN, North Dakota
BARBARA B. KENNELLY, Connecticut
BRIAN J. DONNELLY, Massachusetts
WILLIAM J. COYNE, Pennsylvania
MICHAEL A. ANDREWS, Texas
SANDER M. LEVIN, Michigan
JIM MOODY, Wisconsin
BENJAMIN L. CARDIN, Maryland
JIM McDERMOTT, Washington
Robert J. Leonard, ChiefCounsel andStaffDirector
Philup D. Moseley, Minority ChiefofStaff
Subcommittee on Health
FORTNEY PETE STARK, California, Chairman
MARTY RUSSO. Illinois BILL GRADISON, Ohio
BRIAN J. DONNELLY, Massachusetts ROD CHANDLER, Washington
WILLIAM J. COYNE, Pennsylvania NANCY L. JOHNSON, Connecticut
SANDER M. LEVIN, Michigan RAYMOND J. McGRATH, New York
JIM MOODY, Wisconsin
BENJAMIN L. CARDIN, Maryland
(II)
CONTENTS
Page
PressreleaseofThursday, June 13, 1991, announcingthehearing 2
H.R. 2565, text 4
WITNESSES
U.S. Department of Health and Human Services, Public Health Service,
William L. Roper, M.D., M.P.H., Director, Centers forDisease Control 25
Office of Technology Assessment, Roger C. Herdman, M.D., Assistant Direc-
tor, HealthandLife Sciences Division, andJudyWagner, SeniorAssociate.. 50
American AssociationofRetiredPersons, AnneJackson 112
American Diabetes Association, Jay Skyler, M.D 107
Association ofSchools ofPublic Health, Jacob A. Brody, M.D.; also on behalf
ofGilbert S. Omenn, M.D., Ph.D 66
Boxer, Hon. Barbara, a Representative in Congress from the State ofCalifor-
nia 37
Steinwachs, Donald M., Ph.D., Health Services Research and Development
Center, Johns Hopkins University 98
SUBMISSIONS FOR THE RECORD
AmericanCancerSociety, Inc., Gerald D. Dodd, M.D., letter 121
American College ofPreventive Medicine, statementand attachments 123
Digestive Disease National Coalition, statement 127
National Committee To Preserve Social Security and Medicare, Martha
McSteen, statement 128
Regula, Hon. Ralph, aRepresentative in Congressfrom the State ofOhio 21
Rostenkowski, Hon. Dan, Chairman, Committee on Ways and Means, aRepre-
sentativeinCongressfromthe State ofIllinois, statement 20
(III)

MEDICARE PREVENTIVE BENEFITS ACT OF
1991
THURSDAY, JUNE 20, 1991
House of Representatives,
Committee on Ways and Means,
Subcommittee on Health,
Washington, DC.
The subcommittee met, pursuant to call, at 1 p.m., in room
B-318, Rayburn House Office Building, Hon. Fortney Pete Stark
(chairman ofthe subcommittee) presiding.
[The press release announcing the hearing, and a copy ofthe bill,
H.R. 2565, follow:]
(1)
, ,
2
FOR IMMEDIATE RELEASE PRESS RELEASE #14
THURSDAY, JUNE 13, 1991 SUBCOMMITTEE ON HEALTH
COMMITTEE OM WAYS AMD MEANS
U.S. HOUSE OF REPRESENTATIVES
1102 LONGWORTB HOUSE OFFICE BLDG.
WASHINGTON, D.C. 20515
TELEPHONE: [phone]
THE HONORABLE FORTMEY PETE STARK (D., CALIF.), CHAIRMAN,
SUBCOMMITTEE ON HEALTH,
COMMITTEE ON WAYS AND MEANS, U.S. HOUSE OF REPRESENTATIVES,
ANNOUNCES A HEARING ON
H.R. 2565,
THE "MEDICARE PREVENTIVE BENEFITS ACT OF 1991"
SubcoTnhneittHeoenoroanblHeealPteht,e SCtoamrmkitt(eD.e,onCalWiafy.s),andChaMeiarnmsa,n,U.S. House
of Representatives, announced today that the Subcommittee will
hold a hearing on Medicare preventive benefits, including,
H.R. 2565, the "Medicare Preventive Benefits Act of 1991." The
hearing will be held on Thursday, June 20, 1991, beginning at
1:00 p.m., in room B-318 Rayburn House Office Building.
On June 6, 1991, H.R. 2565, the "Medicare Preventive
Benefits Act of 1991" was introduced by Committee Chairman
DCCaaolnmimfiR.to)ts,etee.nMrk.owAsCkchioamnpd(alD.neir,on1(1R.1b.i,)l,lW,asfhoS..r),h1i2m3a1sn,edlfw2,a1sMorti.hnetrSrtoaMdreukmc,beedr(sDi.nofthethe
SCehnaaitremanonoJfuntehe6SbeynatteheFHionnaonrceablCeommLiltotyede.BenTthseesne(bD.il,lsTexwaosu)ld
provide Medicare coverage for certain preventive services
outlined below.
In announcing the hearing. Chairman Stark stated, "While
Medicare pays for the treatment of illness, it does very little
to encoxarage the prevention or early detection of illness.
Prevention not only saves money, but also reduces unnecessary
pain and suffering."
Oral tftstimony will be heard from invited witnesses only.
However, any individual or organization may submit a written
statement for consideration by the Subcommittee and for inclusion
in the printed record of the hearing.
SCQpg OF TCT HBftRIW
H.R. 2565, would provide Medicare coverage for colorectal
cancer screening, influenza and tetanus vaccinations, annual
maonmography screening for older women, and coverage of well-child
care for Medicare end-stage renal disease beneficiaries under the
age of seven. The bill would also authorize a series of
demonstration projects to determine the appropriateness of
providing coverage of other preventive services. Also, the
Office of Technology Assessment would conduct a study and
recommend a process for determining when other preventive
services should be covered under Medicare.
In addition, the Subcommittee invites testimony on a
prbposed increase of $1.10 per month in 1992, increasing to $1.60
per month in 1996, in the Part B premium to finance H.R. 2565.
Such a financing mechanism, or an alternative, is required under
the pay-as-you-go provisions enacted in last year's budget
reconciliation bill.
(MORE)
.
3
-2-
Preventive services generally have not been reimbursed under
Medicare. With limited exceptions, Medicare payment for
preventive services is specifically prohibited under Section 1862
of the Social Security Act. Services covered by Medicare under
current law, and the effective dates of the benefits, are:
* Pneumococcal vaccine, since 1980;
* Hepatitis B vaccine for certain high-risk individuals,
since 1984;
* Pap smears to screen for cervical cancer, since July,
1990; and
* Biennial mammography screening for breast cancer, since
January 1991.
In 1991, an estimated 155,000 new cases of colon/rectal
cancer will be identified, and 61,000 people will die of this
disease. Patient survival depends on the extent of the disease
at the time of diagnosis. Screening, through periodic fecal
occult blood tests and sigmoidoscopies, can mean earlier
detection and a less life-threatening diesease. The Department
of Health and Human Services' health promotion and disease
prevention goals for the year 2000 include substantial increases
in the number of people who are routinely screened for colorectal
cancer
In 1991, an estimated 150,000 new cases of breast cancer
will be diagnosed, and 44,000 women will die of this disease.
Studies have confirmed the effectiveness of mammography screening
in reducing breast cancer mortality.
The Medicare benefit for mammography screening enacted in
the Omnibus Budget Reconciliation Act of 1990 (OBRA 1990)
includes certain limits on the frequency with which mammography
screening would be covered. For women ages 65 and above,
mammography screening is covered only once every two years. The
American Cancer Society recommends annual screenings for women
over age 50.
DETAILS FOR 80BMIBBI0M OF TOITTEH COMMmTSl
For those who wish to file a written statement for the
printed record of the hearing, six (6) copies are required and
must be submitted by the close of business on Monday, July 1,
1991, to Robert J. Leonard, Chief Counsel and Staff Director,
Committee on Ways and Means, U.S. House of Representatives, 1102
Longworth House Office Building, Washington, D.C. 20515. An
additional supply of statements may be furnished for distribution
to the press and public if supplied to the Subcommittee office,
1114 Longworth House Office Building, before the hearing begins.
FQRMftTTIMq RBQyiREMEMTgt
EachstatementpresentedforprintingtotheCommitteebyawitness,anywrittenstatementorexhibitsubmittedforthe
printedrecordoranywrittencommentsinresponsetoarequestforwrittencommentsmustconformtotheguidelineslistedbelow.
Anystatementorexhibitnotincompliancewiththeseguidelineswillnotbeprinted,butwillbemaintainedintheCommittee
filesforreviewandusebytheCommittee.
1. eAlxlcesetdataemteotnatlsoafnd10anpyagaecs.companyingexhibitsforprintingmustbetypedinsinglespaceonlegal-sizepaperandmaynot
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3. Statementsmustcontainthenameandcapacityinwhichthewitnesswillappearor.forwrittencomments,thenamean(
caapppaecairtsyoorftfhoerpwehrsoomnstuhbemsitttaitnegmetnhtesistastuebmmeinttt,eda.swellasanyclientsorpersons,oranyorganizationforwhomthewitnesi
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orthedesignatedrepresentativemaybereachedandatopicaloutlineorsummaryofthecommentsandrecommcndattors
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Theabove restrictionsand limitationsapplyonlytomaterial being submittedforprinting.Statementsandexhibitsor
supplementarymaterialsubmittedsolelyfordistributiontotheMembers,thepressandpublicduringthecourseofapublichearin).
maybesubmittedinotherforms. '
4
O ^ f
102D CONGRESS J J ^OOO
1ST Session |-|
^
To amend title XVill of the Social Security Act to provide for coverage
of colorectal screening examinations and certain immunizations under
partB ofthe medicareprogram, and for otherpurposes.
IN THE HOUSE OF REPRESENTATIVES
June 6, 1991
Mr. RosTENKOwsKi (for himself, Mr. Stark, Mr. Chandler, Mr. Gibbons,
Mr. Pickle, Mr. Rangel, Mr. Jacobs, Mr. Jenkins, Mr. Guarini, Mr.
Matsui, Mr. Anthony, Mr. Dorgan ofNorthDakota, Mrs. Kennelly,
Mr. Coyne, Mr. Andrews of Texas, Mr. Levin of Michigan, Mr.
Moody, Mr. Cardin, Mr. McDermott, Mr. Vander Jagt, Mr.
SCHULZE, Mr. Thomas ofCalifomia, Mr. McGrath, andMrs. Johnson
of Connecticut) introduced the following bill; which was referred jointly
to the Committees onWays EindMeans andEnergyaindCommerce
A
BILL
To amend title XVin of Social Security Act to provide
for coverage of colorectal screening examinations and
certain immunizations under part B of the medicare
program, and for other purposes.
1 Be it enacted hy the Senate and House ofRepresenta-
2 tives ofthe United States ofAmericain Congress assembled,
3 SECTION 1. SHORTTITLE.
4 This Act may be cited as the "Medicare Preventive
5 BenefitsAct of 1991".
—
5
2
1 SEC.2.COVERAGE OFCOLORECTALSCREENING.
—
2 (a) In General. Section 1834 ofthe Social Securi-
3 ty Act (42 U.S.C. 1395m), as amended by section
4 4163(b)(2) of the Omnibus Budget Reconciliation Act of
5 1990 (hereafter referred to as *'OBEA-1990"), is amend-
6 ed by inserting after subsection (c) the following new sub-
7 section:
8 *'(d) Frequency and Payment Limits for
9 Screening Fecal-Occult Blood Tests and Screen-
—
10 iNGFlexible Sigmoidoscopies.
11 "(1) Screening fecal-occult blood
—
12 tests.
13 "(A) Payment limit.—In establishing fee
14 schedules under section 1833(h) with respect to
15 screening fecal-occult blood tests provided for
16 the purpose of early detection of colon cancer,
17 except as provided by the Secretaryunder para-
18 graph (3)(A), the payment amount estabhshed
19 for tests performed
20 '*(i) in 1992 shall not exceed $5; and
21 "(ii) in a subsequent year, shall not
22 exceed the limit on the payment amount
23 estabhshed under this subsection for such
24 tests for the preceding year, adjusted by
25 the appKcable adjustment under section
26 1833(h) for tests performed in such year.
m
•HR2<t$6
——
6
3
—
1 "(B) Frequency limit. Subject to revi-
2 sion by the Secretary under paragraph (3)(B),
3 no payment may be made under this part for
4 a screening fecal-occult blood test provided to
5 an individual for the purpose of early detection
6 of colon cancer
7 "(i) if the individual is under 50 years
8 of age; or
9 "(ii) if the test is performed within
10 the 11 months after a previous screening
11 fecal-occult blood test.
12 "(2) Screening flexible
13 sigmoidoscopies.
—
14 "(A) Payment amount. The Secretary
15 shall establish a payment amount under section
16 1848 with respect to screening flexible
17 sigmoidoscopies provided for the purpose of
18 early detection of colon cancer that is consistent
19 with payment amounts under such section for
20 similar or related services, except that such
21 payment amount shall be established without
22 regard to subsection (a)(2)(A) of such section.
—
23 "(B) Frequency limit. Subject to revi-
24 sion by the Secretary under paragraph (3)(B),
25 no payment may be made under this part for
m
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