article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Prostate Cancer Diagnosis and Treatment Act of 1997''. SEC. 2. MEDICARE COVERAGE OF PROSTATE CANCER SCREENING AND CERTAIN DRUG TREATMENTS. (a) Coverage of Screening Services.-- (1) In general.--Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended-- (A) by striking ``and'' at the end of subparagraph (N); (B) by striking ``and'' at the end of subparagraph (O); and (C) by inserting after subparagraph (O) the following new subparagraph: ``(P) services for the early detection of prostate cancer (as defined in subsection (oo)); and''. (2) Services described.--Section 1861 of such Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection: ``Services for the Early Detection of Prostate Cancer ``(oo) The term `services for the early detection of prostate cancer' means the following procedures provided to a man for the purpose of early detection of prostate cancer: ``(1) Digital rectal examination. ``(2) Prostate-specific antigen blood test. ``(3) Transrectal ultrasonography. ``(4) Such other procedures as the Secretary may designate as appropriate for early detection of prostate cancer.''. (3) Payment amounts; limitations on frequency of coverage.--Section 1834 of such Act (42 U.S.C. 1395m) is amended by inserting after subsection (c) the following new subsection: ``(d) Payment Amounts and Frequency Limits for Services for the Early Detection of Prostate Cancer.-- ``(1) In general.--Notwithstanding any other provision of this part, with respect to expenses incurred for services for the early detection of prostate cancer (as defined in section 1861(oo))-- ``(A) payment may be made only for services provided consistent with the frequency permitted under paragraph (2); and ``(B) the amount of the payment under this part shall be equal to 80 percent of the lesser of the actual charge for the service or-- ``(i) in the case of a service for the early detection of prostate cancer consisting of a prostate-specific antigen blood test, the fee schedule amount established for the service under section 1833(h) (relating to payments for clinical diagnostic laboratory tests); or ``(ii) in the case of any other service for the early detection of prostate cancer, the amount provided under the fee schedule established by the Secretary under paragraph (3) (subject to the deductible established under section 1833(b)). ``(2) Frequency covered.-- ``(A) In general.--Subject to subparagraph (B) and to revision by the Secretary under subparagraph (C), no payment may be made under this part for a service for the early detection of prostate cancer provided to an individual-- ``(i) if the individual is under 50 years of age; or ``(ii) if the service is provided within the 11 months after a previous service for the early detection of prostate cancer. ``(B) Exception for high risk individuals.--Payment may be made under this part for a service for the early detection of prostate cancer provided to an individual more frequently than the limit established under subparagraph (A)(ii) if the individual is at a high risk of developing prostate cancer (as determined pursuant to factors identified by the Secretary). ``(C) Revision by secretary.-- ``(i) Review.--The Secretary, in consultation with the Director of the National Cancer Institute, shall review periodically the appropriate frequency for performing services for the early detection of prostate cancer based on age and such other factors as the Secretary believes to be pertinent. ``(ii) Revision of frequency.--The Secretary, taking into consideration the review made under clause (i), may revise from time to time the frequency with which such services may be paid for under this subsection, but no such revision shall apply to services performed before January 1, 2000. ``(3) Establishment of fee schedule.-- ``(A) In general.--The Secretary shall establish fee schedules (on such geographic basis as the Secretary considers appropriate) for payment for services for the early detection of prostate cancer under this part (other than prostate-specific antigen blood tests), effective for services furnished after the expiration of the 90-day period beginning on the date the Secretary establishes the fee schedules. ``(B) Factors considered.--In establishing fee schedules under subparagraph (A), the Secretary shall take into consideration variations in the cost of furnishing such services among geographic areas and among different sites where services are furnished, together with such other factors as may be appropriate to assure that payment amounts are equitable. ``(4) Limiting charges of nonparticipating physicians.--In the case of a service for the early detection of prostate cancer for which payment may be made under this part, if a nonparticipating physician or nonparticipating supplier or other person (as defined in section 1842(i)(2)) who does not accept payment on an assignment-related basis provides the service to an individual enrolled under this part, section 1848(g)(1) shall apply to the service in the same manner as such section applies to a physician's service.''. (4) Conforming amendments.--(A) Paragraphs (1)(D) and (2)(D) of section 1833(a) of such Act (42 U.S.C. 1395l(a)) are each amended by striking ``subsection (h)(1),'' and inserting ``subsection (h)(1) or section 1834(d)(1)(B)(i),''. (B) Section 1833(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) is amended-- (i) by striking ``and (P)'' and inserting ``(P)''; and (ii) by striking the semicolon at the end and inserting the following: ``, and (Q) with respect to services for the early detection of prostate cancer (as defined in section 1861(oo)) (other than prostate- specific antigen tests), the amounts paid shall be the amounts described in section 1834(d)(1);''. (C) Section 1833(a) of such Act (42 U.S.C. 1395l(a)) is amended-- (i) by striking ``and'' at the end of paragraph (6); (ii) by striking the period at the end of paragraph (7) and inserting ``; and''; and (iii) by adding at the end the following new paragraph: ``(8) in the case of services for the early detection of prostate cancer (as defined in section 1861(oo)) (other than prostate-specific antigen tests), the amounts described in section 1834(d)(1).''. (D) Section 1833(h)(1)(A) of such Act (42 U.S.C. 1395l(h)(1)(A)) is amended by striking ``The Secretary'' and inserting ``Subject to section 1834(d), the Secretary''. (E) Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended-- (i) in paragraph (1)-- (I) in subparagraph (E), by striking ``and'' at the end, (II) in subparagraph (F), by striking the semicolon at the end and inserting ``, and'', and (III) by adding at the end the following new subparagraph: ``(G) in the case of services for the early detection of prostate cancer (as defined in section 1861(oo)), which are performed more frequently than is covered under section 1834(d)(2);''; and (ii) in paragraph (7), by striking ``paragraph (1)(B) or under paragraph (1)(F)'' and inserting ``subparagraphs (B), (F), or (G) of paragraph (1)''. (b) Coverage of Certain Drug Treatments.--Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by subsection (a)(1), is further amended-- (1) by striking ``and'' at the end of subparagraph (P); (2) by adding ``and'' at the end of subparagraph (Q); and (3) by adding at the end the following new subparagraph: ``(R) an oral drug prescribed for the treatment of prostate cancer, if the use of the drug for such purpose is a medically accepted indication under subsection (t)(2);''. (c) Effective Date.--The amendments made by this section shall apply to services provided on or after January 1, 1998, without regard to whether or not the Secretary has established fee schedules under section 1834(d)(3) of the Social Security Act (as added by subsection (a)(3)) or promulgated other regulations to carry out such amendments by that date. SEC. 3. EARLY DETECTION AND TREATMENT OF PROSTATE CANCER IN VETERANS. (a) Preventive Health Services.--Section 1701(9) of title 38, United States Code is amended-- (1) by redesignating subparagraphs (J) and (K) as subparagraphs (K) and (L), respectively; and (2) by inserting after subparagraph (I) the following new subparagraph (J): ``(J) tests for the early detection and diagnosis of prostate cancer;''. (b) Coverage of Services for Early Detection and Treatment of Prostate Cancer.-- (1) In general.--Chapter 17 of such title is amended by inserting after section 1724 the following new section: ``Sec. 1725. Prostate cancer detection and treatment ``(a) The Secretary shall include in the medical services furnished to veterans under this chapter-- ``(1) services for the early detection and treatment of prostate cancer; ``(2) information on the early detection and treatment of prostate cancer; and ``(3) counseling regarding prostate cancer. ``(b) Based on the best available medical evidence, the Secretary shall implement a schedule for early detection of prostate cancer for veterans confined to hospitals or other institutions. ``(c) For the purposes of this section-- ``(1) services for the early detection of prostate cancer are procedures provided to a male for the purpose of the early detection of prostate cancer, including digital rectal examinations, prostate-specific antigen blood tests, and transrectal ultrasonography; and ``(2) services for treatment of prostate cancer may include the furnishing of drugs approved by the Food and Drug Administration for the treatment of prostate cancer. ``(d) The Secretary may carry out research and research training in the diagnosis and treatment of prostate cancer based upon the prostate cancer services provided under this section and may develop guidelines outlining effective treatment regimens for prostate cancer.''. (2) Clerical amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1724 the following new item: ``1725. Prostate cancer detection and treatment.''.
summary: Prostate Cancer Diagnosis and Treatment Act of 1997 - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of services for the early detection of prostate cancer and certain drug treatments for such cancer. Requires the Secretary of Health and Human Services to establish fee schedules for such services. Amends Federal law to cover such detection and treatment services for veterans as a preventive health service.