Proposed Rule Falls Short of Necessary Measures to Protect Seniors from Unexpected Bills after Colonoscopies
WASHINGTON, D.C. – Today, Senator Sherrod Brown (D-OH) urged the Centers for Medicare and Medicaid Services (CMS) to take the necessary steps to protect seniors from unexpected, out-of-pocket costs following preventive colonoscopies as the Agency considers its annual rule changes. Currently, Medicare charges seniors a twenty percent
Private insurers cannot impose cost-sharing for a screening that leads to polyp removal, but Medicare can charge fees if a polyp is removed.
coinsurance for colonoscopies when a polyp is removed during the procedure even though colorectal cancer screenings are promoted as a free service under Medicare. In December 2018, Brown led 51 of his Senate colleagues in writing to CMS, urging the Agency to act to protect older Americans from out-of-pocket costs for preventive colonoscopies as part of the 2019 updates to the Medicare program.
Each year, CMS makes updates to the Medicare program through notice and comment rulemaking, in which CMS proposes updates to the program, solicits comments from stakeholders, and then finalizes policy changes in a final rule to take effect the following year. CMS released its proposed updates to the program earlier this week, part of which relates to colorectal cancer screenings. In its proposed rule, CMS agreed with Brown’s assertion that these unexpected out-of-pocket costs after a preventive colonoscopy can be “surprise bills” for beneficiaries and solicited comment on ways to improve notice for beneficiaries. However, the proposed rule fell short of taking the necessary steps to protect seniors from these costs. Today, Brown again urged the agency to address this issue in its final rule.
“The most effective preventive action against colorectal cancer is a screening colonoscopy,”Brown said. “Unfortunately, many seniors choose not to undergo this lifesaving procedure because they don’t know if the procedure will be covered by their insurance. I’m urging CMS to update their final rule and ensure all Medicare beneficiaries are protected from unexpected bills after these screenings.”
Brown has also introduced bipartisan legislation to protect seniors from these unexpected costs. In March, Brown, along with Sens. Roger Wicker (R-MS), Ben Cardin (D-MD), and Susan Collins (R-ME), reintroduced bipartisan legislation to protect seniors from out-of-pocket costs for preventive colonoscopies. The Removing Barriers to Colorectal Cancer Screening Act make a long-overdue fix to Medicare to ensure seniors aren’t charged for a colonoscopy – regardless of whether or not a polyp or tissue is removed. Removing harmful tissue during these procedures is key to preventing cancer, yet the fear of having to pay unexpectedly could prevent Medicare recipients from getting these important screenings.
Colonoscopies allow for the detection and removal of polyps that could become cancerous, as well as for the early detection of colorectal cancer when treatment can be most effective. Under current law, seniors covered by Medicare are eligible for colorectal cancer screenings without out-of-pocket costs. However, if a physician takes a further preventive action – like removing a polyp – during the screening while the patient is under anesthesia, the patient is billed as if the procedure was treatment rather than prevention.
Because there is no way of knowing whether a polyp will be removed during a screening colonoscopy in advance, Medicare beneficiaries do not know whether or not their screening colonoscopy will be fully covered until after the procedure is over. This potential cost could lead to Medicare beneficiaries electing to forgo this important preventive screening, even though colorectal cancer screening is promoted as a service without cost-sharing under Medicare. Private insurers cannot impose cost-sharing for a screening that leads to polyp removal, but Medicare can charge fees if a polyp is removed. The Removing Barriers to Colorectal Cancer Screening Act would correct this discrepancy by waiving cost-sharing under Medicare for preventive colonoscopies, even if a polyp or tissue is removed.
Colorectal cancer is the second leading cause of cancer death in the United States for both men and women combined. However, when caught early, it is curable and can even be prevented.