AGA Washington Insider

A policy blog for GIs

Effort to Include Colonoscopy Coinsurance Issue in SGR Reform Package

capitol bldg down PA AveLate last year, the House Ways and Means and Senate Finance Committees both unanimously passed H.R. 2810, the Medicare Patient Access and Quality Improvement Act. This legislation repeals the sustainable growth rate (SGR) formula and transitions physicians to a more value-based payment system. Since three committees of jurisdiction — House Ways and Means, House Energy and Commerce, and Senate Finance — each passed their own versions of the legislation, negotiations are currently occurring to reconcile the differences. Congressional leaders hope to pass a final version this year, but it may not be finalized before the temporary physician fix expires in March.

Adding Colorectal Cancer Screening Legislation

There is an effort by Reps. Charlie Dent, R-PA, and Joe Courtney, D-CT, authors of H.R. 1070, the Removing Barriers to Colorectal Cancer Screening Act, to include this legislation in a final SGR package. Reps. Dent and Courtney have organized a “Dear Colleague” letter in the House to send to the chairs of the House Ways and Means and Energy and Commerce Committees to urge them to include H.R. 1070 in the SGR package. H.R. 1070 would waive the coinsurance for Medicare beneficiaries who undergo a screening colonoscopy and have a polyp or lesion removed, since according to Medicare it is no longer classified as a screening.

AGA and all of the GI societies have been trying to resolve this issue since the passage of the Affordable Care Act, which included colonoscopy as a mandated benefit without cost-sharing. We are hopeful that Congress will resolve this issue once and for all, which is confusing for Medicare beneficiaries and for physicians.

AGA staff has been reaching out to cosponsors of H.R. 1070 to encourage them to sign the Dent-Courtney letter to demonstrate support to Congressional leadership for this issue. We will keep you abreast as to the status of this issue. Continue to look for updates on this and the SGR reform package in AGA eDigest and the AGA Washington Insider.

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