Budget Proposal Eliminates Coinsurance When Screening Colonoscopy Turns Therapeutic

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    Whitfield L. Knapple, MD, FACG Chair, ACG National Affairs

    Whitfield L. Knapple, MD, FACG
    Chair, ACG National Affairs

    On Tuesday, February 9th, President Obama released his blueprint federal budget for fiscal year (FY) 2017. Each year, the President sends a recommended federal budget for congressional consideration. GOP lawmakers quickly criticized the budget plan, announcing last week that they will skip the budget committees’ usual hearings over the President’s budget.

    The budget includes two important provisions impacting ACG members and our patients:

    Eliminate Beneficiary Coinsurance for Screening Colonoscopies with Polyp Removal. Medicare beneficiaries are not subject to the Part B deductible or coinsurance for most recommended preventive and screening services, including screening colonoscopies. However, if a screening colonoscopy results in removal of a polyp, ablation, or other procedure, beneficiaries are subject to 20 percent coinsurance, which presents a financial challenge for beneficiaries to receive care. This budget proposal eliminates beneficiary coinsurance when the screening results in removal of a polyp or other procedure, thereby removing a significant barrier that beneficiaries face in receiving necessary preventive care. [Estimated cost to Federal Government: $2.4 billion over 10 years]

    Hepatitis C Treatment in People Living with HIV. According to the budget proposal, people living with HIV are disproportionally affected by viral hepatitis and are at an increased risk for serious, life-threatening complications. The Administration estimates that one quarter of all people living with HIV are co-infected with hepatitis C, and the rate is even higher (80 percent) amongst people living with HIV who inject drugs. Given the changes in the health care environment and advances in hepatitis C Treatment, the FY 2017 Budget includes $9 million to expand screening and treatment of hepatitis C in people living with HIV.

    Since Republicans have already decided this budget proposal is “dead on arrival,” ACG continues to urge Congress to pass the SCREEN Act. The SCREEN Act (S. 1079, HR 2035) removes all financial barriers for Medicare beneficiaries throughout the screening continuum, so that cost-sharing would not apply, whether the colonoscopy was a preventive test or as the result of a positive finding from another screening modality.

    More about the SCREEN ACT:

    • In April 2015, U.S. Senator Ben Cardin (D-MD) and Representative Richard Neal (D-MA) introduced the “Supporting ColoRectal Examination and Education Now (SCREEN) Act” (S. 1079/H.R. 2035).

    • Not only does the SCREEN Act address barriers to colorectal screening for Medicare beneficiaries, but it also reverses recently implemented Medicare reimbursement cuts to colonoscopy reimbursement for those providers who participate in nationally recognized quality improvement registries. This will encourage quality benchmarking and drive ongoing improvements to care at a time when Medicare reimbursement for these lifesaving exams remains under significant pressure.

    • Another feature of the SCREEN Act is an innovative Medicare demonstration project which authorizes a colonoscopy pre-screening visit and an opportunity for Medicare beneficiaries to discuss hepatitis C screening with their healthcare provider. Under the SCREEN Act (S. 1079 and HR 2035), the Medicare beneficiary can schedule (and the gastroenterologist can bill Medicare for) an age-appropriate hepatitis C screening at the same time as the screening colonoscopy, thus promoting two important public health imperatives in the same encounter.

    • The SCREEN Act is structured to be “budget neutral,” meaning that it does not add any additional cost to the federal budget.

    Contact Congress today

    Whitfield L. Knapple, MD FACG

    ACG National Affairs Committee, Chair

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