H.R.842 - Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act (119th Congress)
Summary
H.R.842, the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act, aims to amend Title XVIII of the Social Security Act to include Medicare coverage for multi-cancer early detection screening tests. The bill defines these tests as those furnished for the concurrent detection of multiple cancer types across multiple organ sites, starting January 1, 2028. It outlines specific criteria for test approval and payment structures.
The bill specifies that the Secretary of Health and Human Services will determine the reasonableness and necessity of these tests, using the national coverage determination process. Payment amounts for these tests are initially tied to the payment amount for multi-target stool screening DNA tests, with adjustments considered after January 1, 2031.
Furthermore, the bill includes limitations based on age and frequency of testing, though these limitations may be waived if the United States Preventive Services Task Force recommends the test with a grade of A or B.
Expected Effects
The primary effect of this bill, if enacted, would be to expand Medicare coverage to include multi-cancer early detection screening tests. This would increase access to these potentially life-saving screenings for Medicare beneficiaries.
It would also establish a framework for evaluating and approving these tests, as well as determining appropriate payment amounts. This framework would likely spur innovation in cancer detection technologies.
Finally, the bill could lead to earlier detection of cancers, potentially improving treatment outcomes and reducing healthcare costs in the long run.
Potential Benefits
- Increased access to early cancer detection for Medicare beneficiaries.
- Potential for improved treatment outcomes due to earlier diagnosis.
- Encouragement of innovation in multi-cancer screening technologies.
- Possible reduction in long-term healthcare costs associated with advanced-stage cancer treatment.
- Alignment with the goal of promoting public health and well-being.
Potential Disadvantages
- Potential for increased Medicare spending, at least initially.
- Risk of false positives leading to unnecessary follow-up testing and anxiety for patients.
- Uncertainty regarding the long-term cost-effectiveness of multi-cancer screening.
- Possible disparities in access to these tests based on geographic location or socioeconomic status.
- The age limitations, while intended to manage costs, may exclude some individuals who could benefit from screening.
Constitutional Alignment
This bill appears to align with the general welfare clause of the US Constitution, as it aims to improve public health by expanding access to cancer screening. The Constitution's preamble states the goal to "promote the general Welfare".
Congress has the power to legislate on matters related to Medicare under its authority to provide for the general welfare. The specific mechanisms for test approval and payment determination fall within the scope of congressional authority to regulate healthcare.
However, the bill's impact on fiscal responsibility should be carefully considered to ensure it does not unduly burden taxpayers, balancing the benefits of early cancer detection with the need for responsible government spending.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).