Proposed Medicare Rule Would Remove Barriers to Colorectal Cancer Screening

Today, the Centers for Medicare and Medicaid Services (CMS) released proposed changes to the 2023 Medicare program that, if finalized, would eliminate cost sharing for colonoscopies after an abnormal, non-invasive screening test, and lower the minimum age of colorectal cancer screening to 45. The cost sharing loophole was addressed for individuals with private health plans and Medicaid expansion plans in May.

For years NCCRT members have been advocating for a policy fix to ensure patients do not receive charges for colonoscopies that follow an abnormal non-colonoscopy test. (The Affordable Care Act eliminates cost-sharing for United States Preventive Services Task Force–recommended preventative services for individuals who are privately insured, including screening for colorectal cancer, but some health plans have historically applied cost-sharing to follow-up colonoscopies.)

This is a tremendous development, thanks in no small part to the work of numerous NCCRT members, including the American Cancer Society Cancer Action Network (ACS CAN), Fight Colorectal Cancer, and the American Gastroenterological Association.

Today’s ACS CAN press release is copied below. Watch this newsletter for further developments with this proposal.

Proposed Medicare Rule Would Remove Barriers to Colorectal Cancer Screening

Eliminating Cost Sharing for Complete Screening Will Reduce Health Disparities and Save Lives for Medicare Beneficiaries

WASHINGTON, D.C.—July 8, 2022— The Centers for Medicare and Medicaid Services (CMS) released proposed changes to the 2023 Medicare program that, if finalized, would eliminate cost sharing for colonoscopies after a positive non-invasive screening test, and lower the minimum age of colorectal cancer screening to 45. Lowering the minimum age of coverage from 50 to 45 and providing coverage of medically indicated follow-on colonoscopies with no cost sharing is consistent with the 2018 American Cancer Society screening guidelines and the 2021 United States Preventive Services Task Force (USPSTF) colorectal cancer screening guidelines. The proposal would also ensure that Medicare’s coverage provisions are consistent with private and Medicaid expansion plan requirements.

“We applaud CMS for proposing to eliminate barriers to cancer screening that will save lives,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN). “Currently most Medicare beneficiaries are assessed 20% cost sharing for follow-on colonoscopies after a positive non-invasive test, an anticipated cost that can result in delayed or skipped procedures with potentially life-threatening consequences due to imposing financial hardship for those on fixed incomes.”

Studies have demonstrated that delayed colonoscopies after an abnormal non-invasive screening test are associated with higher risk of colorectal cancer incidence, death, and late-stage colorectal cancer. The proposed rule would eliminate this barrier by clarifying that follow up colonoscopies would be covered at no additional cost sharing to beneficiaries beginning January 1, 2023.

The American Cancer Society Cancer Action Network together with Fight Colorectal Cancer and the American Gastroenterological Association advocated for this critical change that would result in cancer prevention and earlier stage colon and rectal cancer diagnoses when survival chances are greater, and the disease is less costly to treat.

“Removing this barrier to colorectal cancer screening is a critical step forward toward meeting the President’s Cancer Moonshot challenge to ‘end cancer as we know it,’” said Anjee Davis, President, Fight Colorectal Cancer. “We are grateful to CMS for issuing this proposed rule and, once finalized, it will help prevent more people from hearing the words ‘you have colorectal cancer.’”

“This is a win for all patients and should elevate our nation’s screening rates while lowering the overall cancer burden, saving lives. Importantly, the CMS proposed rule changes will lessen colorectal cancer disparities eliminating a financial burden for many patients,” said AGA president John Carethers, MD, AGAF.

The administration’s proposed change explicitly calls out policy alignment with the National Colorectal Cancer Roundtable, created by the American Cancer Society and the Centers for Disease Control and Prevention in 1997, as well as the American Cancer Society’s 2018 colorectal screening guideline, which notes, “Follow-up colonoscopy is an integral part of the screening process.”

“On behalf of cancer patients, survivors and those at risk of future diagnoses, we urge CMS to finalize this change to remove cost barriers to proven, colorectal cancer early detection,” Lacasse said.

Many thanks for the great work you do!

The NCCRT Team