Sponsors (69)
The bill creates a clearer Medicare coverage path and short‑term payment predictability for multi‑cancer early detection tests—potentially expanding preventive access—while imposing age, timing, payment, and evidentiary limits that could restrict access for older beneficiaries and slow or discourage adoption of some innovations.
Medicare beneficiaries (especially seniors) gain a defined Medicare coverage pathway for multi‑cancer early detection tests beginning Jan 1, 2028, and USPSTF A/B‑recommended tests can bypass certain payment/limit rules, increasing access to preventive cancer detection.
Hospitals, manufacturers, and Medicare providers get a predictable interim payment rate (tied to the multi‑target stool DNA test rate) before 1/1/2031, providing short‑term payment clarity for furnishing these tests.
Medicare beneficiaries retain coverage for other recommended cancer screening tests even if they receive a multi‑cancer test, protecting access to standard screenings.
Medicare beneficiaries above the annual age threshold (starting at 68 in 2028 and rising) are ineligible for payment that year, reducing access for older seniors.
Medicare beneficiaries may be barred from payment if a multi‑cancer test was furnished within the previous 11 months, which can limit timely repeat testing when clinically indicated.
Hospitals, providers, and test manufacturers may be underpaid by the interim payment cap (tied to the stool DNA rate and later constrained by section 1834A), which could discourage adoption of or investment in higher‑cost or innovative multi‑cancer tests.
Based on analysis of 2 sections of legislative text.
Introduced January 30, 2025 by Michael Dean Crapo · Last progress January 30, 2025
Creates a Medicare coverage pathway for multi-cancer early detection screening tests and sets rules for how those tests will be reviewed, paid, and limited. Starting January 1, 2028, the Department of Health and Human Services must use the national coverage determination (NCD) process to decide whether these tests are reasonable and necessary for Medicare Part A/B beneficiaries. The law also sets interim and longer-term payment rules, annual age- and interval-based limits on payment, and an exception if a test later receives a USPSTF A or B recommendation and separate Medicare coverage. The change adds a definition for multi-cancer tests to Medicare law, ties payment levels to an existing multi-target stool DNA test payment until 2031 (with a later potential payment under a different payment provision), and clarifies that getting a multi-cancer screening does not block coverage for other cancer screening tests (and vice versa).