Sponsors (69)
The bill expands Medicare coverage and short-term payment certainty for FDA-cleared multi-cancer early detection tests starting in 2028, but pairs that access with age and frequency limits plus a longer-term payment cap and coverage exclusions that could reduce access for older beneficiaries and discourage provider uptake over time.
Medicare beneficiaries will be eligible for coverage of FDA-cleared MCED (multi-cancer early detection) tests beginning January 1, 2028, expanding access to multi-cancer screening for Medicare enrollees.
Providers and hospitals will have predictable Medicare payment rates for MCED tests through 2030 because payments are set immediately using the existing multi-target stool DNA test reimbursement, supporting early adoption and billing stability.
If the U.S. Preventive Services Task Force issues an A or B grade for MCED testing, Medicare coverage would follow preventive-service rules (waiving the statute's age and frequency limits), potentially broadening access beyond the bill's default limits.
Medicare beneficiaries at or above the bill's rising age threshold (68 in 2028 and increasing thereafter) will be ineligible for MCED payments, reducing access for older seniors.
After 2030, Medicare payment for MCED tests is limited to the lesser of the initial amount or the 1834A rate, which could reduce future reimbursement rates and discourage provider adoption and innovation over the long term.
The statute explicitly excludes coverage when an MCED test is not deemed 'reasonable and necessary,' which may narrow coverage compared with broader rules and increase denials or administrative barriers for beneficiaries and providers.
Based on analysis of 2 sections of legislative text.
Establishes Medicare coverage, payment rules, age and timing limits for FDA‑cleared multi‑cancer early detection screening tests starting Jan 1, 2028.
Creates Medicare coverage and payment rules for FDA‑cleared multi‑cancer early detection (MCED) screening tests furnished on or after January 1, 2028. It defines which kinds of tests qualify, requires the Secretary to use the national coverage determination process to decide coverage, sets transitional and permanent payment rules, and establishes age and timing limits for beneficiary eligibility. The bill also adds an explicit exclusion for MCED tests that the Secretary determines are not reasonable and necessary for concurrent detection, preserves coverage for existing single‑cancer screening tests, and allows MCED tests to be used as diagnostic or confirmatory tools when appropriate.
Introduced January 30, 2025 by Michael Dean Crapo · Last progress January 30, 2025