S339119th CongressWALLET

Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act

Sponsored By: Senator Mike Crapo

Introduced

Summary

Medicare coverage for multi-cancer early detection screening tests. This bill would let the Secretary of Health and Human Services set who is eligible, define which tests qualify, and set payment amounts and standards while limiting tests by age and frequency.

Show full summary
  • Older Medicare beneficiaries: People would be eligible starting at age 68 in 2028, with the age limit rising by one year each year. Each person could get one test every 11 months.
  • Patients and clinicians: Covered tests must be FDA-cleared, classified, or approved and must be genomic blood tests that analyze cell-free nucleic acids or provide comparable results. The Secretary must determine a test is reasonable and necessary before Medicare pays.
  • Medicare program and providers: Coverage decisions would use the national coverage determination process and follow a defined, phased payment schedule. The bill also includes an exception tied to U.S. Preventive Services Task Force recommendations when they endorse broader preventive screening.

Bill Overview

Analyzed Economic Effects

3 provisions identified: 0 benefits, 0 costs, 3 mixed.

Medicare age and frequency limits

This bill would limit Medicare payment for a multi-cancer screening test if, on January 1 of the year, the person has reached the specified age (68 in 2028, and the age goes up by one year each later year). It would also bar payment if the person had a qualifying test in the prior 11 months. If the U.S. Preventive Services Task Force gives a test a grade A or B and coverage starts under the preventive coverage rule, those age and 11-month limits would not apply for that test.

Medicare payment rules for tests

This bill would set how Medicare pays for multi-cancer screening tests. Tests given before January 1, 2031 would be paid at the same dollar amount that applied on the date of enactment for a specific multi-target stool DNA test. For tests on or after January 1, 2031, payment would be the lower of that older amount or the amount computed under the Medicare payment rule in section 1834A. The bill would also make conforming cross-reference changes to Medicare payment law when enacted.

New Medicare multi-cancer coverage

This bill would create a new Medicare coverage category for multi-cancer early detection screening tests starting January 1, 2028. Tests would have to meet certain FDA clearance or approval rules and be genomic blood-based tests (or comparable samples) and be judged reasonable and necessary by the Medicare Secretary. The Secretary would use the Medicare national coverage determination process to decide coverage for new tests. The bill would also say Medicare would not pay for tests the Secretary finds are not reasonable and necessary, and it would not change coverage for other cancer screening tests or using these tests as diagnostic or confirmatory tests. These clarifications would take effect when the bill is enacted.

Sponsors & CoSponsors

Sponsor

Mike Crapo

ID • R

Cosponsors

  • Maggie Hassan

    NH • D

    Sponsored 6/24/2025

  • Michael Bennet

    CO • D

    Sponsored 1/30/2025

  • Tim Scott

    SC • R

    Sponsored 1/30/2025

  • Ron Wyden

    OR • D

    Sponsored 1/30/2025

  • James Lankford

    OK • R

    Sponsored 2/4/2025

  • Mike Rounds

    SD • R

    Sponsored 2/4/2025

  • Thomas Tillis

    NC • R

    Sponsored 2/5/2025

  • Ted Budd

    NC • R

    Sponsored 2/5/2025

  • Amy Klobuchar

    MN • D

    Sponsored 2/10/2025

  • Roger Marshall

    KS • R

    Sponsored 2/11/2025

  • Jon Ossoff

    GA • D

    Sponsored 2/18/2025

  • James Risch

    ID • R

    Sponsored 2/20/2025

  • Jeff Merkley

    OR • D

    Sponsored 2/24/2025

  • John Barrasso

    WY • R

    Sponsored 2/25/2025

  • Mark Kelly

    AZ • D

    Sponsored 3/4/2025

  • Shelley Capito

    WV • R

    Sponsored 3/4/2025

  • Jacky Rosen

    NV • D

    Sponsored 3/6/2025

  • Christopher Coons

    DE • D

    Sponsored 3/10/2025

  • John Fetterman

    PA • D

    Sponsored 3/10/2025

  • Richard Blumenthal

    CT • D

    Sponsored 3/11/2025

  • John Reed

    RI • D

    Sponsored 3/11/2025

  • John Hickenlooper

    CO • D

    Sponsored 3/11/2025

  • Jeanne Shaheen

    NH • D

    Sponsored 3/12/2025

  • Sheldon Whitehouse

    RI • D

    Sponsored 3/12/2025

  • Chuck Grassley

    IA • R

    Sponsored 3/13/2025

  • Maria Cantwell

    WA • D

    Sponsored 3/13/2025

  • Kevin Cramer

    ND • R

    Sponsored 3/13/2025

  • John Boozman

    AR • R

    Sponsored 3/14/2025

  • Ruben Gallego

    AZ • D

    Sponsored 3/14/2025

  • Lindsey Graham

    SC • R

    Sponsored 3/24/2025

  • Bill Cassidy

    LA • R

    Sponsored 3/24/2025

  • Markwayne Mullin

    OK • R

    Sponsored 3/24/2025

  • Susan Collins

    ME • R

    Sponsored 3/25/2025

  • Kirsten Gillibrand

    NY • D

    Sponsored 3/26/2025

  • Rick Scott

    FL • R

    Sponsored 3/26/2025

  • Catherine Cortez Masto

    NV • D

    Sponsored 3/26/2025

  • Elissa Slotkin

    MI • D

    Sponsored 3/26/2025

  • Steve Daines

    MT • R

    Sponsored 3/31/2025

  • John Cornyn

    TX • R

    Sponsored 4/2/2025

  • James Justice

    WV • R

    Sponsored 4/3/2025

  • Bernie Moreno

    OH • R

    Sponsored 4/4/2025

  • Martin Heinrich

    NM • D

    Sponsored 4/7/2025

  • Sen. McConnell, Mitch [R-KY]

    KY • R

    Sponsored 4/9/2025

  • Mark Warner

    VA • D

    Sponsored 4/10/2025

  • Tammy Baldwin

    WI • D

    Sponsored 4/10/2025

  • Cory Booker

    NJ • D

    Sponsored 4/28/2025

  • Patty Murray

    WA • D

    Sponsored 4/28/2025

  • Cindy Hyde-Smith

    MS • R

    Sponsored 5/5/2025

  • Angus King

    ME • I

    Sponsored 5/20/2025

  • Peter Welch

    VT • D

    Sponsored 6/3/2025

  • Alex Padilla

    CA • D

    Sponsored 6/3/2025

  • Jim Banks

    IN • R

    Sponsored 6/11/2025

  • Jon Husted

    OH • R

    Sponsored 7/9/2025

  • Angela Alsobrooks

    MD • D

    Sponsored 7/9/2025

  • Todd Young

    IN • R

    Sponsored 7/14/2025

  • John Kennedy

    LA • R

    Sponsored 7/29/2025

  • Tina Smith

    MN • D

    Sponsored 7/31/2025

  • Gary Peters

    MI • D

    Sponsored 9/2/2025

  • Lisa Blunt Rochester

    DE • D

    Sponsored 9/2/2025

  • Adam Schiff

    CA • D

    Sponsored 9/4/2025

  • Andy Kim

    NJ • D

    Sponsored 9/8/2025

  • Lisa Murkowski

    AK • R

    Sponsored 10/8/2025

  • Chris Van Hollen

    MD • D

    Sponsored 10/14/2025

  • Katie Britt

    AL • R

    Sponsored 10/15/2025

  • Roger Wicker

    MS • R

    Sponsored 10/21/2025

  • Dan Sullivan

    AK • R

    Sponsored 10/23/2025

  • Mazie Hirono

    HI • D

    Sponsored 12/15/2025

Roll Call Votes

No roll call votes available for this bill.

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