H.R. 842 — Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act

This section establishes Medicare Part B coverage for multi-cancer early detection screening tests (as defined in new SSA §1861(nnn)), furnished on or after January 1, 2028, that are FDA-cleared or approved, consist of genomic sequencing of blood or comparable biological samples, and are determined by the Secretary via the national coverage determination process to be reasonable and necessary for early detection in Part A or B beneficiaries. (1) It sets payment under new SSA §1834(aa) equal to the payment rate for the multi-target stool DNA colorectal cancer screening test through December 31, 2030, and thereafter the lesser of that rate or the clinical laboratory fee schedule amount under SSA §1834A; (2) limits coverage to once every 11 months for individuals under a specified age that begins at 68 in 2028 and increases by one year annually; and (3) provides that these payment and limit rules cease upon a U.S. Preventive Services Task Force A or B recommendation, at which point standard coverage rules apply. This section makes conforming amendments to SSA §§1833(a), 1833(h), and 1862(a) to incorporate the new payment methodology and exclude non-qualifying tests; and clarifies that coverage of these tests does not affect Medicare coverage of other cancer screenings (e.g., for breast, cervical, colorectal, lung, or prostate cancer).