AB 1763, as introduced, Gipson. Health care coverage: colorectal cancer: screening and testing.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires individual and group health care service plan contracts and health insurance policies to provide coverage for all generally medically accepted cancer screening tests and requires those contracts and policies to also provide coverage for the treatment of breast cancer. Existing law requires an individual or small group health care service plan contract or insurance policy issued, amended, or renewed on or after January 1, 2014, to, at a minimum, include coverage for essential health benefits, which include preventive services, pursuant to the federal Patient Protection and Affordable Care Act.
This bill would require a health care service plan contract or a health insurance policy, except as specified, that is issued, amended, or renewed on or after January 1, 2018, to provide coverage for colorectal cancer screening examinations and laboratory tests, as specified. The bill would require the coverage to include additional colorectal cancer screening examinations and laboratory tests recommended by the treating physician if the individual is at high risk for colorectal cancer. The bill would prohibit a health care service plan contract or a health insurance policy from imposing cost sharing on this coverage for an individual who is 50 years of age or older. Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
Section 1367.667 is added to the Health and
2Safety Code, to read:
(a) Every health care service plan contract, except
4a specialized health care service plan contract, that is issued,
5amended, or renewed on or after January 1, 2018, shall provide
6coverage for all colorectal cancer screening examinations and
7laboratory tests assigned either a grade of A or a grade of B by the
8United States Preventive Services Task Force for individuals at
9average risk. The coverage shall include, at a minimum, all of the
10following:
11(1) High sensitivity fecal occult blood tests (FOBT).
12(2) Flexible sigmoidoscopy with high sensitivity FOBT.
13 (3) Colonoscopies, including the removal of polyps during a
14
screening procedure.
15(b) (1) If an enrollee is at high risk for colorectal cancer, the
16coverage required by subdivision (a) shall include additional
17colorectal cancer screening examinations and laboratory tests as
18recommended by the treating physician.
19(2) For purposes of this subdivision, an individual is at high
20risk for colorectal cancer if the individual has any of the following:
21(A) A family medical history of colorectal cancer.
22(B) A prior occurrence of cancer or precursor neoplastic polyps.
P3 1(C) A prior occurrence of a chronic digestive disease condition,
2including, but not limited to, inflammatory bowel disease, Crohn’s
3disease, or ulcerative colitis.
4(D) Other predisposing factors.
5(c) For an enrollee who is 50 years of age or older, a health care
6service plan contract shall not impose cost sharing on either of the
7following:
8(1) The coverage required by this section.
9(2) Colonoscopies, including the removal of polyps during a
10screening procedure, if the enrollee has a positive result on any
11fecal test assigned either a grade of A or a grade of B by the United
12States Preventive Services Task Force.
13(d) Paragraph (3) of subdivision (a) shall not apply to a high
14deductible health plan, as described in Section 223 of Title 26 of
15the United States Code.
Section 10123.205 is added to the Insurance Code, to
17read:
(a) Every health insurance policy, except a
19specialized health insurance policy, that is issued, amended, or
20renewed on or after January 1, 2018, shall provide coverage for
21all colorectal cancer screening examinations and laboratory tests
22assigned either a grade of A or a grade of B by the United States
23Preventive Services Task Force for individuals at average risk.
24The coverage shall include, at a minimum, all of the following:
25(1) High sensitivity fecal occult blood tests (FOBT).
26(2) Flexible sigmoidoscopy with high sensitivity FOBT.
27(3) Colonoscopies, including the removal of polyps during a
28screening
procedure.
29(b) (1) If an insured is at high risk for colorectal cancer, the
30coverage required by subdivision (a) shall include additional
31colorectal cancer screening examinations and laboratory tests as
32recommended by the treating physician.
33(2) For purposes of this subdivision, an individual is at high
34risk for colorectal cancer if the individual has any of the following:
35(A) A family medical history of colorectal cancer.
36(B) A prior occurrence of cancer or precursor neoplastic polyps.
37(C) A prior occurrence of a chronic digestive disease condition,
38including, but not limited to, inflammatory bowel disease, Crohn’s
39disease, or ulcerative colitis.
40(D) Other predisposing factors.
P4 1(c) For an insured who is 50 years of age or older, a health
2insurance policy shall not impose cost sharing on either of the
3following:
4(1) The coverage required by this section.
5(2) Colonoscopies, including the removal of polyps during a
6screening procedure, if the insured has a positive result on any
7fecal test assigned either a grade of A or a grade of B by the United
8States Preventive Services Task Force.
9(d) Paragraph (3) of subdivision (a) shall not apply to a high
10deductible health plan, as described in Section 223 of Title 26 of
11the United States Code.
No reimbursement is required by this act pursuant to
13Section 6 of Article XIII B of the California Constitution because
14the only costs that may be incurred by a local agency or school
15district will be incurred because this act creates a new crime or
16infraction, eliminates a crime or infraction, or changes the penalty
17for a crime or infraction, within the meaning of Section 17556 of
18the Government Code, or changes the definition of a crime within
19the meaning of Section 6 of Article XIII B of the California
20Constitution.
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