Amended in Assembly April 27, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 1763

Introduced by Assembly Member Gipson

February 3, 2016

An act to add Section 1367.667 to begin insert the end insert Health and Safety Code, and to add Section 10123.205 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 1763, as amended, 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 begin insert without cost sharing end insert 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 begin delete treating physician end delete begin insert health care provider, end insert if the individual is at high risk for colorectal begin delete cancer. end delete begin insert cancer, as determined by the health care provider. end insert The bill would prohibit a health care service plan contract or a health insurance policy from imposing cost sharing on begin delete this coverage for end delete an individual who is 50 years of age or begin delete older. end delete begin insert older for colonoscopies conducted for specified purposes. end insert 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 1.  

Section 1367.667 is added to the Health and
Safety Code, to read:

1367.667.  

(a) Every health care service plan contract, except
a specialized health care service plan contract, that is issued,
amended, or renewed on or after January 1, 2018, shall provide
coverage begin insert without any cost sharing end insert for all colorectal cancer
screening examinations and laboratory tests assigned either a grade
of A or a grade of B by the United States Preventive Services Task
Force for individuals at average begin delete risk. The coverage shall include,
at a minimum, all of the following: end delete

begin delete

(1) High sensitivity fecal occult blood tests (FOBT).

(2) Flexible sigmoidoscopy with high sensitivity FOBT.

(3) Colonoscopies, including the removal of polyps during a
screening procedure.

end delete

begin delete (b) end delete begin delete   end delete begin delete (1) end delete begin delete   end delete begin delete If end delete begin insert risk. If end insert an enrollee is at high risk for colorectal begin delete cancer, end delete
begin insert cancer as determined by the enrollee’s health care provider, end insert the
coverage required by subdivision (a) shall include additional
colorectal cancer screening examinations and laboratory tests as
recommended by the begin delete treating physician. end delete begin insert enrollee’s health care
provider. end insert

begin delete

(2) For purposes of this subdivision, an individual is at high
risk for colorectal cancer if the individual has any of the following:

end delete begin delete

(A) A family medical history of colorectal cancer.

end delete begin delete

(B) A prior occurrence of cancer or precursor neoplastic polyps.

end delete begin delete

(C) A prior occurrence of a chronic digestive disease condition,
including, but not limited to, inflammatory bowel disease, Crohn’s
disease, or ulcerative colitis.

end delete begin delete

(D) Other predisposing factors.

end delete begin delete

(c)

end delete

begin insert (b) end insert  For an enrollee who is 50 years of age or older, a health care
service plan contract shall not impose cost sharing on begin delete either of the
following: end delete begin insert colonoscopies, including the removal of polyps, when
either of the following applies: end insert

begin delete

(1) The coverage required by this section.

end delete begin delete

(2) Colonoscopies, including the removal of polyps during a
screening procedure, if the enrollee has a positive result on any
fecal test assigned either a grade of A or a grade of B by the United
States Preventive Services Task Force.

end delete begin delete

(d) Paragraph (3) of subdivision (a) shall not apply to a high
deductible health plan, as described in Section 223 of Title 26 of
the United States Code.

end delete begin insert

(1) The colonoscopy is a screening procedure not occasioned
by a recent positive test or procedure.

end insert begin insert

(2) The colonoscopy has been scheduled because of a positive
result on a test or procedure, other than a colonoscopy, assigned
either a grade of A or a grade of B by the United States Preventive
Services Task Force.

end insert

SEC. 2.  

Section 10123.205 is added to the Insurance Code, to
read:

10123.205.  

(a) Every health insurance policy, except a
specialized health insurance policy, that is issued, amended, or
renewed on or after January 1, 2018, shall provide coverage begin insert without
cost sharing end insert for all colorectal cancer screening examinations and
laboratory tests assigned either a grade of A or a grade of B by the
United States Preventive Services Task Force for individuals at
average begin delete risk. The coverage shall include, at a minimum, all of the
following: end delete

begin delete

(1) High sensitivity fecal occult blood tests (FOBT).

(2) Flexible sigmoidoscopy with high sensitivity FOBT.

(3) Colonoscopies, including the removal of polyps during a
screening procedure.

end delete

begin delete (b) end delete begin delete   end delete begin delete (1) end delete begin delete   end delete begin delete If end delete begin insert risk. If end insert an insured is at high risk for colorectal begin delete cancer, end delete
begin insert cancer as determined by the insured’s health care provider, end insert the
coverage required by subdivision (a) shall include additional
colorectal cancer screening examinations and laboratory tests as
recommended by the begin delete treating physician. end delete begin insert insured’s health care
provider. end insert

begin delete

(2) For purposes of this subdivision, an individual is at high
risk for colorectal cancer if the individual has any of the following:

end delete begin delete

(A) A family medical history of colorectal cancer.

end delete begin delete

(B) A prior occurrence of cancer or precursor neoplastic polyps.

end delete begin delete

(C) A prior occurrence of a chronic digestive disease condition,
including, but not limited to, inflammatory bowel disease, Crohn’s
disease, or ulcerative colitis.

end delete begin delete

(D) Other predisposing factors.

end delete begin delete

(c)

end delete

begin insert (b) end insert  For an insured who is 50 years of age or older, a health
insurance policy shall not impose cost sharing on begin delete either of the
following: end delete begin insert colonoscopies, including the removal of polyps, when
either of the following applies: end insert

begin delete

(1) The coverage required by this section.

end delete begin delete

(2) Colonoscopies, including the removal of polyps during a
screening procedure, if the insured has a positive result on any
fecal test assigned either a grade of A or a grade of B by the United
States Preventive Services Task Force.

end delete begin delete

(d) Paragraph (3) of subdivision (a) shall not apply to a high
deductible health plan, as described in Section 223 of Title 26 of
the United States Code.

end delete begin insert

(1) The colonoscopy is a screening procedure not occasioned
by a recent positive test or procedure.

end insert begin insert

(2) The colonoscopy has been scheduled because of a positive
result on a test or procedure, other than a colonoscopy, assigned
either a grade of A or a grade of B by the United States Preventive
Services Task Force.

end insert

SEC. 3.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.