BILL NUMBER: AB 1763 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 27, 2016
INTRODUCED BY Assembly Member Gipson
FEBRUARY 3, 2016
An act to add Section 1367.667 to the 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
without cost sharing 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 health care provider,
if the individual is at high risk for colorectal
cancer. cancer, as determined by the health care
provider. 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. older for colonoscopies
conducted for specified purposes. 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 without any cost sharing 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 risk. The coverage
shall include, at a minimum, all of the following:
(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.
(b) (1)
If risk. If an
enrollee is at high risk for colorectal cancer,
cancer as determined by the enrollee's health care provider,
the coverage required by subdivision (a) shall include
additional colorectal cancer screening examinations and laboratory
tests as recommended by the treating physician.
enrollee's health care provider.
(2) For purposes of this subdivision, an individual is at high
risk for colorectal cancer if the individual has any of the
following:
(A) A family medical history of colorectal cancer.
(B) A prior occurrence of cancer or precursor neoplastic polyps.
(C) A prior occurrence of a chronic digestive disease condition,
including, but not limited to, inflammatory bowel disease, Crohn's
disease, or ulcerative colitis.
(D) Other predisposing factors.
(c)
(b) For an enrollee who is 50 years of age or older, a
health care service plan contract shall not impose cost sharing on
either of the following: colonoscopies,
including the removal of polyps, when either of the following
applies:
(1) The coverage required by this section.
(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.
(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.
(1) The colonoscopy is a screening procedure not occasioned by a
recent positive test or procedure.
(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.
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
without cost sharing 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 risk. The coverage shall include, at
a minimum, all of the following:
(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.
(b) (1)
If risk. If an
insured is at high risk for colorectal cancer,
cancer as determined by the insured's health care provider,
the coverage required by subdivision (a) shall include
additional colorectal cancer screening examinations and laboratory
tests as recommended by the treating physician.
insured's health care provider.
(2) For purposes of this subdivision, an individual is at high
risk for colorectal cancer if the individual has any of the
following:
(A) A family medical history of colorectal cancer.
(B) A prior occurrence of cancer or precursor neoplastic polyps.
(C) A prior occurrence of a chronic digestive disease condition,
including, but not limited to, inflammatory bowel disease, Crohn's
disease, or ulcerative colitis.
(D) Other predisposing factors.
(c)
(b) For an insured who is 50 years of age or older, a
health insurance policy shall not impose cost sharing on
either of the following: colonoscopies, including the
removal of polyps, when either of the following applies:
(1) The coverage required by this section.
(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.
(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.
(1) The colonoscopy is a screening procedure not occasioned by a
recent positive test or procedure.
(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.
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.