Amended in Assembly May 31, 2016

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 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 begin delete and laboratory tests recommended by the health care provider, end delete begin insert as listed by the United States Preventative Services Task Force as a recommended screening strategy and at least at the frequency established pursuant to regulations issued by the federal Centers for Medicare and Medicaid Services for the Medicare program end insert if the individual is at high risk for colorectal begin delete cancer, as determined by the health care provider. end delete begin insert cancer. end insert The bill would prohibit a health care service plan contract or a health insurance policy from imposing cost sharing on an individual who is begin delete 50 end delete begin insert between 50 and 75 end insert years of age begin delete or older end delete 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. If an enrollee is at high risk
for colorectal begin delete cancer as determined by the enrollee’s health care
provider, end delete begin insert cancer, end insert the coverage required by begin insert this end insert subdivision begin delete (a) end delete
shall include additional colorectal cancer screening examinations begin delete and laboratory tests as recommended by the enrollee’s health care
provider. end delete begin insert as listed by the United States Preventative Services Task
Force as a recommended screening strategy and at least at the
frequency established pursuant to regulations issued by the federal
Centers for Medicare and Medicaid Services for the Medicare
program. end insert

(b) For an enrollee who is begin delete 50 years of age or older, end delete begin insert between 50
and 75 years of age, end insert a health care service plan contract shall not
impose cost sharing on colonoscopies, including the removal of
polyps, when either of the following applies:

(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. If an insured is at high risk for colorectal begin delete cancer as
determined by the insured’s health care provider, end delete begin insert cancer, end insert the
coverage required by begin insert this end insert subdivision begin delete (a) end delete shall include additional
colorectal cancer screening examinations begin delete and laboratory tests as
recommended by the insured’s health care provider. end delete begin insert as listed by
the United States Preventative Services Task Force as a
recommended screening strategy and at least at the frequency
established pursuant to regulations issued by the federal Centers
for Medicare and Medicaid Services for the Medicare program. end insert

(b) For an insured who is begin delete 50 years of age or older, end delete begin insert between 50
and 75 years of age, end insert a health insurance policy shall not impose
cost sharing on colonoscopies, including the removal of polyps,
when either of the following applies:

(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.