BILL NUMBER: AB 1763	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 31, 2016
	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 health care
provider,   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  if the individual is at high risk for colorectal
 cancer, as determined by the health care provider. 
 cancer.  The bill would prohibit a health care service
plan contract or a health insurance policy from imposing cost sharing
on an individual who is 50   between 50 and 75
 years of age  or 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. If an enrollee is at high risk for
colorectal  cancer as determined by the enrollee's health
care provider,   cancer, the coverage required by
 this  subdivision  (a)  shall include
additional colorectal cancer screening examinations  and
laboratory tests as recommended by the enrollee's health care
provider.   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. 
   (b) For an enrollee who is  50 years of age or older,
  between 50 and 75 years of age,  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 
cancer as determined by the insured's health care provider, 
 cancer,  the coverage required by  this 
subdivision  (a)  shall include additional
colorectal cancer screening examinations  and laboratory
tests as recommended by the insured's health care provider. 
 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. 
   (b) For an insured who is  50 years of age or older,
  between 50 and 75 years of age,  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.