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 as listed by the United Statesbegin delete Preventativeend deletebegin insert Preventiveend insert 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. The bill would
prohibit a health care service plan contract or a health insurance policy from imposing cost sharing on an individual who is between 50 and 75 years of age for colonoscopies conducted for specified purposes.begin insert The bill would also provide that it does not require a plan or insurer to provide benefits for items or services delivered by an out-of-network provider and does not preclude a plan or insurer from imposing cost-sharing requirements for items or services that are delivered by an out-of-network provider.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 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 without any cost sharing for all colorectal cancer
7screening examinations and laboratory tests assigned either a grade
8of A or a grade of B by the United States Preventive Services Task
9Force for individuals at average risk. If an enrollee is at high risk
P3 1for colorectal cancer, the coverage required by this subdivision
2shall include additional colorectal cancer screening examinations
3as listed by the United Statesbegin delete Preventativeend deletebegin insert
Preventiveend insert Services
4Task Force as a recommended screening strategy and at least at
5the frequency established pursuant to regulations issued by the
6federal Centers for Medicare and Medicaid Services for the
7Medicare program.
8(b) For an enrollee who is between 50 and 75 years of age, a
9health care service plan contract shall not impose cost sharing on
10colonoscopies, including the removal of polyps, when either of
11the following applies:
12(1) The colonoscopy is a screening procedure not occasioned
13by a recent positive test or procedure.
14(2) The colonoscopy has been scheduled because of a positive
15result on a test or procedure, other than a colonoscopy, assigned
16either a grade of A or
a grade of B by the United States Preventive
17Services Task Force.
18
(c) Nothing in this section requires a plan that has a network
19of providers to provide benefits for items or services described in
20this section that are delivered by an out-of-network provider or
21precludes a plan that has a network of providers from imposing
22cost-sharing requirements for the items or services described in
23this section that are delivered by an out-of-network provider.
Section 10123.205 is added to the Insurance Code, to
25read:
(a) Every health insurance policy, except a
27specialized health insurance policy, that is issued, amended, or
28renewed on or after January 1, 2018, shall provide coverage without
29cost sharing for all colorectal cancer screening examinations and
30laboratory tests assigned either a grade of A or a grade of B by the
31United States Preventive Services Task Force for individuals at
32average risk. If an insured is at high risk for colorectal cancer, the
33coverage required by this subdivision shall include additional
34colorectal cancer screening examinations
as listed by the United
35Statesbegin delete Preventativeend deletebegin insert Preventiveend insert Services Task Force as a
36recommended screening strategy and at least at the frequency
37established pursuant to regulations issued by the federal Centers
38for Medicare and Medicaid Services for the Medicare program.
39(b) For an insured who is between 50 and 75 years of age, a
40health insurance policy shall not impose cost sharing on
P4 1colonoscopies, including the removal of polyps, when either of
2the following applies:
3(1) The colonoscopy is a screening procedure not occasioned
4by a recent positive test or procedure.
5(2) The colonoscopy has been scheduled because of a positive
6result on a test or procedure, other than a colonoscopy, assigned
7either a grade of A or a grade of B by the United States Preventive
8Services Task Force.
9
(c) Nothing in this section requires an insurer that has a network
10of providers to provide benefits for items or services described in
11this section that are delivered by an out-of-network provider or
12precludes an insurer that has a network of providers from imposing
13cost-sharing requirements for the items or services described in
14this section that are delivered by an out-of-network provider.
No reimbursement is required by this act pursuant to
16Section 6 of Article XIII B of the California Constitution because
17the only costs that may be incurred by a local agency or school
18district will be incurred because this act creates a new crime or
19infraction, eliminates a crime or infraction, or changes the penalty
20for a crime or infraction, within the meaning of Section 17556 of
21the Government Code, or changes the definition of a crime within
22the meaning of Section 6 of Article XIII B of the California
23Constitution.
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