BILL ANALYSIS Ó
AB 1763
Page 1
ASSEMBLY THIRD READING
AB
1763 (Gipson)
As Amended May 31, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |14-0 |Wood, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Campos, Chiu, Gomez, | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Olsen, Rodriguez, | |
| | |Santiago, Steinorth | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |14-3 |Gonzalez, Bloom, |Bigelow, Jones, |
| | |Bonilla, Bonta, |Wagner |
| | |Calderon, Daly, | |
| | |Eggman, Eduardo | |
| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Quirk, Santiago, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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AB 1763
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SUMMARY: Requires health care service plan (health plan)
contracts and health insurance policies to cover all colorectal
cancer (CRC) screening examinations and laboratory tests
assigned either an "A" or "B" grade by the United States
Preventive Services Task Force (USPSTF) for individuals at
average risk. Requires coverage for high risk individuals to
include additional tests as listed by the USPSTF 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. Prohibits cost
sharing for individuals 50 to 75 years of age, as specified.
FISCAL EFFECT:
1)This bill has been narrowed since the California Health
Benefits Review Program (CHBRP) reviewed its provisions.
CHBRP found the following costs associated with a more
expansive version of this bill:
a) No costs to Medi-Cal (General Fund/federal) and $1.3
million to CalPERS for increased premiums.
b) Increased employer-funded premium costs in the private
insurance market of approximately $17.3 million.
c) Increased premium expenditures by employees and
individuals purchasing insurance of $26.5 million, and
decreased out-of-pocket expenses of $35.4 million.
Though a revised CHBRP review is not available at this time,
the narrower bill is likely to result in a lower cost impact
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than noted above.
2)Minor costs to the California Department of Insurance
(Insurance Fund) and the Department of Managed Health Care
(Managed Care Fund) to verify plans and insurers comply with
this requirement.
COMMENTS: According to the author, this bill is needed to
remove cost barriers to colonoscopies for adults 50 to 75 years
of age, helping to catch cases of CRC sooner and save the lives
of many. The author notes that the Patient Protection and
Affordable Care Act (ACA) requires coverage of CRC screening
tests by health plans with no cost sharing for persons age 50 to
75 years. This is important because cost had been a barrier to
more people getting life-saving early detection tests for CRC.
Some individuals, including those from low income communities
and communities of color may not have initial access to
screening colonoscopy or may prefer a stool blood test because
the procedure is simpler, has lower risk of complications, and
is less invasive. If a stool blood test is positive, follow up
colonoscopy is needed to examine the entire colon and remove any
polyps found during the procedure. This process is still part
of the "screening" and completes the continuum of care in CRC
screening. However, some plans impose cost sharing for the
follow up colonoscopy and/or the polyp removal. Some patients,
because of cost, will forgo the follow up colonoscopy leaving
them at higher risk for CRC and death. As with all cancers, the
sooner it is detected and treated, the more likely the patient
is to survive.
The USPSTF recommends, with an "A" grade, screening for
colorectal cancer using fecal occult blood testing,
sigmoidoscopy, or colonoscopy in adults, beginning at age 50
years and continuing until age 75 years. The federal
Departments of Labor, Health and Human Services, and Treasury
has published frequently asked questions (FAQs) with answers
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related to provisions of the ACA. Set 12 of these FAQs include
the following two that are relevant to this bill:
Question: If a colonoscopy is scheduled and performed as a
screening procedure pursuant to the USPSTF recommendation, is it
permissible for a plan or issuer to impose cost-sharing for the
cost of a polyp removal during the colonoscopy? Answer: No.
Based on clinical practice and comments received from the
American College of Gastroenterology, American
Gastroenterological Association, American Society of
Gastrointestinal Endoscopy, and the Society for Gastroenterology
Nurses and Associates, polyp removal is an integral part of a
colonoscopy. Accordingly, the plan or issuer may not impose
cost-sharing with respect to a polyp removal during a
colonoscopy performed as a screening procedure. On the other
hand, a plan or issuer may impose cost-sharing for a treatment
that is not a recommended preventive service, even if the
treatment results from a recommended preventive service.
Question: Some USPSTF recommendations apply to certain
populations identified as high-risk. Some individuals, for
example, are at increased risk for certain diseases because they
have a family or personal history of the disease. It is not
clear, however, how a plan or issuer would identify individuals
who belong to a high-risk population. How can a plan or issuer
determine when a service should or should not be covered without
cost-sharing? Answer: Identification of "high-risk"
individuals is determined by clinical expertise. Decisions
regarding whether an individual is part of a high-risk
population, and should therefore receive a specific preventive
item or service identified for those at high-risk, should be
made by the attending provider. Therefore, if the attending
provider determines that a patient belongs to a high-risk
population and a USPSTF recommendation applies to that high-risk
population, that service is required to be covered in accordance
with the requirements of the interim final regulations (that is,
without cost-sharing, subject to reasonable medical management).
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The American Cancer Society Cancer Acton Network (ACS CAN), a
cosponsor of this bill, states that CRC is the second leading
cause of cancer deaths in the United States (U.S.) but is the
most preventable with screening and early detection. Timely and
appropriate screening can decrease CRC incidence and mortality
by 30% to 60%. ACS CAN argues that the overall reduction of CRC
incidence and mortality rates in the U.S. over the last few
years has largely been attributed to increased preventative
screening. Eliminating out-of-pocket cost - sharing for
follow-up colonoscopy after a positive stool test will remove a
significant barrier to CRC screening and it will greatly
contribute to the goal of increasing the nation's CRC screening
rate to 80% by 2018. The California Black Health Network
supports this bill because of the devastating incidence of CRC
in the African-American community.
The California Association of Health Plans argues that this bill
will increase costs for employers and individuals by creating a
new benefit mandate that expands CRC screening while prohibiting
cost-sharing. Blue Shield of California argues that new USPSTF
screening recommendations expected later in 2016 are likely to
be different than current ones, making this bill premature. The
Association of California Health Insurance Companies and
America's Health Insurance Plans oppose all mandate bills this
year arguing that they all negatively impact a robust health
insurance marketplace offering competition and choice and stifle
the use of innovative, evidence-based medicine. The California
Chamber of Commerce has a number of concerns, including that the
cost impact of this bill falls on all enrollees, not only those
in the 50 to75-year age range.
Analysis Prepared by:
John Gilman / HEALTH / (916) 319-2097 FN:
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