BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1763 (Gipson) - Health care coverage: colorectal cancer:
screening and testing
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|Version: June 27, 2016 |Policy Vote: HEALTH 7 - 1 |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: August 1, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 1763 would require health insurers and health plans
to provide coverage for specified colorectal cancer screening
examinations and laboratory tests with no cost sharing.
Fiscal
Impact:
No fiscal impact on the Medi-Cal program is anticipated, as
program beneficiaries are not subject to cost sharing.
Increased costs of $1.3 million per year to CalPERS, due to
increased utilization of screening tests (various funds).
According to an analysis of a prior version of this bill by
the California Health Benefits Review Program, prohibiting
cost sharing for specified screening will modestly increase
utilization of screening examinations. Overall, the Program
projects that about 2,500 additional individuals per year will
receive colorectal screening exams due to the elimination of
cost sharing. The proportional impact of that increased
utilization on the CalPERS system is $1.3 million. According
AB 1763 (Gipson) Page 1 of
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to the Program, subsequent amendments to the bill since that
analysis was prepared will not substantially change the
projected costs.
No state cost to subsidize health care coverage through
Covered California is anticipated. Under federal law, any new
mandated health benefit that exceeds the benefits in the
state's essential health benefits benchmark plan would be a
state responsibility. In other words, to the extent that the
state imposes a new benefit mandate that exceeds the essential
health benefits benchmark, the state would be responsible for
paying for the cost to subsidize that benefit for those
individuals who receive subsidized coverage through Covered
California. Because this bill does not mandate a new benefit,
but only change the terms of an existing benefit, the bill is
not expected to result in the state being responsible for
subsidizing coverage.
One-time costs of about $90,000 over the first two years and
ongoing costs of $25,000 per year for reviews of insurance
plan compliance by the Department of Insurance (Insurance
Fund).
Ongoing costs of less than $50,000 per year for review of
health plan compliance by the Department of Managed Health
Care (Managed Care Fund).
Background: Under current law, health insurers are regulated by the
Department of Insurance and health plans are regulated by the
Department of Managed Health Care.
Under current federal and state law, health insurers and health
plans are required to provide coverage without cost sharing for
certain preventative services. One category of covered
preventative are those services that have been rated either "A"
or "B" by the United States Preventive Services Task Force.
The United States Preventive Services Task Force has given an
"A" rating to colorectal screening for individuals aged 50 to
75, including fecal occult blood test, flexible sigmoidoscopy,
and colonoscopy. Draft recommendations for an update to the
recommendations includes an "A" rating for fecal immunochemical
test.
AB 1763 (Gipson) Page 2 of
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While current law requires all recommended screening to be
covered without cost sharing, in some circumstances recommended
screening tests are not currently being covered. For example,
patients can receive a fecal occult blood test without any cost
sharing. If the test comes back positive, current guidelines
recommend a follow-up colonoscopy. However, some health insurers
or health plans characterize the follow-up colonoscopy as a
diagnostic test, rather than a screening test. In those cases,
the patient may have a copayment or coinsurance requirement.
Proposed Law:
AB 1763 would require health insurers and health plans to
provide coverage for specified colorectal cancer screening
examinations and laboratory tests with no cost sharing.
Specific provisions of the bill would:
Require every health insurance policy or health care service
plant contract (except a specialized health care service plan)
to provide coverage without any cost sharing for all
colorectal cancer screening examinations and laboratory tests
assigned either a grade of "A" or "B" by the United States
Preventive Services Task Force for individuals at average
risk;
For enrollees at high risk for colorectal cancer, the bill
would require coverage without cost sharing for additional
colorectal cancer screening examinations listed by the United
States Preventive Services Task Force, at the frequency
required under Medicare;
Impose the above requirements beginning on January 1, 2018;
For an enrollee between 50 and 75 years of age, prohibit cost
sharing for colonoscopies when the colonoscopy is a screening
procedure not occasioned by a positive result from another
test or when a colonoscopy has been scheduled due to a
positive result from another test;
Specify that the bill does not require a health insurer or
health plan to provide coverage for services provided by an
out-of-network provider or prohibit a health insurer or health
plan from imposing cost sharing requirements for services
provided by an out-of-network provider.
AB 1763 (Gipson) Page 3 of
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Staff
Comments: According to an analysis of a prior version of the
bill by the California Health Benefits Program, there is a
preponderance of evidence that recommended screening tests for
colorectal cancer are medically effective for the detection and
prevention of colorectal cancer. At the individual level, the
bill is likely to result in health and quality of life
improvements due to earlier identification of colorectal cancer
when it is more treatable. At the population level, the Program
did not find that the bill will result in measureable public
health impacts, because a relatively small number of individuals
would receive additional screening under the bill.
The only costs that may be incurred by a local agency relate to
crimes and infractions. Under the California Constitution, such
costs are not reimbursable by the state.
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