BILL ANALYSIS Ó
AB 1763
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CONCURRENCE IN SENATE AMENDMENTS
AB
1763 (Gipson)
As Amended June 27, 2016
Majority vote
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|ASSEMBLY: |67-5 |(June 2, 2016) |SENATE: |24-12 |(August 18, |
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Original Committee Reference: HEALTH
SUMMARY: Requires health care service plan (health plan) and
health insurance coverage without cost sharing for specified
colorectal cancer screening examinations and laboratory tests
for individuals at average risk, and requires coverage for
additional colorectal cancer screening examinations without
cost-sharing for individuals at high risk, as specified.
Prohibits the imposition of cost sharing on colonoscopies,
including the removal of polyps, for an enrollee who is between
50 and 75 years of age and has received a positive test, as
specified.
The Senate amendments add language specifying that this bill
does not require a health plan or insurer with a network of
providers to provide benefits for out-of-network services nor
does it preclude a health plan or insurer with a network of
providers from imposing cost-sharing requirements for
out-of-network provider services.
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FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)No fiscal impact on the Medi-Cal program is anticipated, as
program beneficiaries are not subject to cost sharing.
2)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 (CHBRP),
prohibiting cost sharing for specified screening will modestly
increase utilization of screening examinations. Overall,
CHBRP 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 to CHBRP, subsequent amendments to this bill since
that analysis was prepared will not substantially change the
projected costs.
3)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
states 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, this bill is
not expected to result in the state being responsible for
subsidizing coverage.
4)One-time costs of about $90,000 over the first two years and
ongoing costs of $25,000 per year for reviews of insurance
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plan compliance by the Department of Insurance (CDI Insurance
Fund).
5)Ongoing costs of less than $50,000 per year for review of
health plan compliance by the Department of Managed Health
Care (DMHC Managed Care Fund).
COMMENTS: According to the author, stool blood tests are an
important colorectal cancer screening option. Availability is
better than for colonoscopy, the cost is lower, and they offer
the opportunity to increase the overall screening rate which
would reduce incidence and mortality. Some individuals,
including those from low income communities and communities of
color may not have initial access to screening colonoscopy.
Some prefer a stool blood test because the procedure is simpler,
there is lower risk of complications and it is less invasive.
Screening with stool blood tests has been shown to decrease
incidence and mortality in randomized controlled trials, and
years of life saved are essentially the same as with colonoscopy
screening. However, the benefits of stool blood tests as a
strategy to reach more Californians, especially in communities
with lower access to colonoscopy services are not realized when
there is a cost to patients. A co-pay or cost-sharing can be a
barrier, preventing some individuals with positive stool blood
tests from getting a follow up colonoscopy to complete the
colorectal cancer screening process, defeating the purpose of
screening. A policy that removes the cost to patients will make
stool blood tests a more viable screening option and will reduce
costs to payers.
Patient Protection and Affordable Care Act (ACA) Preventive
Services Mandate. The ACA requires coverage for and elimination
of cost-sharing on certain recommended preventive health
services, for policies renewing on or after September 23, 2010,
based on guidelines from the United States Preventive Services
Task Force (USPSTF). There are 15 covered preventive services
for adults which include one-time screening for abdominal aortic
aneurysm, screening and counseling for alcohol misuse, aspirin,
blood pressure screening, cholesterol screening, depression
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screening, screening for Type 2 Diabetes, diet counseling, HIV
screening, immunizations, obesity screening and counseling,
prevention counseling for sexually transmitted infection,
screening and cessation interventions for tobacco use, and
colorectal cancer screening for adults over 50.
Colorectal Cancer Screening. According to the National Cancer
Institute, colorectal cancer is a disease in which malignant
(cancer) cells form in the tissues of the colon or the rectum.
Colorectal cancer is the second leading cause of death from
cancer in the United States. For the vast majority of adults,
the most important risk factor for colorectal cancer is older
age. Most cases of colorectal cancer occur among adults older
than 50 years; the median age at diagnosis is 68 years. A
positive family history (excluding known inherited familial
syndromes) is thought to be linked to about 20% of cases of
colorectal cancer. The final USPSTF recommendation for
colorectal cancer screening recommends screening with one of
several approved methodologies for colorectal cancer starting at
age 50 years and continuing until age 75 years. The decision to
screen for colorectal cancer in adults aged 76 to 85 years
should be an individual one, taking into account the patients
overall health and prior screening history. The screening
modalities and intervals are fecal occult blood test (FOBT),
which has received an A or B recommendation from the USPSTF and
Fecal immunochemical test (FIT), which is recommended in the
2016 draft updated guidelines. Both tests are suggested
annually to detect cancer. A flexible sigmoidoscopy is
recommended every five years to detect polyps and cancer and has
received an A or B recommendation from the USPSTF. A
colonoscopy is recommended every 10 years to detect polyps and
cancer and has received an A or B recommendation. It is also
recommended that a colonoscopy should be performed if test
results are positive.
Analysis Prepared by:
Kristene Mapile / HEALTH / (916) 319-2097 FN:
0004119
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