S.F. 2061 Section 1. NEW SECTION . 514C.26 Preventive health care 1 services —— colorectal cancer screening coverage. 2 1. Notwithstanding the uniformity of treatment requirements 3 of section 514C.6, a policy, contract, or plan providing for 4 third-party payment or prepayment of health or medical expenses 5 shall provide coverage for the cost of preventive health care 6 services for colorectal cancer screening as provided in this 7 section. 8 2. Such coverage shall be provided for preventive health 9 care services for colorectal cancer screening for the early 10 detection of colorectal cancer and adenomatous polyps for all 11 of the following covered persons: 12 a. Asymptomatic, average-risk adults who are fifty years of 13 age or older. 14 b. Persons who are at high risk for colorectal cancer, 15 including persons who have a family medical history of 16 colorectal cancer, a prior occurrence of cancer or precursor 17 neoplastic polyps, a prior occurrence of a chronic digestive 18 disease condition such as inflammatory bowel disease, Crohn’s 19 disease, or ulcerative colitis, or who have other predisposing 20 factors as determined by the person’s treating physician. 21 3. Such coverage shall include colorectal cancer screening, 22 as determined by a covered person’s treating physician, that 23 detects colorectal cancer or adenomatous polyps, pursuant to a 24 recommendation adopted by the task force. 25 4. As used in this section, unless the context otherwise 26 requires: 27 a. “Recommendation” means a recommendation adopted by the 28 task force that does either of the following: 29 (1) Strongly recommends that clinicians provide a 30 preventive health care service for the early detection of 31 colorectal cancer or adenomatous polyps to eligible patients 32 because the task force found good evidence that the preventive 33 health care service improves important health outcomes and 34 concluded that the benefits of the preventive health care 35 -1- LSB 5371XS (5) 83 av/sc 1/ 4

S.F. 2061 service substantially outweigh the harms of providing the 1 service. 2 (2) Recommends that clinicians provide a preventive health 3 care service for the early detection of colorectal cancer or 4 adenomatous polyps to eligible patients because the task force 5 found fair evidence that the preventive health care service 6 improves important health outcomes and concluded that the 7 benefits of the preventive health care service outweigh the 8 harms of providing the service. 9 b. “Small employer” means a person actively engaged in 10 business who, during at least fifty percent of the employer’s 11 working days during the preceding calendar year, employed not 12 less than two and not more than fifty full-time equivalent 13 employees. 14 c. “Task force” means the United States preventive services 15 task force, or any successor organization, sponsored by the 16 agency for health care research and quality of the United 17 States department of health and human services. 18 5. Coverage required pursuant to this section shall not be 19 subject to policy, contract, or plan deductibles. Copayments 20 and coinsurance may apply to coverage required pursuant to 21 this section. For a health maintenance organization that 22 directly provides health care services to its enrollees, the 23 policy deductibles, copayments, coinsurance, and any other form 24 of cost sharing for the total costs associated with coverage 25 required by this section shall not exceed ten percent of the 26 cost of the preventive health care service required by this 27 section. 28 6. a. This section applies to the following classes of 29 third-party payment provider policies, contracts, or plans 30 delivered, issued for delivery, continued, or renewed in this 31 state on or after July 1, 2010: 32 (1) Individual or group accident and sickness insurance 33 providing coverage on an expense-incurred basis. 34 (2) An individual or group hospital or medical service 35 -2- LSB 5371XS (5) 83 av/sc 2/ 4

S.F. 2061 contract issued pursuant to chapter 509, 514, or 514A. 1 (3) An individual or group health maintenance organization 2 contract regulated under chapter 514B. 3 (4) A policy, contract, or plan offered by an entity that 4 is engaged in the business of insurance, risk transfer, or 5 risk retention and that is subject to the jurisdiction of the 6 commissioner. 7 (5) A plan established pursuant to chapter 509A for public 8 employees. 9 (6) A policy, contract, or plan offered by an organized 10 delivery system licensed by the director of public health. 11 b. Notwithstanding paragraph “a” , a small employer may 12 purchase health benefit coverage that does not include the 13 coverage required by this section. 14 c. This section shall not apply to accident-only, specified 15 disease, short-term hospital or medical, hospital confinement 16 indemnity, credit, dental, vision, Medicare supplement, 17 long-term care, basic hospital and medical-surgical expense 18 coverage as defined by the commissioner by rule, disability 19 income insurance coverage, coverage issued as a supplement 20 to liability insurance, workers’ compensation or similar 21 insurance, or automobile medical payment insurance. 22 EXPLANATION 23 This bill creates new Code section 514C.26, which requires 24 that certain health insurance policies, contracts, or plans 25 provide coverage for preventive health services for colorectal 26 cancer screening for the early detection of colorectal cancer 27 and adenomatous polyps. The coverage is required for covered 28 persons who are asymptomatic, average-risk adults 55 years of 29 age or older or persons at high risk for colorectal cancer, 30 based on a number of specified factors. 31 The required coverage includes tests as determined by a 32 covered person’s treating physician that detect colorectal 33 cancer or adenomatous polyps pursuant to a recommendation made 34 by the United States preventive services task force, sponsored 35 -3- LSB 5371XS (5) 83 av/sc 3/ 4

S.F. 2061 by the agency for health care research and quality, which is 1 the health services research arm of the federal department 2 of health and human services. Such recommendations must be 3 based either on a strong recommendation by the task force 4 that there is good evidence or a recommendation that there is 5 fair evidence that the preventive health care service being 6 recommended improves important health outcomes and that the 7 benefits of the service outweigh the harms of providing the 8 service. 9 New Code section 514C.26 applies to specified classes of 10 third-party payment provider policies, contracts, or plans 11 delivered, issued for delivery, continued, or renewed in this 12 state on or after July 1, 2010. A small employer employing two 13 to 50 employees is not required to purchase the required health 14 services coverage. The Code section also does not apply to 15 specified limited types of health coverage. 16 -4- LSB 5371XS (5) 83 av/sc 4/ 4