HSB 591 (LSB 5371HC (1) 83)

HOUSE FILE _____

BY  (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON PETERSEN)

A BILL FOR

An Act requiring that certain health insurance policies provide coverage for preventive screenings and services for colorectal cancer.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.26  Preventive health care services —— colorectal cancer screening coverage.
   1.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide coverage for the cost of preventive health care services for colorectal cancer screening as provided in this section.
   2.  Such coverage shall be provided for preventive health care services for colorectal cancer screening for the early detection of colorectal cancer and adenomatous polyps for all of the following covered persons:
   a.  Asymptomatic, average-risk adults who are fifty years of age or older.
   b.  Persons who are at high risk for colorectal cancer, including persons who have a family medical history of colorectal cancer, a prior occurrence of cancer or precursor neoplastic polyps, a prior occurrence of a chronic digestive disease condition such as inflammatory bowel disease, Crohn’s disease, or ulcerative colitis, or who have other predisposing factors as determined by the person’s treating physician.
   3.  Such coverage shall include colorectal cancer screening, as determined by a covered person’s treating physician, that detects colorectal cancer or adenomatous polyps, pursuant to a recommendation adopted by the task force.
   4.  As used in this section, unless the context otherwise requires:
   a.  “Recommendation” means a recommendation adopted by the task force that does either of the following:
   (1)  Strongly recommends that clinicians provide a preventive health care service for the early detection of colorectal cancer or adenomatous polyps to eligible patients because the task force found good evidence that the preventive health care service improves important health outcomes and concluded that the benefits of the preventive health care service substantially outweigh the harms of providing the service.
   (2)  Recommends that clinicians provide a preventive health care service for the early detection of colorectal cancer or adenomatous polyps to eligible patients because the task force found fair evidence that the preventive health care service improves important health outcomes and concluded that the benefits of the preventive health care service outweigh the harms of providing the service.
   b.  “Small employer” means a person actively engaged in business who, during at least fifty percent of the employer’s working days during the preceding calendar year, employed not less than two and not more than fifty full-time equivalent employees.
   c.  “Task force” means the United States preventive services task force, or any successor organization, sponsored by the agency for health care research and quality of the United States department of health and human services.
   5.  Coverage required pursuant to this section shall not be subject to policy, contract, or plan deductibles. Copayments and coinsurance may apply to coverage required pursuant to this section. For a health maintenance organization that directly provides health care services to its enrollees, the policy deductibles, copayments, coinsurance, and any other form of cost sharing for the total costs associated with coverage required by this section shall not exceed ten percent of the cost of the preventive health care service required by this section.
   6.  a.  This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2010:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  A policy, contract, or plan offered by an entity that is engaged in the business of insurance, risk transfer, or risk retention and that is subject to the jurisdiction of the commissioner.
   (5)  A plan established pursuant to chapter 509A for public employees.
   (6)  A policy, contract, or plan offered by an organized delivery system licensed by the director of public health.
   b.  Notwithstanding paragraph “a”, a small employer may purchase health benefit coverage that does not include the coverage required by this section.
   c.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner by rule, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
EXPLANATION
   This bill creates new Code section 514C.26, which requires that certain health insurance policies, contracts, or plans provide coverage for preventive health services for colorectal cancer screening for the early detection of colorectal cancer and adenomatous polyps. The coverage is required for covered persons who are asymptomatic, average-risk adults 55 years of age or older or persons at high risk for colorectal cancer, based on a number of specified factors.
   The required coverage includes tests as determined by a covered person’s treating physician that detect colorectal cancer or adenomatous polyps pursuant to a recommendation made by the United States preventive services task force, sponsored by the agency for health care research and quality, which is the health services research arm of the federal department of health and human services. Such recommendations must be based either on a strong recommendation by the task force that there is good evidence or a recommendation that there is fair evidence that the preventive health care service being recommended improves important health outcomes and that the benefits of the service outweigh the harms of providing the service.
   New Code section 514C.26 applies to specified classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2010. A small employer employing two to 50 employees is not required to purchase the required health services coverage. The Code section also does not apply to specified limited types of health coverage.