Senate
File
2061
-
Introduced
SENATE
FILE
2061
BY
McCOY
A
BILL
FOR
An
Act
requiring
that
certain
health
insurance
policies
1
provide
coverage
for
preventive
screenings
and
services
for
2
colorectal
cancer.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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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
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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
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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
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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
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