SF 2048 (LSB 5480XS (2) 91)

SENATE FILE 2048

BY  DONAHUE, STAED, HARDMAN, DREY, BLAKE, KNOX, BISIGNANO, TOWNSEND, PETERSEN, ZIMMER, WINCKLER, QUIRMBACH, DOTZLER, WEINER, TRONE GARRIOTT, and BENNETT

A BILL FOR

An Act relating to insurance coverage and Medicaid coverage for annual lung cancer screenings for at-risk individuals.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  249A.34  Annual lung cancer screenings.
   1.  As used in this section, unless the context requires otherwise:
   a.  “At-risk individual” means a recipient forty years of age or older to which any of the following circumstances apply:
   (1)  The individual has smoked cigarettes regularly or experienced secondhand smoke regularly.
   (2)  The individual has an immediate family member diagnosed with lung cancer.
   (3)  The individual has been regularly exposed to asbestos, radon, arsenic, nickel, chromium, tar, or soot in the individual’s home or workplace.
   b.  “Lung cancer screening” means a scan of the lungs using low-dose computed tomography.
   2.  The department shall seek any federal waiver necessary for the medical assistance program to provide coverage for an annual lung cancer screening for at-risk individuals. Contingent on receiving approval of a federal waiver, and effective immediately upon receiving approval of a federal waiver, the medical assistance program shall provide coverage for annual lung cancer screenings for at-risk individuals.
    Sec. 2.  NEW SECTION.  514C.37  Annual lung cancer screening —— coverage.
   1.  As used in this section, unless the context otherwise requires:
   a.  “At-risk individual” means a covered person forty years of age or older to which any of the following circumstances apply:
   (1)  The individual has smoked cigarettes regularly or experienced secondhand smoke regularly.
   (2)  The individual has an immediate family member diagnosed with lung cancer.
   (3)  The individual has been regularly exposed to asbestos, radon, arsenic, nickel, chromium, tar, or soot in the individual’s home or workplace.
   b.  “Cost-sharing” means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense obligation imposed on a covered person by a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses.
   c.  “Covered person” means a policyholder, subscriber, or other person participating in a policy, contract, or plan that provides for third-party payment or prepayment of health or medical expenses.
   d.  “Lung cancer screening” means a scan of the lungs using low-dose computed tomography.
   2.  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 an annual lung cancer screening for an at-risk individual.
   3.  Cost-sharing shall not be imposed by a health carrier for coverage required under this section.
   4.  a.  This section applies to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2027:
   (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 plan established for public employees pursuant to chapter 509A.
   b.  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 of insurance, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   5.  The commissioner of insurance may adopt rules pursuant to chapter 17A to administer this section.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to insurance coverage and medical assistance program (Medicaid) coverage for annual lung cancer screenings for at-risk individuals.
   The bill defines “at-risk individual” as a recipient or covered person 40 years of age or older that either has smoked cigarettes regularly or experienced secondhand smoke regularly, has an immediate family member diagnosed with lung cancer, or has been regularly exposed to asbestos, radon, arsenic, nickel, chromium, tar, or soot in the individual’s home or workplace. The bill defines “lung cancer screening” as a scan of the lungs using low-dose computed tomography.
   Under the bill, the department of health and human services shall seek any federal waiver necessary for Medicaid to provide coverage for an annual lung cancer screening for at-risk individuals. Contingent on receiving approval of, and effective immediately upon receiving approval of, a federal waiver, Medicaid shall provide coverage for annual lung cancer screenings for at-risk individuals.
   The bill requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses to provide coverage for an annual lung cancer screening for an at-risk individual. Cost-sharing shall not be imposed by a health carrier for coverage required under the bill.
   Coverage required under the bill shall not be less favorable than coverage a health carrier offers for screening mammograms.
   The bill applies to third-party payment providers enumerated in the bill, and the commissioner of insurance may adopt rules to administer the requirements of the bill applying to such third-party payment providers.
   The bill specifies the types of specialized health-related insurance which are not subject to the coverage requirements of the bill.