House Study Bill 591



                                    HOUSE FILE       
                                    BY  (PROPOSED COMMITTEE ON
                                        COMMERCE BILL BY
                                        CHAIRPERSON PETERSEN)

                                         A BILL FOR

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



  1  1    Section 1.  NEW SECTION.  514C.26  Preventive health care
  1  2 services == colorectal cancer screening coverage.
  1  3    1.  Notwithstanding the uniformity of treatment requirements
  1  4 of section 514C.6, a policy, contract, or plan providing for
  1  5 third=party payment or prepayment of health or medical expenses
  1  6 shall provide coverage for the cost of preventive health care
  1  7 services for colorectal cancer screening  as provided in this
  1  8 section.
  1  9    2.  Such coverage shall be provided for preventive health
  1 10 care services for colorectal cancer screening for the early
  1 11 detection of colorectal cancer and adenomatous polyps for all
  1 12 of the following covered persons:
  1 13    a.  Asymptomatic, average=risk adults who are fifty years of
  1 14 age or older.
  1 15    b.  Persons who are at high risk for colorectal cancer,
  1 16 including persons who have a family medical history of
  1 17 colorectal cancer, a prior occurrence of cancer or precursor
  1 18 neoplastic polyps, a prior occurrence of a chronic digestive
  1 19 disease condition such as inflammatory bowel disease, Crohn's
  1 20 disease, or ulcerative colitis, or who have other predisposing
  1 21 factors as determined by the person's treating physician.
  1 22    3.  Such coverage shall include colorectal cancer screening,
  1 23 as determined by a covered person's treating physician, that
  1 24 detects colorectal cancer or adenomatous polyps, pursuant to a
  1 25 recommendation adopted by the task force.
  1 26    4.  As used in this section, unless the context otherwise
  1 27 requires:
  1 28    a.  "Recommendation" means a recommendation adopted by the
  1 29 task force that does either of the following:
  1 30    (1)  Strongly recommends that clinicians provide a
  1 31 preventive health care service for the early detection of
  1 32 colorectal cancer or adenomatous polyps to eligible patients
  1 33 because the task force found good evidence that the preventive
  1 34 health care service improves important health outcomes and
  1 35 concluded that the benefits of the preventive health care
  2  1 service substantially outweigh the harms of providing the
  2  2 service.
  2  3    (2)  Recommends that clinicians provide a preventive health
  2  4 care service for the early detection of colorectal cancer or
  2  5 adenomatous polyps to eligible patients because the task force
  2  6 found fair evidence that the preventive health care service
  2  7 improves important health outcomes and concluded that the
  2  8 benefits of the preventive health care service outweigh the
  2  9 harms of providing the service.
  2 10    b.  "Small employer" means a person actively engaged in
  2 11 business who, during at least fifty percent of the employer's
  2 12 working days during the preceding calendar year, employed not
  2 13 less than two and not more than fifty full=time equivalent
  2 14 employees.
  2 15    c.  "Task force" means the United States preventive services
  2 16 task force, or any successor organization, sponsored by the
  2 17 agency for health care research and quality of the United
  2 18 States department of health and human services.
  2 19    5.  Coverage required pursuant to this section shall not be
  2 20 subject to policy, contract, or plan deductibles.  Copayments
  2 21 and coinsurance may apply to coverage required pursuant to
  2 22 this section.  For a health maintenance organization that
  2 23 directly provides health care services to its enrollees, the
  2 24 policy deductibles, copayments, coinsurance, and any other form
  2 25 of cost sharing for the total costs associated with coverage
  2 26 required by this section shall not exceed ten percent of the
  2 27 cost of the preventive health care service required by this
  2 28 section.
  2 29    6.  a.  This section applies to the following classes of
  2 30 third=party payment provider policies, contracts, or plans
  2 31 delivered, issued for delivery, continued, or renewed in this
  2 32 state on or after July 1, 2010:
  2 33    (1)  Individual or group accident and sickness insurance
  2 34 providing coverage on an expense=incurred basis.
  2 35    (2)  An individual or group hospital or medical service
  3  1 contract issued pursuant to chapter 509, 514, or 514A.
  3  2    (3)  An individual or group health maintenance organization
  3  3 contract regulated under chapter 514B.
  3  4    (4)  A policy, contract, or plan offered by an entity that
  3  5 is engaged in the business of insurance, risk transfer, or
  3  6 risk retention and that is subject to the jurisdiction of the
  3  7 commissioner.
  3  8    (5)  A plan established pursuant to chapter 509A for public
  3  9 employees.
  3 10    (6)  A policy, contract, or plan offered by an organized
  3 11 delivery system licensed by the director of public health.
  3 12    b.  Notwithstanding paragraph "a", a small employer may
  3 13 purchase health benefit coverage that does not include the
  3 14 coverage required by this section.
  3 15    c.  This section shall not apply to accident=only, specified
  3 16 disease, short=term hospital or medical, hospital confinement
  3 17 indemnity, credit, dental, vision, Medicare supplement,
  3 18 long=term care, basic hospital and medical=surgical expense
  3 19 coverage as defined by the commissioner by rule, disability
  3 20 income insurance coverage, coverage issued as a supplement
  3 21 to liability insurance, workers' compensation or similar
  3 22 insurance, or automobile medical payment insurance.
  3 23                           EXPLANATION
  3 24    This bill creates new Code section 514C.26, which requires
  3 25 that certain health insurance policies, contracts, or plans
  3 26 provide coverage for preventive health services for colorectal
  3 27 cancer screening for the early detection of colorectal cancer
  3 28 and adenomatous polyps.  The coverage is required for covered
  3 29 persons who are asymptomatic, average=risk adults 55 years of
  3 30 age or older or persons at high risk for colorectal cancer,
  3 31 based on a number of specified factors.
  3 32    The required coverage includes tests as determined by a
  3 33 covered person's treating physician that detect colorectal
  3 34 cancer or adenomatous polyps pursuant to a recommendation made
  3 35 by the United States preventive services task force, sponsored
  4  1 by the agency for health care research and quality, which is
  4  2 the health services research arm of the federal department
  4  3 of health and human services.  Such recommendations must be
  4  4 based either on a strong recommendation by the task force
  4  5 that there is good evidence or a recommendation that there is
  4  6 fair evidence that the preventive health care service being
  4  7 recommended improves important health outcomes and that the
  4  8 benefits of the service outweigh the harms of providing the
  4  9 service.
  4 10    New Code section 514C.26 applies to specified classes of
  4 11 third=party payment provider policies, contracts, or plans
  4 12 delivered, issued for delivery, continued, or renewed in this
  4 13 state on or after July 1, 2010.   A small employer employing two
  4 14 to 50 employees is not required to purchase the required health
  4 15 services coverage.  The Code section also does not apply to
  4 16 specified limited types of health coverage.
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