Text: HSB590            Text: HSB592


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: TLSB 5371HC (1) 83 av/sc 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. LSB 5371HC (1) 83 av/sc
Text: HSB590            Text: HSB592