HOUSE Amended 3rd Reading April 26, 2013 HOUSE Amended 2nd Reading April 25, 2013First Regular Session Sixty-ninth General Assembly STATE OF COLORADO REENGROSSED This Version Includes All Amendments Adopted in the House of Introduction LLS NO. 13-0492.01 Kristen Forrestal x4217HOUSE BILL 13-1309 HOUSE SPONSORSHIP Primavera, SENATE SPONSORSHIP Nicholson, House Committees Senate Committees Public Health Care & Human Services Appropriations A BILL FOR AN ACT Concerning health insurance coverage for preventive breast imaging. Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries.) The bill requires all sickness and accident insurance policies to provide coverage for breast imaging for all individuals possessing at least one risk factor for breast cancer, including a family history of breast cancer, being 40 years of age or older, or a genetic predisposition to breast cancer. Preventive breast imaging is not subject to copayments, deductibles, or coinsurance. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. In Colorado Revised Statutes, 10-16-104, amend (18) (a) (II) and (18) (b) introductory portion; and repeal (18) (b) (III) as follows: 10-16-104. Mandatory coverage provisions - definitions. (18) Preventive health care services. (a) (II) Nothing in this subsection (18) shall be deemed to apply to a basic health benefit plan issued pursuant to section 10-16-105 (7.2) (b) (I), (7.2) (b) (III), or (7.2) (b) (IV). except that the required coverage for mammography set forth in subparagraph (III) of paragraph (b) of this subsection (18) shall apply to a basic health benefit plan issued pursuant to section 10-16-105 (7.2) (b) (IV). (b) The coverage required by this subsection (18) shall include includes preventive health care services for the following, in accordance with the A or B recommendations of the task force for the particular preventive health care service: (III) (A) Breast cancer screening with mammography: (B) Coverage for breast cancer screening with mammography shall be the lesser of one hundred dollars per mammography screening or the actual charge for such screening, but in no case shall the covered person be required to pay more than the copayment required by the policy or contract for preventive health care services. The minimum benefit required under this subparagraph (III) shall be adjusted to reflect increases and decreases in the consumer price index. (C) Benefits for preventive mammography screenings shall be determined on a calendar year or a contract year basis, which shall be specified in the policy or contract. The preventive and diagnostic coverages provided pursuant to this subparagraph (III) shall in no way diminish or limit diagnostic benefits otherwise allowable under a policy. If a covered person who is eligible for a preventive mammography screening benefit pursuant to this subparagraph (III) has not utilized such benefit during a calendar year or a contract year, then the coverage shall apply to one diagnostic screening for that year. If more than one diagnostic screening is provided for the covered person in a given calendar year or contract year, the other diagnostic service benefit provisions in the policy or contract shall apply with respect to the additional screenings. (D) Notwithstanding the A or B recommendations of the task force, an annual breast cancer screening with mammography shall be covered for all individuals possessing at least one risk factor including, but not limited to, a family history of breast cancer, being forty years of age or older, or a genetic predisposition to breast cancer. SECTION 2. In Colorado Revised Statutes, 10-16-104, repeal as amended by House Bill 13-1266 (18) (b) (III) (A), (18 (b) (III) (C), and (18) (b) (III) (D) as follows: (18) Preventive health care services. (b) The coverage required by this subsection (18) must include preventive health care services for the following, in accordance with the A or B recommendations of the task force for the particular preventive health care service: (III) (A) One breast cancer screening with mammography per year, covering the actual charge for the screening with mammography. (C) Benefits for preventive mammography screenings are determined on a calendar year or a contract year basis, which fact must be specified in the policy or contract. The preventive and diagnostic coverages provided pursuant to this subparagraph (III) do not diminish or limit diagnostic benefits otherwise allowable under a policy or contract. If the covered person receives more than one in a given calendar year or contract year, the other benefit provisions in the policy or contract apply with respect to the additional screenings. (D) Notwithstanding the A or B recommendations of the task force, a policy or contract subject to this subsection (18) must cover an annual breast cancer screening with mammography for all individuals possessing at least one risk factor, including a family history of breast cancer, being forty years of age or older, or a genetic predisposition to breast cancer. SECTION 3. In Colorado Revised Statutes, 10-16-104, add (18.5) as follows: 10-16-104. Mandatory coverage provisions - definitions. (18.5) Breast imaging. (a) All individual and all group sickness and accident insurance policies, except supplemental policies covering a specified disease or other limited benefit, that are delivered or issued for delivery within this state by an entity subject to part 2 of this article; all individual and group health care service or indemnity contracts issued by an entity subject to part 3 or 4 of this article; and any other individual or group health care coverage offered to residents of this state shall provide coverage for the preventive mammography and diagnostic breast imaging as specified in paragraph (b) of this subsection (18.5). (b) (I) The policies subject to this subsection (18.5) must provide coverage for preventive mammography and diagnostic breast imaging, with or without a clinical examination, for all individuals: (A) Possessing at least one risk factor for breast cancer, including a family history of breast cancer; (B) Forty years of age or older; (C) Presenting with symptoms; or (D) With an increased lifetime risk of breast cancer determined by a risk factor model such as Tyrer-Cuzick, BRCAPRO, or Gail. (II) The coverage for preventive mammography is not subject to policy deductibles, copayments, or coinsurance. (III) The coverage for breast imaging is not subject to cost-sharing. For the purposes of this subsection (18.5), "diagnostic breast imaging" means the medically necessary testing needed for the acting provider to fully evaluate an individual's health status as it relates to the early detection of breast cancer. SECTION 4. In Colorado Revised Statutes, 10-3-903, amend (2) (h) as follows: 10-3-903. Definition of transacting insurance business. (2) The provisions of this section do not apply to: (h) Transactions in this state involving group sickness and accident or blanket sickness and accident insurance where the master policy was lawfully issued and delivered to a single employer in another state in which the company was authorized to do an insurance business, when a master policy which that covers residents of this state includes mammography benefits at a level at least as comprehensive as those required by section 10-16-104 (18) (b) (III) (18.5); SECTION 5. In Colorado Revised Statutes, 10-16-105, amend (7.2) (b) (II), (7.2) (b) (IV) (A), and (7.2) (b) (IV) (C) as follows: 10-16-105. Small group sickness and accident insurance - guaranteed issue - mandated provisions for basic health benefit plans - rules. (7.2) The commissioner shall promulgate rules to implement a basic health benefit plan and a standard health benefit plan to be offered by each small employer carrier as a condition of transacting business in this state. The commissioner shall survey small group carriers annually to determine the range of health benefit plans available. The commissioner shall implement a basic plan that approximates the lowest level of coverage offered in small group health benefit plans. A basic health benefit plan may be based on the latest medical evidence. The commissioner shall implement a standard plan that approximates the average level of coverage offered in small group health benefit plans. In determining levels of coverage, the commissioner shall consider factors such as coinsurance, copayments, deductibles, out-of-pocket maximums, and covered benefits. The commissioner shall amend the rules as necessary to implement the basic and standard health benefit plans. The rules shall be in conformity with article 4 of title 24, C.R.S., and shall incorporate the following standard health benefit plan design described in paragraph (a) of this subsection (7.2) and the various options for the basic health benefit plan design described in paragraph (b) of this subsection (7.2): (b) (II) A basic health benefit plan may reflect a health benefit plan that is a high deductible plan that would qualify for a health savings account pursuant to 26 U.S.C. sec. 223. A carrier may apply deductible amounts for mandatory health benefits for mammography breast imaging, prostate screening, child supervision services, or prosthetic devices pursuant to section 10-16-104 (10), (11), (14), and (18) (b) (III) and (18.5) if such the mandatory benefits are not considered by the federal department of treasury to be preventive or to have an acceptable deductible amount. (IV) On and after January 1, 2009, a basic health benefit plan may reflect a medical evidence-based health benefit plan that: (A) Does not include coverage pursuant to the mandatory coverage provisions of section 10-16-104 (5), (9), (10), (12), and (18); except that a basic health benefit plan issued pursuant to this subparagraph (IV) shall include coverage for mammography breast imaging as specified in section 10-16-104 (18) (b) (III) (18.5); (C) Covers limited prevention and screening based on the latest medical evidence embodied in recommendations of an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services; except that a carrier may apply deductible amounts for mandatory health benefits for mammography breast imaging, child supervision services, or prosthetic devices pursuant to section 10-16-104 (11), (14), and (18) (b) (III) and (18.5) if such the mandatory benefits are not considered by the federal department of treasury to be preventive or to have an acceptable deductible amount; SECTION 6. In Colorado Revised Statutes, 10-16-116, amend (3) as follows: 10-16-116. Catastrophic health insurance - coverage. (3) Insurers shall provide a written disclosure to a covered person that indicates the mandated benefits of section 10-16-104 (1), (1.7), (5), (5.5), (8), (9), (10), (11), (12), (13), (14), and (18) (b) (III) and (18.5) are covered benefits of the high deductible health plan offered pursuant to section 10-16-105 (7.2) (b) (II); except that the mandated benefits for mammography breast imaging, prostate screenings, child health supervision services, and prosthetic devices shall be subject to policy deductibles. SECTION 7. In Colorado Revised Statutes, amend 10-16-129 as follows: 10-16-129. Health savings accounts. Any carrier authorized to conduct business in this state that offers coverage pursuant to part 2, 3, or 4 of this article may offer a high deductible health plan that would qualify for and may be offered in conjunction with a health savings account pursuant to 26 U.S.C. sec. 223, as amended. A carrier offering a high deductible health plan that may be offered in conjunction with a health savings account may apply the deductible to mandatory health benefits for mammography breast imaging, prostate cancer screening, child health supervision services, and prosthetic devices pursuant to section 10-16-104 (10), (11), (14), and (18) (b) (III) and (18.5) if such the mandatory benefits are not considered by the federal department of treasury to be preventive or to have an acceptable deductible amount. SECTION 8. Act subject to petition - effective date - applicability. (1) Except as otherwise provided in this section, this act takes effect January 1, 2015. (2) Section 2 of this act takes effect only if House Bill 13-1266 becomes law. (3) Sections 1, 5, and 6 of this act takes effect only if House Bill 13-1266 does not become law. (4) If a referendum petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within the ninety-day period after final adjournment of the general assembly, then the act, item, section, or part will not take effect unless approved by the people at the general election to be held in November 2014 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor. (5) This act applies to policies issued, delivered, renewed, or reinstated on or after the applicable effective date of this act.