HOUSE 3rd Reading Unamended April 22, 2016 HOUSE Amended 2nd Reading April 21, 2016Second Regular Session Seventieth General Assembly STATE OF COLORADO REENGROSSED This Version Includes All Amendments Adopted in the House of Introduction LLS NO. 16-0676.01 Kristen Forrestal x4217HOUSE BILL 16-1381 HOUSE SPONSORSHIP Primavera, Esgar, Melton, Williams SENATE SPONSORSHIP Todd, House Committees Senate Committees Public Health Care & Human Services A BILL FOR AN ACT Concerning health insurance coverage for the early detection of cancer. 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.) Current law requires health care coverage for certain cancers. The bill requires annual health care coverage for breast cancer screening using the breast imaging modality appropriate for each individual as determined by the individual's physician or radiologist. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Legislative declaration. (1) The general assembly hereby finds and declares that: (a) Colorado recognizes cancer as a public health burden that affects families, businesses, and communities throughout the state, with one in two men and two in five women diagnosed with the disease at some point in their lifetimes. (b) The American Cancer Society estimates twenty-four thousand seven hundred thirty Coloradans will be diagnosed with the disease and seven thousand seven hundred sixty Coloradans will die from the disease in 2016 ; (c) The agency for health care research and quality of the United States department of health and human services estimates that direct medical costs for cancer in the United States in 2011 were eighty-eight billion seven hundred million dollars; (d) National research indicates that, when the disease is diagnosed at later stages, cancer treatment becomes more costly, invasive, and likely to contribute to workplace absenteeism attributable to side effects of more intensive treatment protocols and the time necessary to obtain care; (e) Advances in medical and scientific research have led to evidenced-based strategies to prevent some cancers, reducing the burden of the disease; (f) While not wholly preventable, cancer that is detected early increases the likelihood of survival and reduces expenses incurred by individuals, families, and the health care system; (g) Advances in medical and scientific research have diversified and increased the screening modalities that are available to identify each person's unique risk of cancer and corresponding recommended surveillance to detect the disease at its earliest stages; (h) Current law requires health insurance plans to provide coverage for cancer screening to promote early detection of the disease; (i) Coloradans purchasing health insurance plans in this state should have the peace of mind to know that their policies include coverage for the most recent medical and scientific advances in cancer screening procedures that have been shown to increase early detection of cancer. SECTION 2. In Colorado Revised Statutes, 10-16-104, amend (18) (b) (III) as follows: 10-16-104. Mandatory coverage provisions - definitions - rules. (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 Coverage for the actual cost of an annual breast cancer screening with mammography per year, covering the actual charge for the screening with mammography using the breast imaging modality appropriate for each individual's breast health needs, as determined by the individual's health care provider, and if the screening falls within the appropriate use guidelines as determined by the American college of radiology. (B) (Deleted by amendment, L. 2013) (B.5) For the purpose of this subparagraph (III), "breast cancer screening" or "screening" means a: (I) Mammogram, with or without a clinical exam, for individuals at average risk; or (II) Mammogram, with or without a clinical exam, and medically recommended subsequent noninvasive imaging modality or modalities that fall within appropriate use guidelines as determined by the American college of radiology for the early detection of breast cancer for individuals at average risk who have an incomplete mammogram result, or individuals at high risk. (C) Benefits for preventive mammography breast cancer 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. Coverage for the additional noninvasive imaging modality or modalities must be no less favorable than for the initial screening modality. A covered individual is not subject to cost sharing for a breast cancer screening when an imaging modality has been recommended by the individual's health care provider and if the screening falls within appropriate use guidelines as determined by the American college of radiology. If the covered person receives more than one screening in excess of what is recommended by the American College of Radiology 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 using the appropriate imaging modality or combination of modalities recognized by the American College of Radiology for all individuals possessing at least one risk factor for breast cancer, including: A family history of breast cancer; being forty years of age or older; presenting with symptoms; or a genetic predisposition to an increased lifetime risk of breast cancer determined by a risk factor model such as tyrer-cuzick, BRCAPRO, or GAIL. SECTION 3. Act subject to petition - effective date. This act takes effect January 1, 2018; except that, 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 2016 and, in such case, will take effect on January 1, 2018, or on the date of the official declaration of the vote thereon by the governor, whichever is later.