First Regular Session
Sixty-second General Assembly
LLS NO. 99-0663.01 Julie Hoerner SENATE BILL 99-148
STATE OF COLORADO
BY SENATOR Tanner
HEALTH, ENVIRONMENT, WELFARE & INSTITUTIONS
APPROPRIATIONS
A BILL FOR AN ACT
101 CONCERNING THE EXTENSION OF REIMBURSEMENT FOR DIAGNOSTIC
102 MAMMOGRAPHY SCREENING EXPENSES TO MEN, AND, IN
103 CONNECTION THEREWITH, CLARIFYING THAT COVERAGE SHALL BE
104 PROVIDED FOR DIAGNOSTIC SCREENING EXPENSES IN CERTAIN
105 INSTANCES.
Bill Summary
(Note: This summary applies to this bill as introduced and does
not necessarily reflect any amendments that may be subsequently
adopted.)
Provides mandated mammography coverage diagnostic screening
for men. Makes conforming amendments.
1 Be it enacted by the General Assembly of the State of Colorado:
2 SECTION 1. The introductory portion to 10-16-104 (4) (a),
3 Colorado Revised Statutes, is amended, and the said 10-16-104 (4) (a) is
4 further amended BY THE ADDITION OF A NEW SUBPARAGRAPH,
5 to read:
6 10-16-104. Mandatory coverage provisions. (4) Low-dose
7 mammography. (a) For the purposes of this subsection (4), "low-dose
8 mammography" means the X-ray examination of the breast using
[ ] denotes HOUSE amendment. { } denotes SENATE amendment.
Capital letters indicate new material to be added to existing statute.
Dashes through the words indicate material to be deleted from existing statute.
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1 equipment dedicated specifically for mammography, including but not
2 limited to the X-ray tube, filter, compression device, screens, and film
3 and cassettes, with an average radiation exposure delivery of less than one
4 rad mid-breast, with two views for each breast. All individual and all
5 group sickness and accident insurance policies, except supplemental
6 policies covering a specified disease or other limited benefit, which THAT
7 are delivered or issued for delivery within the state by an entity subject
8 to the provisions of part 2 of this article and all individual and group
9 health care service or indemnity contracts issued by an entity subject to
10 the provisions of part 3 or 4 of this article, as well as any other group
11 health care coverage provided to residents of this state, shall provide
12 coverage for routine and certain diagnostic screening by low-dose
13 mammography for the presence of breast cancer in adult women, AND
14 DIAGNOSTIC SCREENING BY LOW-DOSE MAMMOGRAPHY FOR ADULT MEN.
15 Routine and diagnostic screenings provided pursuant to subparagraph (II)
16 or (III) of this paragraph (a) shall be provided on a contract year or a
17 calendar year basis by entities subject to part 2 or 3 of this article and
18 shall not be subject to policy deductibles. Such coverages shall be the
19 lesser of sixty dollars per mammography screening, or the actual charge
20 for such screening. The minimum benefit required under this subsection
21 (4) shall be adjusted to reflect increases and decreases in the consumer
22 price index. Benefits for routine mammography screenings shall be
23 determined on a calendar year or a contract year basis, which shall be
24 specified in the policy or contract. The routine and diagnostic coverages
25 provided pursuant to this subsection (4) shall in no way diminish or limit
26 diagnostic benefits otherwise allowable under a policy. If an insured
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1 person who is eligible for a routine mammography screening benefit
2 pursuant to subparagraphs (I), (II), (III), and (IV) of this paragraph (a) has
3 not utilized such benefit during a calendar year or a contract year, then
4 such provisions shall apply to one diagnostic screening for such year. If
5 more than one diagnostic screening is provided for such person in a given
6 calendar year or contract year, the other diagnostic service benefit
7 provisions in the policy or contract shall apply with respect to such
8 additional screenings. This mandated mammography coverage shall be
9 provided according to the following guidelines:
10 (IV) DIAGNOSTIC SCREENING FOR ALL ADULT MEN WHO HAVE RISK
11 FACTORS FOR BREAST CANCER AS DETERMINED BY THE MAN'S PHYSICIAN
12 FOR AN ENTITY SUBJECT TO PART 2 OR 3 OF THIS ARTICLE, OR AS
13 DETERMINED BY A PARTICIPATING PHYSICIAN FOR AN ENTITY SUBJECT TO
14 PART 4 OF THIS ARTICLE.
15 SECTION 2. 25-4-1501, Colorado Revised Statutes, is amended
16 to read:
17 25-4-1501. Legislative declaration. The general assembly hereby
18 finds and declares that the incidence of breast cancer in women
19 RESIDENTS of this state is a significant health problem that can and should
20 be reduced through early detection and treatment. Accordingly, it is the
21 intention of the general assembly in enacting this part 15 to provide breast
22 cancer screening where it is not otherwise readily available for reasons
23 of cost or distance to suitable medical facilities.
24 SECTION 3. 25-4-1504 (1) (b), Colorado Revised Statutes, is
25 amended to read:
26 25-4-1504. Allocation of fund. (1) All moneys in the fund shall
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1 be used by the department for the following purposes:
2 (b) The creation and operation of a referral service for the benefit
3 of women INDIVIDUALS for whom further examination or treatment is
4 indicated by the breast cancer screening.
5 SECTION 4. 25-4-1505 (3) and (4), Colorado Revised Statutes,
6 are amended to read:
7 25-4-1505. Powers and duties of the department and the
8 advisory board. (3) Any program of breast cancer screening conducted
9 pursuant to this part 15 shall be conducted so as to make such screening
10 available to women INDIVIDUALS whose economic circumstances or
11 geographic location otherwise serve to limit access to similar screening
12 facilities. Emphasis shall be placed upon providing service to rural areas
13 not otherwise served by alternate providers of breast cancer screening.
14 (4) The department may adopt a schedule of fees to be charged for
15 breast cancer screening. The schedule of fees shall be determined so as
16 to make such screening available to the largest possible number of
17 women INDIVIDUALS. The department shall, where practical, collect any
18 available insurance proceeds or other reimbursement payable on behalf
19 of any recipient of a breast cancer screening under this part 15 and may
20 adjust the schedule of fees to reflect insurance contributions. All fees
21 collected shall be credited to the fund.
22 SECTION 5. Safety clause. The general assembly hereby finds,
23 determines, and declares that this act is necessary for the immediate
24 preservation of the public peace, health, and safety.