Health care coverage: colorectal cancer screening., the official text

An act to amend Section 1367.668 of the Health and Safety Code, and to amend Section 10123.207 of the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL'S DIGEST

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally requires a health care service plan contract or a health insurance policy issued, amended, or renewed on or after January 1, 2022, to provide coverage without cost sharing for a colorectal cancer screening test assigned either a grade of A or a grade of B by the United States Preventive Services Task Force and for a required colonoscopy for a positive result on a test with those grades.
This bill would additionally require that coverage if the screening test is approved by the United States Food and Drug Administration and either meets requirements for coverage established by the federal Centers for Medicare and Medicaid Services, as specified, or is included in the most recently published guidelines from the American Cancer Society. Because a violation of the bill by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

The people of the State of California do enact as follows:

SECTION 1.
Section 1367.668 of the Health and Safety Code is amended to read:
1367.668.
(a) Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2022, shall provide coverage without cost sharing for a colorectal cancer screening test that meets any of the following conditions:
(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.
(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.
(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.
(b) The required colonoscopy for a positive result on a test or procedure, other than a colonoscopy, that is a colorectal cancer screening examination or laboratory test that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.
(c) This section does not preclude a health care service plan that has coverage for out-of-network benefits from imposing cost-sharing requirements for the items or services described in this section that are delivered by an out-of-network provider.

SEC. 2.
Section 10123.207 of the Insurance Code is amended to read:
10123.207.
(a) Every health insurance policy, except a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2022, shall provide coverage without cost sharing for a colorectal cancer screening test that meets any of the following conditions:
(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.
(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.
(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.
(b) The required colonoscopy for a positive result on a test or procedure, other than a colonoscopy, that is a colorectal cancer screening examination or laboratory test that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.
(c) This section does not preclude a health insurer that has a network of providers from imposing cost-sharing requirements for the items or services described in this section that are delivered by an out-of-network provider.

SEC. 3.
No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.