108th CONGRESS
1st Session
H. R. 3362
To amend the Employee Retirement Income Security Act of 1974, Public
Health Service Act, and the Internal Revenue Code of 1986 to require that
group and individual health insurance coverage and group health plans provide
coverage of screening for breast, prostate, and colorectal cancer.
IN THE HOUSE OF REPRESENTATIVES
October 21, 2003
Mrs. MALONEY introduced the following bill; which was referred to the Committee
on Energy and Commerce, and in addition to the Committees on Education and
the Workforce, Ways and Means, and Government Reform, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provisions
as fall within the jurisdiction of the committee concerned
A BILL
To amend the Employee Retirement Income Security Act of 1974, Public
Health Service Act, and the Internal Revenue Code of 1986 to require that
group and individual health insurance coverage and group health plans provide
coverage of screening for breast, prostate, and colorectal cancer.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Cancer Screening Coverage Act of 2003'.
SEC. 2. CANCER SCREENING COVERAGE.
(1) PUBLIC HEALTH SERVICE ACT AMENDMENTS-
(A) IN GENERAL- Subpart 2 of part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at the end
the following:
`SEC. 2707. COVERAGE OF CANCER SCREENING.
`(a) REQUIREMENT- A group health plan, and a health insurance issuer offering
group health insurance coverage, shall provide coverage and payment under
the plan or coverage for the following items and services under terms and
conditions that are no less favorable than the terms and conditions applicable
to other screening benefits otherwise provided under the plan or coverage:
`(1) MAMMOGRAMS- In the case of a female participant or beneficiary who
is 40 years of age or older, or is under 40 years of age but is at high
risk (as defined in subsection (e)) of developing breast cancer, an annual
mammography (as defined in section 1861(jj) of the Social Security Act)
conducted by a facility that has a certificate (or provisional certificate)
issued under section 354.
`(2) CLINICAL BREAST EXAMINATIONS- In the case of a female participant or
beneficiary who--
`(A)(i) is 40 years of age or older or (ii) is at least 20 (but less than
40) years of age and is at high risk of developing breast cancer, an annual
clinical breast examination; or
`(B) is at least 20, but less than 40, years of age and who is not at
high risk of developing breast cancer, a clinical breast examination each
3 years.
`(3) PAP TESTS AND PELVIC EXAMINATIONS- In the case of a female participant
or beneficiary who is 18 years of age or older, or who is under 18 years
of age and is or has been sexually active--
`(A) an annual diagnostic laboratory test (popularly known as a `pap smear')
consisting of a routine exfoliative cytology test (Papanicolaou test)
provided to a woman for the purpose of early detection of cervical or
vaginal cancer and including an interpretation by a qualified health professional
of the results of the test; and
`(B) an annual pelvic examination.
`(4) COLORECTAL CANCER SCREENING PROCEDURES- In the case of a participant
or beneficiary who is 50 years of age or older, or who is under 50 years
of age and is at high risk of developing colorectal cancer, the procedures
described in section 1861(pp)(1) of the Social Security Act (42 U.S.C. 1395x(pp)(1))
or section 4104(a)(2) of the Balanced Budget Act of 1997 (111 Stat. 362),
shall be furnished to the individual for the purpose of early detection
of colorectal cancer. The group health plan or health insurance issuer shall
provide coverage for the method and frequency of colorectal cancer screening
determined to be appropriate by a health care provider treating such participant
or beneficiary, in consultation with the participant or beneficiary.
`(5) PROSTATE CANCER SCREENING- In the case of a male participant or beneficiary
who is 50 years of age or older, or who is younger than 50 years of age
and is at high risk for prostate cancer (including African American men
or a male who has a history of prostate cancer in 1 or more first degree
family members), the procedures described in section 1861(oo)(2) of Social
Security Act (42 U.S.C. 1395x(oo)(2)) shall be furnished to the individual
for the early detection of prostate cancer. The group health plan or health
insurance issuer shall provide coverage for the method and frequency of
prostate cancer screening determined to be appropriate by a health care
provider treating such participant or beneficiary, in consultation with
the participant or beneficiary.
`(b) PROHIBITIONS- A group health plan, and a health insurance issuer offering
group health insurance coverage in connection with a group health plan, shall
not--
`(1) deny to an individual eligibility, or continued eligibility, to enroll
or to renew coverage under the terms of the plan, solely for the purpose
of avoiding the requirements of this section;
`(2) provide monetary payments or rebates to individuals to encourage such
individuals to accept less than the minimum protections available under
this section;
`(3) penalize or otherwise reduce or limit the reimbursement of a provider
because such provider provided care to an individual participant or beneficiary
in accordance with this section; or
`(4) provide incentives (monetary or otherwise) to a provider to induce
such provider to provide care
to an individual participant or beneficiary in a manner inconsistent with
this section.
`(c) RULES OF CONSTRUCTION-
`(1) Nothing in this section shall be construed to require an individual
who is a participant or beneficiary to undergo a procedure, examination,
or test described in subsection (a).
`(2) Nothing in this section shall be construed as preventing a group health
plan or issuer from imposing deductibles, coinsurance, or other cost-sharing
in relation to benefits described in subsection (a) consistent with such
subsection, except that such coinsurance or other cost-sharing shall not
discriminate on any basis related to the coverage required under this section.
`(d) NOTICE- A group health plan under this part shall comply with the notice
requirement under section 714(d) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements of this section as if such section
applied to such plan.
`(e) HIGH RISK DEFINED- For purposes of this section, an individual is considered
to be at `high risk' of developing a particular type of cancer if, under guidelines
developed or recognized by the Secretary based upon scientific evidence, the
individual--
`(1) has 1 or more first degree family members who have developed that type
of cancer;
`(2) has previously had that type of cancer;
`(3) has the presence of an appropriate recognized gene marker that is identified
as putting the individual at a higher risk of developing that type of cancer;
or
`(4) has other predisposing factors that significantly increase the risk
of the individual contracting that type of cancer.
For purposes of this subsection, the term `type of cancer' includes other
types of cancer that the Secretary recognizes as closely related for purposes
of establishing risk.
`SEC. 2708. PATIENT ACCESS TO INFORMATION.
`(a) DISCLOSURE REQUIREMENT- A group health plan, and health insurance issuer
offering group health insurance coverage shall--
`(1) provide to participants and beneficiaries at the time of initial coverage
under the plan (or the effective date of this section, in the case of individuals
who are participants or beneficiaries as of such date), and at least annually
thereafter, the information described in subsection (b) in printed form;
`(2) provide to participants and beneficiaries, within a reasonable period
(as specified by the appropriate Secretary) before or after the date of
significant changes in the information described in subsection (b), information
in printed form regarding such significant changes; and
`(3) upon request, make available to participants and beneficiaries, the
applicable authority, and prospective participants and beneficiaries, the
information described in subsection (b) in printed form.
`(b) INFORMATION PROVIDED- The information described in subsection (a) that
shall be disclosed includes the following, as such relates to cancer screening
required under section 2707(a):
`(1) BENEFITS- Benefits offered under the plan or coverage, including--
`(A) covered benefits, including benefit limits and coverage exclusions;
`(B) cost sharing, such as deductibles, coinsurance, and copayment amounts,
including any liability for balance billing, any maximum limitations on
out of pocket expenses, and the maximum out of pocket costs for services
that are provided by nonparticipating providers or that are furnished
without meeting the applicable utilization review requirements;
`(C) the extent to which benefits may be obtained from nonparticipating
providers; and
`(D) the extent to which a participant, beneficiary, or enrollee may select
from among participating providers and the types of providers participating
in the plan or issuer network.
`(2) ACCESS- A description of the following:
`(A) The number, mix, and distribution of providers under the plan or
coverage.
`(B) Out-of-network coverage (if any) provided by the plan or coverage.
`(C) Any point-of-service option (including any supplemental premium or
cost-sharing for such option).
`(D) The procedures for participants, beneficiaries, and enrollees to
select, access, and change participating primary and specialty providers.
`(E) The rights and procedures for obtaining referrals (including standing
referrals) to participating and nonparticipating providers.
`(F) The name, address, and telephone number of participating health care
providers and an indication of whether each such provider is available
to accept new patients.
`(G) How the plan or issuer addresses the needs of participants, beneficiaries,
and enrollees and others who do not speak English or who have other special
communications needs in accessing providers under the plan or coverage,
including the provision of information under this subsection.'.
(B) TECHNICAL AMENDMENT- Section 2723(c) of the Public Health Service
Act (42 U.S.C. 300gg-23(c)) is amended by striking `section 2704' and
inserting `sections 2704 and 2707'.
(A) IN GENERAL- Subpart B of part 7 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended
by adding at the end the following new section:
`SEC. 714. COVERAGE OF CANCER SCREENING.
`(a) REQUIREMENT- A group health plan, and a health insurance issuer offering
group health insurance coverage, shall provide coverage and payment under
the plan or coverage for the following items and services under
terms and conditions that are no less favorable than the terms and conditions
applicable to other screening benefits otherwise provided under the plan or
coverage:
`(1) MAMMOGRAMS- In the case of a female participant or beneficiary who
is 40 years of age or older, or is under 40 years of age but is at high
risk (as defined in subsection (e)) of developing breast cancer, an annual
mammography (as defined in section 1861(jj) of the Social Security Act)
conducted by a facility that has a certificate (or provisional certificate)
issued under section 354 of the Public Health Service Act.
`(2) CLINICAL BREAST EXAMINATIONS- In the case of a female participant or
beneficiary who--
`(A)(i) is 40 years of age or older or (ii) is at least 20 (but less than
40) years of age and is at high risk of developing breast cancer, an annual
clinical breast examination; or
`(B) is at least 20, but less than 40, years of age and who is not at
high risk of developing breast cancer, a clinical breast examination each
3 years.
`(3) PAP TESTS AND PELVIC EXAMINATIONS- In the case of a female participant
or beneficiary who is 18 years of age or older, or who is under 18 years
of age and is or has been sexually active--
`(A) an annual diagnostic laboratory test (popularly known as a `pap smear')
consisting of a routine exfoliative cytology test (Papanicolaou test)
provided to a woman for the purpose of early detection of cervical or
vaginal cancer and including an interpretation by a qualified health professional
of the results of the test; and
`(B) an annual pelvic examination.
`(4) COLORECTAL CANCER SCREENING PROCEDURES- In the case of a participant
or beneficiary who is 50 years of age or older, or who is under 50 years
of age and is at high risk of developing colorectal cancer, the procedures
described in section 1861(pp)(1) of the Social Security Act (42 U.S.C. 1395x(pp)(1))
or section 4104(a)(2) of the Balanced Budget Act of 1997 (111 Stat. 362),
shall be furnished to the individual for the purpose of early detection
of colorectal cancer. The group health plan or health insurance issuer shall
provided coverage for the method and frequency of colorectal cancer screening
determined to be appropriate by a health care provider treating such participant
or beneficiary, in consultation with the participant or beneficiary.
`(5) PROSTATE CANCER SCREENING- In the case of a male participant or beneficiary
who is 50 years of age or older, or who is younger than 50 years of age
and is at high risk for prostate cancer (including African American men
or a male who has a history of prostate cancer in 1 or more first degree
family members), the procedures described in section 1861(oo)(2) of Social
Security Act (42 U.S.C. 1395x(oo)(2)) shall be furnished to the individual
for the early detection of prostate cancer. The group health plan or health
insurance issuer shall provide coverage for the method and frequency of
prostate cancer screening determined to be appropriate by a health care
provider treating such participant or beneficiary, in consultation with
the participant or beneficiary.
`(b) PROHIBITIONS- A group health plan, and a health insurance issuer offering
group health insurance coverage in connection with a group health plan, may
not--
`(1) deny to an individual eligibility, or continued eligibility, to enroll
or to renew coverage under the terms of the plan, solely for the purpose
of avoiding the requirements of this section;
`(2) provide monetary payments or rebates to individuals to encourage such
individuals to accept less than the minimum protections available under
this section;
`(3) penalize or otherwise reduce or limit the reimbursement of a provider
because such provider provided care to an individual participant or beneficiary
in accordance with this section; or
`(4) provide incentives (monetary or otherwise) to a provider to induce
such provider to provide care to an individual participant or beneficiary
in a manner inconsistent with this section.
`(c) RULES OF CONSTRUCTION-
`(1) Nothing in this section shall be construed to require an individual
who is a participant or beneficiary to undergo a procedure, examination,
or test described in subsection (a).
`(2) Nothing in this section shall be construed as preventing a group health
plan or issuer from imposing deductibles, coinsurance, or other cost-sharing
in relation to benefits described in subsection (a) consistent with such
subsection, except that such coinsurance or other cost-sharing shall not
discriminate on any basis related to the coverage required under this section.
`(d) NOTICE UNDER GROUP HEALTH PLAN- The imposition of the requirement of
this section shall be treated as a material modification in the terms of the
plan described in section 102(a), for purposes of assuring notice of such
requirements under the plan; except that the summary description required
to be provided under the last sentence of section 104(b)(1) with respect to
such modification shall be provided by not later than 60 days after the first
day of the first plan year in which such requirement apply.
`(e) HIGH RISK DEFINED- For purposes of this section, an individual is considered
to be at `high risk' of developing a particular type of cancer if, under guidelines
developed or recognized by the Secretary based upon scientific evidence, the
individual--
`(1) has 1 or more first degree family members who have developed that type
of cancer;
`(2) has previously had that type of cancer;
`(3) has the presence of an appropriate recognized gene marker that is identified
as putting the individual at a higher risk of developing that type of cancer;
or
`(4) has other predisposing factors that significantly increase the risk
of the individual contracting that type of cancer.
For purposes of this subsection, the term `type of cancer' includes other
types of cancer that the Secretary recognizes as closely related for purposes
of establishing risk.
`SEC. 715. PATIENT ACCESS TO INFORMATION.
`(a) DISCLOSURE REQUIREMENT- A group health plan, and health insurance issuer
offering group health insurance coverage shall--
`(1) provide to participants and beneficiaries at the time of initial coverage
under the plan (or the effective date of this section, in the case of individuals
who are participants or beneficiaries as of such date), and at least annually
thereafter, the information described in subsection (b) in printed form;
`(2) provide to participants and beneficiaries, within a reasonable period
(as specified by the appropriate Secretary) before or after the date of
significant changes in the information described in subsection (b), information
in printed form regarding such significant changes; and
`(3) upon request, make available to participants and beneficiaries, the
applicable authority, and prospective participants and beneficiaries, the
information described in subsection (b) in printed form.
`(b) INFORMATION PROVIDED- The information described in subsection (a) that
shall be disclosed includes the following, as such relates to cancer screening
required under section 714(a):
`(1) BENEFITS- Benefits offered under the plan or coverage, including--
`(A) covered benefits, including benefit limits and coverage exclusions;
`(B) cost sharing, such as deductibles, coinsurance, and copayment amounts,
including any liability for balance billing, any maximum limitations on
out of pocket expenses, and the maximum out of pocket costs for services
that are provided by nonparticipating providers or that are furnished
without meeting the applicable utilization review requirements;
`(C) the extent to which benefits may be obtained from nonparticipating
providers; and
`(D) the extent to which a participant, beneficiary, or enrollee may select
from among participating providers and the types of providers participating
in the plan or issuer network.
`(2) ACCESS- A description of the following:
`(A) The number, mix, and distribution of providers under the plan or
coverage.
`(B) Out-of-network coverage (if any) provided by the plan or coverage.
`(C) Any point-of-service option (including any supplemental premium or
cost-sharing for such option).
`(D) The procedures for participants, beneficiaries, and enrollees to
select, access, and change participating primary and specialty providers.
`(E) The rights and procedures for obtaining referrals (including standing
referrals) to participating and nonparticipating providers.
`(F) The name, address, and telephone number of participating health care
providers and an indication of whether each such provider is available
to accept new patients.
`(G) How the plan or issuer addresses the needs of participants, beneficiaries,
and enrollees and others who do not speak English or who have other special
communications needs in accessing providers under the plan or coverage,
including the provision of information under this subsection.'.
(B) TECHNICAL AMENDMENTS-
(i) Section 731(c) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1191(c)) is amended by striking `section 711' and inserting
`sections 711 and 714'.
(ii) Section 732(a) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1191a(a)) is amended by striking `section 711' and inserting
`sections 711 and 714'.
(iii) The table of contents in section 1 of the Employee Retirement
Income Security Act of 1974 is amended by inserting after the item relating
to section 713 the following new items:
`Sec. 714. Coverage of cancer screening.
`Sec. 715. Patient access to information.'.
(3) INTERNAL REVENUE CODE AMENDMENTS- Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended--
(A) in the table of sections, by inserting after the item relating to
section 9812 the following new items:
`Sec. 9813. Coverage of cancer screening.
`Sec. 9814. Patient access to information.';
(B) by inserting after section 9812 the following:
`SEC. 9813. COVERAGE OF CANCER SCREENING.
`(a) REQUIREMENT- A group health plan shall provide coverage and payment under
the plan for the following items and services under terms and conditions that
are no less favorable than the terms and conditions applicable to other screening
benefits otherwise provided under the plan:
`(1) MAMMOGRAMS- In the case of a female participant or beneficiary who
is 40 years of age or older, or is under 40 years of age but is at high
risk (as defined in subsection (d)) of developing breast cancer, an annual
mammography (as defined in section 1861(jj) of the Social Security Act)
conducted by a facility that has a certificate (or provisional certificate)
issued under section 354 of the Public Health Service Act.
`(2) CLINICAL BREAST EXAMINATIONS- In the case of a female participant or
beneficiary who--
`(A)(i) is 40 years of age or older or (ii) is at least 20 (but less than
40) years of age and is at high risk of developing breast cancer, an annual
clinical breast examination; or
`(B) is at least 20, but less than 40, years of age and who is not at
high risk of developing breast cancer, a clinical breast examination each
3 years.
`(3) PAP TESTS AND PELVIC EXAMINATIONS- In the case of a female participant
or beneficiary who is 18 years of age or older, or who is under 18 years
of age and is or has been sexually active--
`(A) an annual diagnostic laboratory test (popularly known as a `pap smear')
consisting of a routine exfoliative cytology test (Papanicolaou test)
provided to a woman for the purpose of early detection of cervical or
vaginal cancer and including an interpretation by a qualified health professional
of the results of the test; and
`(B) an annual pelvic examination.
`(4) COLORECTAL CANCER SCREENING PROCEDURES- In the case of a participant
or beneficiary who is 50 years of age or older, or who is under 50 years
of age and is at high risk of developing colorectal cancer, the procedures
described in section 1861(pp)(1) of the Social Security Act (42 U.S.C. 1395x(pp)(1))
or section 4104(a)(2) of the Balanced Budget Act of 1997 (111 Stat. 362),
shall be furnished to the individual for the purpose of early detection
of colorectal cancer. The group health plan or health insurance issuer shall
provide coverage for the method and frequency of colorectal cancer screening
determined to be appropriate by a health care provider treating such participant
or beneficiary, in consultation with the participant or beneficiary.
`(5) PROSTATE CANCER SCREENING- In the case of a male participant or beneficiary
who is 50 years of age or older, or who is younger than 50 years of age
and is at high risk for prostate cancer (including African American men
or a male who has a history of prostate cancer in 1 or more first degree
family members), the procedures described in section 1861(oo)(2) of Social
Security Act (42 U.S.C. 1395x(oo)(2)) shall be furnished to the individual
for the early detection of prostate cancer. The group health plan or health
insurance issuer shall provide coverage for the method and frequency of
prostate cancer screening determined to be appropriate by a health care
provider treating such participant or beneficiary, in consultation with
the participant or beneficiary.
`(b) PROHIBITIONS- A group health plan may not--
`(1) deny to an individual eligibility, or continued eligibility, to enroll
or to renew coverage under the terms of the plan, solely for the purpose
of avoiding the requirements of this section;
`(2) provide monetary payments or rebates to individuals to encourage such
individuals to accept less than the minimum protections available under
this section;
`(3) penalize or otherwise reduce or limit the reimbursement of a provider
because such provider provided care to an individual participant or beneficiary
in accordance with this section; or
`(4) provide incentives (monetary or otherwise) to a provider to induce
such provider to provide care to an individual participant or beneficiary
in a manner inconsistent with this section.
`(c) RULES OF CONSTRUCTION-
`(1) Nothing in this section shall be construed to require an individual
who is a participant or beneficiary to undergo a procedure, examination,
or test described in subsection (a).
`(2) Nothing in this section shall be construed as preventing a group health
plan from imposing deductibles, coinsurance, or other cost-sharing in relation
to benefits described in subsection (a) consistent with such subsection,
except that such coinsurance or other cost-sharing shall not discriminate
on any basis related to the coverage required under this section.
`(d) HIGH RISK DEFINED- For purposes of this section, an individual is considered
to be at `high risk' of developing a particular type of cancer if, under guidelines
developed or recognized by the Secretary based upon scientific evidence, the
individual--
`(1) has 1 or more first degree family members who have developed that type
of cancer;
`(2) has previously had that type of cancer;
`(3) has the presence of an appropriate recognized gene marker that is identified
as putting the individual at a higher risk of developing that type of cancer;
or
`(4) has other predisposing factors that significantly increase the risk
of the individual contracting that type of cancer.
For purposes of this subsection, the term `type of cancer' includes other
types of cancer that the Secretary recognizes as closely related for purposes
of establishing risk.
`SEC. 9814. PATIENT ACCESS TO INFORMATION.
`(a) DISCLOSURE REQUIREMENT- A group health plan, and health insurance issuer
offering group health insurance coverage shall--
`(1) provide to participants and beneficiaries at the time of initial coverage
under the plan (or the effective date of this section, in the case of individuals
who are participants or beneficiaries as of such date), and at least annually
thereafter, the information described in subsection (b) in printed form;
`(2) provide to participants and beneficiaries, within a reasonable period
(as specified by the appropriate Secretary) before or after the date of
significant changes in the information described in subsection (b), information
in printed form regarding such significant changes; and
`(3) upon request, make available to participants and beneficiaries, the
applicable authority, and prospective participants and beneficiaries, the
information described in subsection (b) in printed form.
`(b) INFORMATION PROVIDED- The information described in subsection (a) that
shall be disclosed includes the following, as such relates to cancer screening
required under section 9813(a):
`(1) BENEFITS- Benefits offered under the plan or coverage, including--
`(A) covered benefits, including benefit limits and coverage exclusions;
`(B) cost sharing, such as deductibles, coinsurance, and copayment amounts,
including any liability for balance billing, any maximum limitations on
out of pocket expenses, and the maximum out of pocket costs for services
that are provided by nonparticipating providers or that are furnished
without meeting the applicable utilization review requirements;
`(C) the extent to which benefits may be obtained from nonparticipating
providers; and
`(D) the extent to which a participant, beneficiary, or enrollee may select
from among participating providers and the types of providers participating
in the plan or issuer network.
`(2) ACCESS- A description of the following:
`(A) The number, mix, and distribution of providers under the plan or
coverage.
`(B) Out-of-network coverage (if any) provided by the plan or coverage.
`(C) Any point-of-service option (including any supplemental premium or
cost-sharing for such option).
`(D) The procedures for participants, beneficiaries, and enrollees to
select, access, and change participating primary and specialty providers.
`(E) The rights and procedures for obtaining referrals (including standing
referrals) to participating and nonparticipating providers.
`(F) The name, address, and telephone number of participating health care
providers and an indication of whether each such provider is available
to accept new patients.
`(G) How the plan or issuer addresses the needs of participants, beneficiaries,
and enrollees and others who do not speak English or who have other special
communications needs in accessing providers under the plan or coverage,
including the provision of information under this subsection.'.
(b) INDIVIDUAL HEALTH INSURANCE-
(1) IN GENERAL- Part B of title XXVII of the Public Health Service Act is
amended by inserting after section 2752 (42 U.S.C. 300gg-52) the following
new section:
`SEC. 2753. STANDARD RELATING PATIENT FREEDOM OF CHOICE.
`(a) IN GENERAL- The provisions of section 2707 (other than subsection (d))
shall apply to health insurance coverage offered by a health insurance issuer
in the individual market with respect to an enrollee under such coverage in
the same manner as they apply to health insurance coverage offered by a health
insurance issuer in connection with a group health plan in the small or large
group market to a participant or beneficiary in such plan.
`(b) NOTICE- A health insurance issuer under this part shall comply with the
notice requirement under section 714(d) of the Employee Retirement Income
Security Act of 1974 with respect to the requirements referred to in subsection
(a) as if such section applied to such issuer and such issuer were a group
health plan.
`SEC. 2754. PATIENT ACCESS TO INFORMATION.
`The provisions of section 2708 shall apply health insurance coverage offered
by a health insurance issuer in the individual market with respect to an enrollee
under such coverage in the same manner as they apply to health insurance coverage
offered by a health insurance issuer in connection with a group health plan
in the small or large group market to a participant or beneficiary in such
plan.'.
(2) TECHNICAL AMENDMENT- Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2))
is amended by striking `section 2751' and inserting `sections 2751 and 2753'.
(1) GROUP HEALTH PLANS- Subject to paragraph (3), the amendments made by
subsection (a) shall apply with respect to group health plans for plan years
beginning on or after January 1, 2004.
(2) INDIVIDUAL PLANS- The amendment made by subsection (b) shall apply with
respect to health insurance coverage offered, sold, issued, renewed, in
effect, or operated in the individual market on or after such date.
(3) COLLECTIVE BARGAINING AGREEMENT- In the case of a group health plan
maintained pursuant to 1 or more collective bargaining agreements between
employee representatives and 1 or more employers ratified before the date
of enactment of this Act, the amendments made to subsection (a) shall not
apply to plan years beginning before the later of--
(A) the date on which the last collective bargaining agreements relating
to the plan terminates (determined without regard to any extension thereof
agreed to after the date of enactment of this Act), or
For purposes of subparagraph (A), any plan amendment made pursuant to a
collective bargaining agreement relating to the plan which amends the plan
solely to conform to any requirement added by subsection (a) shall not be
treated as a termination of such collective bargaining agreement.
(d) COORDINATED REGULATIONS- Section 104(1) of Health Insurance Portability
and Accountability Act of 1996 (Public Law 104-191) is amended by striking
`this subtitle (and the amendments made by this subtitle and section 401)'
and inserting `the provisions of part 7 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974, the provisions of parts A and C of
title XXVII of the Public Health Service Act, and chapter 100 of the Internal
Revenue Code of 1986'.
(e) MODIFICATION OF COVERAGE-
(1) IN GENERAL- The Secretary of Health and Human Services may modify the
coverage requirements for the amendments under this Act to allow such requirements
to incorporate and reflect new scientific and technological advances regarding
cancer screening, practice pattern changes in such screening, or other updated
medical practices regarding such screening, such as the use of new tests
or other emerging technologies. Such modifications shall not in any way
diminish the coverage requirements listed under this Act. Such modifications
may be made on the Secretary's own initiative or upon petition to the Secretary
by an individual or organization.
(2) CONSULTATION- In modifying coverage requirements under paragraph (1),
the Secretary of Health and Human Services shall consult with appropriate
organizations, experts, and agencies.
(3) PETITIONS- The Secretary of Health and Human Services may issue requirements
for the petitioning process under paragraph (1), including requirements
that the petition be in writing and include scientific or medical bases
for the modification sought. Upon receipt of such a petition, the Secretary
shall respond to the petitioner and decide whether to propose a regulation
proposing a change within 90 days of such receipt. If a regulation is required,
the Secretary shall propose such regulation within 6 months of such determination.
The Secretary shall provide the petitioner the reasons for the decision
of the Secretary. The Secretary may make changes requested by a petitioner
in whole or in part.
SEC. 3. APPLICATION TO OTHER HEALTH CARE COVERAGE.
Chapter 89 of title 5, United States Code, is amended by adding at the end
the following:
`Sec. 8915. Standards relating to coverage of cancer screening and patient
access to information.
`(a) The provisions of sections 2707 and 2708 of the Public Health Service
Act shall apply to the provision of items and services under this chapter.
`(b) Nothing in this section or section 2707(c) of the Public Health Service
Act shall be construed as authorizing a health insurance issuer or entity
to impose cost sharing with respect to the coverage or benefits required to
be provided under section 2707 of the Public Health Service Act that is inconsistent
with the cost sharing that is otherwise permitted under this chapter.'.
END
