108th CONGRESS
2d Session
H. R. 4097
To require group and individual health plans to provide coverage
for colorectal cancer screenings.
IN THE HOUSE OF REPRESENTATIVES
March 31, 2004
Ms. SLAUGHTER (for herself and Mr. KING of New York) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and in addition
to the Committee on Education and the Workforce, 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 require group and individual health plans to provide coverage
for colorectal cancer screenings.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) SHORT TITLE- This Act may be cited as the `Eliminate Colorectal Cancer
Act of 2004'.
(b) FINDINGS- The Congress finds the following:
(1) Colorectal cancer is the second leading cause of cancer deaths in the
United States for men and women combined.
(2) It is estimated that in 2004, 146,940 new cases of colorectal cancer
will be diagnosed in men and women in the United States.
(3) Colorectal cancer is expected to kill 56,730 individuals in the United
States in 2004.
(4) When colorectal cancer is diagnosed early, at a localized stage, more
than 90 percent of patients survive for 5 years or more. Once the disease
has metastasized, 92 percent of patients die within 5 years. Yet, only 37
percent of colorectal cancer cases are diagnosed while the disease is still
in the localized stage.
(5) If all men and women age 50 and over practiced regular colorectal cancer
screening, without any new scientific discoveries, the United States could
see up to a 50 to 90 percent reduction in deaths from this disease.
(6) Currently, many private insurance health plans are not providing coverage
for the full range of colorectal cancer screening tests. Lack of insurance
coverage can act as a barrier to care.
(7) Assuring coverage for the full range of colorectal cancer tests is an
important step in increasing screening rates for these life saving tests.
SEC. 2. COVERAGE FOR COLORECTAL CANCER SCREENING.
(1) PUBLIC HEALTH SERVICE ACT AMENDMENTS- The Public Health Service Act
(42 U.S.C. 201 et seq.) is amended by adding at the end the following:
`TITLE XXIX--MISCELLANEOUS HEALTH COVERAGE
`SEC. 2901. COVERAGE FOR COLORECTAL CANCER SCREENING.
`(a) COVERAGE FOR COLORECTAL CANCER SCREENING-
`(1) IN GENERAL- A group health plan, and a health insurance issuer offering
group health insurance coverage, shall provide coverage for colorectal cancer
screening consistent with this subsection to--
`(A) any participant or beneficiary age 50 or over; and
`(B) any participant or beneficiary under the age of 50 who is at a high
risk for colorectal cancer.
`(2) DEFINITION OF HIGH RISK- For purposes of subsection (a)(1)(B), the
term `high risk for colorectal cancer' has the meaning given such term in
section 1861(pp)(2) of the Social Security Act (42 U.S.C. 1395x(pp)(2)).
`(3) REQUIREMENT FOR SCREENING- The group health plan or health insurance
issuer shall cover methods of colorectal cancer screening that--
`(A) are deemed appropriate by a physician (as defined in section 1861(r)
of the Social Security Act (42 U.S.C. 1395x(r))) treating the participant
or beneficiary, in consultation with the participant or beneficiary;
`(i) described in section 1861(pp)(1) of the Social Security Act (42
U.S.C. 1395x(pp)(1)) or section 410.37 of title 42, Code of Federal
Regulations; or
`(ii) specified by the Secretary, based upon the recommendations of
appropriate organizations with special expertise in the field of colorectal
cancer; and
`(C) are performed at a frequency not greater than that--
`(i) described for such method in section 1834(d) of the Social Security
Act (42 U.S.C. 1395m(d)) or section 410.37 of title 42, Code of Federal
Regulations; or
`(ii) specified by the Secretary for such method, if the Secretary finds,
based upon new scientific knowledge and consistent with the recommendations
of appropriate organizations with special expertise in the field of
colorectal cancer, that a different frequency would not adversely affect
the effectiveness of such screening.
`(b) NOTICE- A group health plan under this section shall comply with the
notice requirement under section 714(b) 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.
`(c) NON-PREEMPTION OF MORE PROTECTIVE STATE LAW WITH RESPECT TO HEALTH INSURANCE
ISSUERS- This section shall not be construed to supersede any provision of
State law which establishes, implements, or continues in effect any standard
or requirement solely relating to health insurance issuers in connection with
group health insurance coverage that provides greater protections to participants
and beneficiaries than the protections provided under this section.
`(d) DEFINITIONS AND ENFORCEMENT- The definitions and enforcement provisions
of title XXVII shall apply for purposes of this section.'.
(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 FOR COLORECTAL CANCER SCREENING.
`(a) COVERAGE FOR COLORECTAL CANCER SCREENING-
`(1) IN GENERAL- A group health plan, and a health insurance issuer offering
group health insurance coverage, shall provide coverage for colorectal cancer
screening consistent with this subsection to--
`(A) any participant or beneficiary age 50 or over; and
`(B) any participant or beneficiary under the age of 50 who is at a high
risk for colorectal cancer.
`(2) DEFINITION OF HIGH RISK- For purposes of subsection (a)(1)(B), the
term `high risk for colorectal cancer' has the meaning given such term in
section 1861(pp)(2) of the Social Security Act (42 U.S.C. 1395x(pp)(2)).
`(3) REQUIREMENT FOR SCREENING- The group health plan or health insurance
issuer shall cover methods of colorectal cancer screening that--
`(A) are deemed appropriate by a physician (as defined in section 1861(r)
of the Social Security Act (42 U.S.C. 1395x(r))) treating the participant
or beneficiary, in consultation with the participant or beneficiary;
`(i) described in section 1861(pp)(1) of the Social Security Act (42
U.S.C. 1395x(pp)(1)) or section 410.37 of title 42, Code of Federal
Regulations; or
`(ii) specified by the Secretary, based upon the recommendations of
appropriate organizations with special expertise in the field of colorectal
cancer; and
`(C) are performed at a frequency not greater than that--
`(i) described for such method in section 1834(d) of the Social Security
Act (42 U.S.C. 1395m(d)) or section 410.37 of title 42, Code of Federal
Regulations; or
`(ii) specified by the Secretary for such method, if the Secretary finds,
based upon new scientific knowledge and consistent with the recommendations
of appropriate organizations with special expertise in the field of
colorectal cancer, that a different frequency would not adversely affect
the effectiveness of such screening.
`(b) NOTICE UNDER GROUP HEALTH PLAN- The imposition of the requirements 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 third to 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 requirements apply.'.
(B) TECHNICAL AND CONFORMING 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 item:
`Sec. 714. Coverage for colorectal cancer screening.'.
(b) INDIVIDUAL HEALTH INSURANCE-
(1) IN GENERAL- Part B of title XXVII of the Public Health Service Act (42
U.S.C. 300gg-41 et seq.) is amended by inserting after section 2752 the
following new section:
`SEC. 2753. COVERAGE FOR COLORECTAL CANCER SCREENING.
`(a) IN GENERAL- The provisions of section 2901(a) shall apply to health insurance
coverage offered by a health insurance issuer in the individual market in
the same manner as it applies to health insurance coverage offered by a health
insurance issuer in connection with a group health plan in the small or large
group market.
`(b) NOTICE- A health insurance issuer under this part shall comply with the
notice requirement under section 714(b) 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.'.
(2) TECHNICAL AMENDMENT- Section 2762(b)(2) of the Public Health Service
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- The amendments made by subsection (a) shall apply
with respect to group health plans for plan years beginning on or after
January 1, 2005.
(2) INDIVIDUAL HEALTH INSURANCE- The amendments 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 January 1, 2005.
(d) COORDINATED REGULATIONS- The Secretary of Labor and the Secretary of Health
and Human Services shall ensure, through the execution of an interagency memorandum
of understanding among such Secretaries, that--
(1) regulations, rulings, and interpretations issued by such Secretaries
relating to the same matter over which both Secretaries have responsibility
under the provisions of this section (and the amendments made thereby) are
administered so as to have the same effect at all times; and
(2) coordination of policies relating to enforcing the same requirements
through such Secretaries in order to have a coordinated enforcement strategy
that avoids duplication of enforcement efforts and assigns priorities in
enforcement.
END
