HB 1319

1	A bill to be entitled
2	An act relating to health insurance; creating s.
3	627.64173, F.S.; providing legislative intent; requiring
4	each health insurance policy in the state to provide
5	coverage for certain colorectal cancer screenings and
6	tests; specifying required examinations and tests;
7	specifying covered individuals; providing for frequency of
8	examinations and tests; providing a definition; providing
9	requirements for sharing costs of examinations and tests;
10	requiring notification of benefits; providing criteria for
11	referrals; providing requirements for payments; providing
12	an effective date.
13
14	Be It Enacted by the Legislature of the State of Florida:
15
16	Section 1.  Section 627.64173, Florida Statutes, is created
17	to read:
18	627.64173  Coverage for colorectal cancer screening.--
19	(1)  INTENT.--It is the intent of the Legislature to reduce
20	the incidence and mortality of colorectal cancers in this state
21	through screening, enhancing early detection, and treatment.
22	(2)  COVERAGE.--Each individual and group health insurance
23	policy providing coverage on an expense-incurred basis; an
24	individual or group service or indemnity type contract issued by
25	a health maintenance organization; a policy of the state medical
26	assistance program and its contracted insurers, whether
27	providing services on a managed care or fee-for-service basis; a
28	policy of the state employees' health insurance program; a
29	policy of a self-insured group arrangement to the extent not
30	preempted by federal law; and a policy of a managed health care
31	delivery entity of any type or description that is delivered,
32	issued for delivery, continued, or renewed on or after January
33	1, 2008, and providing coverage to any resident of this state
34	must provide benefits and coverage for all colorectal cancer
35	screening examinations and laboratory tests specified in
36	paragraph (a) for colorectal cancer screenings of asymptomatic
37	individuals.
38	(a)  The colorectal cancer screening examinations and
39	laboratory tests to be covered pursuant to this section shall
40	include, at a minimum:
41	1.  A fecal occult blood test conducted annually.
42	2.  A flexible sigmoidoscopy conducted every 5 years.
43	3.  A combination of a fecal occult blood test conducted
44	annually together with a flexible sigmoidoscopy conducted every
45	5 years.
46	4.  A colonoscopy conducted every 10 years.
47	5.  A double contrast barium enema conducted every 5 years.
48	6.  Any additional medically recognized screening tests for
49	colorectal cancer as required by the State Health Officer, in
50	consultation with appropriate organizations.
51	(b)  Benefits shall be provided under this section for a
52	covered individual who is:
53	1.  At least 50 years of age; or
54	2.  Less than 50 years of age and at high risk for
55	colorectal cancer.
56	(c)  All colorectal cancer screening examinations and
57	laboratory tests identified in this section shall be covered by
58	the insurer, with the choice of examination or test determined
59	by the covered individual in consultation with a health care
60	provider.
61	(d)  For those individuals considered to be at average risk
62	for colorectal cancer, coverage or benefits shall be provided
63	for the choice of screening, provided the screening is conducted
64	in accordance with the specified frequency prescribed in this
65	section, or for those individuals considered to be at high risk
66	for colorectal cancer, provided at a frequency deemed necessary
67	by a health care provider.
68	(e)  For the purposes of this section, the term "individual
69	at high risk for colorectal cancer" means:
70	1.  An individual who, because of family history; prior
71	experience of cancer or precursor neoplastic polyps; a history
72	of chronic digestive disease condition, including inflammatory
73	bowel disease, Crohn's Disease, or ulcerative colitis; the
74	presence of any appropriate recognized gene markers for
75	colorectal cancer; or other predisposing factors faces a higher
76	than normal risk for colorectal cancer.
77	2.  An individual who meets any expanded definition as
78	generally recognized by prevailing medical science and as may be
79	defined by the State Health Officer, in consultation with
80	appropriate organizations.
81	(3)  COST SHARING.--To encourage colorectal cancer
82	screenings, individuals and health care providers must not be
83	required to meet criteria or significant obstacles to secure
84	coverage. An individual shall not be required to pay an
85	additional deductible or coinsurance for testing that is greater
86	than an annual deductible or coinsurance established for similar
87	benefits. If the program or contract does not cover a similar
88	benefit, a deductible or coinsurance may not be set at a level
89	that materially diminishes the value of the colorectal cancer
90	benefit required. Reimbursement to health care providers for
91	colorectal cancer screenings provided under this section shall
92	be equal to or greater than the reimbursement to health care
93	providers provided under Title XVII of the Social Security Act,
94	Medicare.
95	(4)  BENEFIT NOTIFICATION.--Each health insurance carrier
96	or health benefit plan shall notify enrollees annually of
97	colorectal cancer screenings covered by the enrollees' health
98	benefit plan as well as notify enrollees of generally accepted
99	screening guidelines. Such notification shall be delivered by
100	mail, unless the enrollee and health insurance carrier have
101	agreed upon another method of notification.
102	(5)  REFERRALS TO PARTICIPATING PROVIDERS.--A group health
103	plan or health insurance carrier is not required under this
104	section to provide for a referral to a nonparticipating health
105	care provider, unless the plan or issuer does not have an
106	appropriate health care provider that is available and
107	accessible to administer the screening examination and is a
108	participating health care provider with respect to such
109	treatment.
110	(6)  PAYMENT OF NONPARTICIPATING PROVIDERS.--If a plan or
111	issuer refers an individual to a nonparticipating health care
112	provider pursuant to this section, services provided as part of
113	the approved screening examination and laboratory tests or
114	resultant treatment, if any, shall be provided at no additional
115	cost to the individual beyond what the individual would
116	otherwise pay for services rendered by such a participating
117	health care provider.
118	Section 2.  This act shall take effect July 1, 2007.

CODING: Words stricken are deletions; words underlined are additions.