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A bill to be entitled

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An act relating to cancer screening; providing legislative

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intent; creating s. 627.64173, F.S.; requiring certain

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health insurance policies, health maintenance organization

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contracts, health insurance programs, group arrangements,

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and managed health care delivery entities providing

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coverage to state residents to provide coverage for

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certain colorectal cancer examinations and laboratory

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tests for colorectal cancer; providing requirements for

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the colorectal screening examination; specifying covered

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individuals; requiring coverage of certain evidence-based

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screening strategies; providing a definition; prohibiting

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patients and providers from being required to meet certain

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requirements in order to secure coverage; prohibiting

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certain deductible or coinsurance requirements; specifying

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absence of any requirement to make nonparticipating

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provider referrals under certain circumstances; providing

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for payment of nonparticipating providers; excluding

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application to certain insurance policies; providing an

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effective date.

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Be It Enacted by the Legislature of the State of Florida:

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     Section 1. It is the intent of the Legislature to help

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reduce the state's inordinately high cancer burden through early

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detection and treatment of colon cancer through ensuring coverage

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for the full range of colon cancer screenings, including

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colonoscopies, in health insurance policies written in this

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state.

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     Section 2.  Section 627.64173, Florida Statutes, is created

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to read:

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     627.64173 Colorectal cancer screening coverage.--

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     (1) Any individual and group health insurance policy

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providing coverage on an expense-incurred basis or any individual

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or group service or indemnity type contract that is issued by a

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health maintenance organization, a state medical assistance

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program and its contracted insurers whether providing services on

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a managed care or fee-for-service basis, the state employees'

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health insurance program, a self-insured group arrangement to the

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extent not preempted by federal law, or a managed health care

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delivery entity of any type or description which policy or

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contract is delivered, issued for delivery, continued, or renewed

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on or after January 1, 2009, and which provides coverage to any

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resident of this state shall provide benefits or coverage for all

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colorectal cancer examinations and laboratory tests specified in

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subsection (2) for colorectal cancer.

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     (2) A colorectal screening examination and laboratory test

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to be covered under this section must include, at a minimum:

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     (a) A fecal occult blood test conducted annually.

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     (b) A flexible sigmoidoscopy conducted every 5 years.

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     (c) A combination of a fecal occult blood test conducted

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annually along with a flexible sigmoidoscopy conducted every 5

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years.

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     (d) The screening contained in the guidelines from the

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United States Preventive Services Task Force or a double contrast

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barium enema every 5 years as an alternative when indicated by a

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licensed physician.

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     (e) The screening contained in the guidelines from the

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United States Preventive Services Task Force or a colonoscopy

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every 10 years as an alternative when indicated by a licensed

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physician.

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     (3) Benefits under this section shall be provided to a

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covered individual who is:

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     (a) At least 50 years of age; or

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     (b) Younger than 50 years of age and at high risk for

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colorectal cancer.

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     (4) Any evidence-based screening strategy identified in

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this section shall be covered by the insurer, with the choice of

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strategy determined by the covered individual in consultation

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with a licensed physician.

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     (5) For those individuals considered to be at average risk

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for colorectal cancer, coverage or benefits shall be provided for

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the choice of screening if it is conducted in accordance with the

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specified frequency prescribed in this section and, for those

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individuals considered to be at high risk for colorectal cancer,

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provided at a frequency deemed necessary by a licensed physician.

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     (6) As used in this section, the term "individual at high

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risk for colorectal cancer" means any individual who, because of

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family history; prior experience of cancer or precursor

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neoplastic polyps; a history of chronic digestive disease

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condition, including inflammatory bowel disease, Crohn's disease,

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or ulcerative colitis; the presence of any appropriate recognized

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gene markers for colorectal cancer; or other predisposing

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factors, faces a higher than normal risk for colorectal cancer.

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     (7) To encourage potentially lifesaving colorectal cancer

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screenings, patients and health care providers may not be

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required to meet burdensome criteria or overcome significant

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obstacles in order to secure such coverage. An individual may not

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be required to pay an additional deductible or coinsurance for

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testing which is greater than an annual deductible or coinsurance

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established for similar screening benefits. If the program or

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contract does not cover a similar benefit, a deductible or

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coinsurance may not be set at a level that materially diminishes

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the value of colorectal cancer screening benefit required under

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this section.

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     (8) A group health plan or health insurance issuer is not

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required under this section to provide a referral to a

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nonparticipating health care provider unless the plan or issuer

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does not have an appropriate health care provider that is

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available and accessible to administer the screening examination

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and that is a participating health care provider with respect to

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such treatment.

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     (9) If a plan or issuer refers an individual to a

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nonparticipating health care provider under this section,

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services provided as part of the approved screening examination

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or resultant treatment shall be reimbursed as provided under the

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policy or contract.

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     Section 3. This act does not apply to any insurance policy

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that solely covers a specified accident, a specified disease,

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disability income, Medicare supplement, or long-term care.

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     Section 4.  This act shall take effect July 1, 2008.