Bill H.3575

HOUSE DOCKET, NO. 3220 FILED ON: 1/20/2017

HOUSE . . . . . . . . . . . . . . . No. 3575

By Mr. Miceli of Wilmington, a petition (accompanied by bill, House, No. 3575) of James R. Miceli relative to providing healthcare coverage for certain colon screenings. Financial Services.

The Commonwealth of Massachusetts

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In the One Hundred and Ninetieth General Court
(2017-2018)

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An Act relative to colon screenings.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. The General Court hereby finds and declares that:

(a) Colorectal cancer is the second leading cause of cancer death in the United States. Metastatic disease accounts for 40 to 50 per cent of newly diagnosed patients and is associated with high morbidity. In 2016, an estimated 134,000 persons will be diagnosed with colorectal cancer, and about 49,000 will die from it. Colorectal cancer is the third most common cancer worldwide.

(b) Despite the availability of effective screening options, nearly one-third of eligible adults have never been screened for colorectal cancer.

(c) The United States Preventive Services Task Force has concluded, with high certainty, that screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years is of substantial net benefit.

(d) In December of 2010 the commonwealth’s division of health care finance and policy issued a review and evaluation of proposed legislation regarding mandated colorectal cancer screenings. The review noted that in 2010, the federal Patient Protection Affordable Care Act mandated coverage for colorectal screening.

(e) The President and the Congress of the United States have pledged to repeal the Affordable Care Act. Congress has already attempted to repeal the act 62 times and in 2017, the U.S. House of Representatives has begun the process anew to repeal the Affordable Care Act. Repeal of the Affordable Care Act eliminates the federal mandate for colorectal screening health insurance coverage.

(f) Mandated coverage and regulation of colorectal screening availability, cost and pricing are important public policy goals to provide health care and insurance for the prevention and treatment of a highly curable, deadly cancer.

SECTION 2. Chapter 32A of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting after section 17N the following section:-

Section 17O. (a) The commission shall provide to any active or retired employee of the commonwealth starting at 50 years of age who is insured under the group insurance commission coverage for colorectal cancer screening as found medically necessary by the insured’s primary care physician, including: (i) Flexible sigmoidoscopy every 5 years; (ii) Flexible sigmoidoscopy every 10 years plus FIT every year; (iii) KRAS, BRAF, PIK3CA Array as frequent as medically necessary; (iv) FIT-DNA every year or every 3 years, as medically necessary; (v) FIT every year; (vi) HSgFOBT every year; (vii) CT colonography every 5 years; and (vii) colonoscopy every 5 or 10 years. For the purposes of this section the term “colonoscopy”, shall mean a colorectal cancer screening service procedure that enables a physician to examine visually the inside of a patient's entire colon and includes the concurrent removal of polyps or biopsy, or both.

(b) Colorectal cancer screening services pursuant to subsection (a) performed under contract with the commission shall not be subject to any co-payment, deductible, coinsurance or other cost-sharing requirement. In addition, an insured shall not be subject to any additional charge for any service associated with a procedure or test for colorectal cancer screening, which may include 1 or more of the following: (i) removal of tissue or other matter; (ii) laboratory services; (iii) physician services; (iv) facility use, regardless of whether such facility is a hospital; and (v) anesthesia.

SECTION 3. Chapter 175 of the General Laws, as so appearing, is hereby amended by inserting after section 47II the following section:-

Section 47JJ. (a) Any policy of accident and sickness insurance issued pursuant to section 108, and any group blanket policy of accident and sickness insurance issued pursuant to section 110 that is delivered, issued or renewed by agreement within or without the commonwealth shall provide coverage, starting at 50 years of age, for colorectal cancer screening as found medically necessary by the insured’s primary care physician, including: (i) Flexible sigmoidoscopy every 5 years; (ii) Flexible sigmoidoscopy every 10 years plus FIT every year; (iii) KRAS, BRAF, PIK3CA Array as frequent as medically necessary; (iv) FIT-DNA every year or every 3 years, as medically necessary; (v) FIT every year; (vi) HSgFOBT every year; (vii) CT colonography every 5 years; and (viii) colonoscopy every 5 or 10 years. For the purposes of this section the term “colonoscopy”, shall mean a procedure that enables a physician to examine visually the inside of a patient's entire colon and includes the concurrent removal of polyps or biopsy, or both.

(b) Colorectal cancer screening services pursuant to subsection (a) performed under this section shall not be subject to any co-payment, deductible, coinsurance or other cost-sharing requirement. In addition, an insured shall not be subject to any additional charge for any service associated with a procedure or test for colorectal cancer screening, which may include 1 or more of the following: (i) removal of tissue or other matter; (ii) laboratory services; (iii) physician services; (iv) facility use, regardless of whether such facility is a hospital; and (v) anesthesia.

SECTION 4. Chapter 176A of the General Laws, as so appearing, is hereby amended by inserting after section 8KK the following section:-

Section 8LL. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall provide coverage, starting at 50 years of age, for colorectal cancer screening as found medically necessary by the insured’s primary care physician, including: (i) Flexible sigmoidoscopy every 5 years; (ii) Flexible sigmoidoscopy every 10 years plus FIT every year; (iii) KRAS, BRAF, PIK3CA Array as frequent as medically necessary; (iv) FIT-DNA every year or every 3 years, as medically necessary; (v) FIT every year; (vi) HSgFOBT every year; (vii) CT colonography every 5 years; and (viii) colonoscopy every 5 or 10 years. For the purposes of this section the term “colonoscopy”, shall mean a procedure that enables a physician to examine visually the inside of a patient's entire colon and includes the concurrent removal of polyps or biopsy, or both.

SECTION 5. Chapter 176B of the General Laws, as so appearing, is hereby amended by inserting after section 4KK the following section:-

Section 4LL. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage, starting at 50 years of age, for colorectal cancer screening as found medically necessary by the insured’s primary care physician, including: (i) Flexible sigmoidoscopy every 5 years; (ii) Flexible sigmoidoscopy every 10 years plus FIT every year; (iii) KRAS, BRAF, PIK3CA Array as frequent as medically necessary; (iv) FIT-DNA every year or every 3 years, as medically necessary; (iv) FIT every year; (vi) HSgFOBT every year; (vii) CT colonography every 5 years; and (viii) colonoscopy every 5 or 10 years. For the purposes of this section the term “colonoscopy”, shall mean a procedure that enables a physician to examine visually the inside of a patient's entire colon and includes the concurrent removal of polyps or biopsy, or both.

SECTION 6. Chapter 176G of the General Laws, as so appearing, is hereby amended by inserting after section 4CC the following section:-

Section 4DD. (a) An individual or group health maintenance contract that is issued or renewed shall provide coverage, starting at 50 years of age, for colorectal cancer screening as found medically necessary by the insured’s primary care physician, including: (i) Flexible sigmoidoscopy every 5 years; (ii) Flexible sigmoidoscopy every 10 years plus FIT every year; (iii) KRAS, BRAF, PIK3CA Array as frequent as medically necessary; (iv) FIT-DNA every year or every 3 years, as medically necessary; (v) FIT every year; (vi) HSgFOBT every year; (vii) CT colonography every 5 years; and (viii) colonoscopy every 5 or 10 years. For the purposes of this section the term “colonoscopy”, shall mean a procedure that enables a physician to examine visually the inside of a patient's entire colon and includes the concurrent removal of polyps or biopsy, or both.

Name:	District/Address:	Date Added:
James R. Miceli	19th Middlesex	1/20/2017