Today's Law As Amended


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AB-1986 Health care coverage: colorectal cancer: screening and testing.(2019-2020)



As Amends the Law Today


SECTION 1.

 Section 1367.668 is added to the Health and Safety Code, to read:

1367.668.
 (a) Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2021, shall provide coverage without any cost sharing for all colorectal cancer screening examinations and laboratory tests assigned either a grade of A or a grade of B by the United States Preventive Services Task Force for individuals at average risk. If an enrollee is at high risk for colorectal cancer, the coverage required by this subdivision shall include additional colorectal cancer screening examinations as listed by the United States Preventive Services Task Force as a recommended screening strategy and at least at the frequency established pursuant to regulations issued by the federal Centers for Medicare and Medicaid Services for the Medicare program.
(b) For an enrollee who is between 50 and 75 years of age, a health care service plan contract shall not impose cost sharing on colonoscopies, including the removal of polyps, when either of the following applies:
(1) The colonoscopy is a screening procedure not occasioned by a recent positive test or procedure.
(2) The colonoscopy has been scheduled because of a positive result on a test or procedure, other than a colonoscopy, assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.
(c) Nothing in this section requires a health care service plan that has a network of providers to provide benefits for items or services described in this section that are delivered by an out-of-network provider or precludes a health care service plan that has a network of providers from imposing cost-sharing requirements for the items or services described in this section that are delivered by an out-of-network provider.

SEC. 2.

 Section 10123.207 is added to the Insurance Code, to read:

10123.207.
 (a) Every health insurance policy, except a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2021, shall provide coverage without cost sharing for all colorectal cancer screening examinations and laboratory tests assigned either a grade of A or a grade of B by the United States Preventive Services Task Force for individuals at average risk. If an insured is at high risk for colorectal cancer, the coverage required by this subdivision shall include additional colorectal cancer screening examinations as listed by the United States Preventive Services Task Force as a recommended screening strategy and at least at the frequency established pursuant to regulations issued by the federal Centers for Medicare and Medicaid Services for the Medicare program.
(b) For an insured who is between 50 and 75 years of age, a health insurance policy shall not impose cost sharing on colonoscopies, including the removal of polyps, when either of the following applies:
(1) The colonoscopy is a screening procedure not occasioned by a recent positive test or procedure.
(2) The colonoscopy has been scheduled because of a positive result on a test or procedure, other than a colonoscopy, assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.
(c) Nothing in this section requires a health insurer that has a network of providers to provide benefits for items or services described in this section that are delivered by an out-of-network provider or precludes a health insurer that has a network of providers from imposing cost-sharing requirements for the items or services described in this section that are delivered by an out-of-network provider.
SEC. 3.
 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.