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H. 3536
STATUS INFORMATION
General Bill
Sponsors: Reps. J.E. Smith, Duncan and M.A. Pitts
Document Path: l:\council\bills\dka\3188dw05.doc
Introduced in the House on February 15, 2005
Currently residing in the House Committee on Labor, Commerce and Industry
Summary: Insurance coverage for early detection of colorectal cancer required
HISTORY OF LEGISLATIVE ACTIONS
Date Body Action Description with journal page number
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2/15/2005 House Introduced and read first time HJ-5
2/15/2005 House Referred to Committee on Labor, Commerce and Industry
HJ-5
2/23/2005 House Member(s) request name added as sponsor: Duncan
2/24/2005 House Member(s) request name added as sponsor: M.A.Pitts
View the latest legislative information at the LPITS web site
VERSIONS OF THIS BILL
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-48 SO AS TO REQUIRE INSURANCE COVERAGE FOR COLORECTAL CANCER EARLY DETECTION FOR CERTAIN PERSONS.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Article 1, Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-48. (A) An 'individual at high risk for colorectal cancer' means:
(1) an individual who because of family history; prior experience of cancer or precursor neoplastic polyps; a history of chronic digestive disease condition, including inflammatory bowel disease, Crohn's Disease, or ulcerative colitis; the presence of any appropriate recognized gene markers for colonrectal cancer; or other predisposing factors, faces a high risk for colorectal cancer; or
(2) an additional or expanded definition of 'individual at high risk for colorectal cancer' as recognized by medical science and required by the Commissioner of the Department of Health and Environmental Control, determined in consultation with appropriate organizations.
(B) All individual and group health insurance policies providing coverage on an expense incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, the state employees' health insurance program, all self-insured group arrangements to the extent not preempted by federal law, and all managed health care delivery entities of any type or description, that are delivered, issued for delivery, continued or renewed on or after the effective date of this section, and providing coverage to a resident of this State shall provide benefits or coverage for all colorectal cancer examinations and laboratory tests specified in subsection (C) for colorectal cancer screening of asymptomatic individuals.
(C) The colorectal screening examinations and laboratory tests to be covered include the following full range of options:
(1) a fecal occult blood test conducted annually;
(2) a flexible sigmoidoscopy conducted every five years;
(3) a combination of a fecal occult blood test conducted annually along with a flexible sigmoidoscopy conducted every five years;
(4) a colonoscopy conducted every ten years;
(5) a double contrast barium enema every five years; and
(6) any additional medically recognized screening tests for colorectal cancer as required by the Commissioner of DHEC sdetermined in consultation with appropriate organizations.
(D)(1) Benefits are provided by this section for a covered individual who is:
(a) at least fifty years of age; or
(b) less than fifty years of age and at high risk for colorectal cancer.
(2) All screening strategies identified in item (1) must be covered by the insurer, with the choice of strategy determined by the covered individual in consultation with a health care provider.
(3) For an individual who is considered to be at average risk for colorectal cancer, coverage or benefits must be provided for the choice of screening, if it is conducted in accordance with the specified frequency, or for an individual who is considered to be at high risk for colorectal cancer, provided at a frequency determined necessary by a health care provider.
(E) The coverage required by subsections (A) through (D) must meet the requirements as provided by subsection (F).
(F) To encourage colorectal cancer screenings, a patient and health care provider is not required to meet burdensome criteria or overcome significant obstacles to secure the coverage. An individual is not required to pay an additional deductible or coinsurance for testing that is greater than an annual deductible or coinsurance established for similar benefits. If the program or contract does not cover a similar benefit, a deductible or coinsurance may not be set at a level that materially diminishes the value of the colorectal cancer benefit required. Reimbursement to a health care provider for colorectal cancer screenings as provided by this section is equal to or greater than reimbursement to a health care provider as provided by Title XVII of the Social Security Act (Medicare).
(G) Each health carrier or health benefit plan shall notify enrollees annually of colorectal cancer screenings covered by the enrollees' health benefit plan and the current American Cancer Society guidelines for colorectal cancer screenings or notify enrollees at intervals consistent with current American Cancer Society guidelines of colorectal cancer screenings which are covered by the enrollees' health benefit plans. The notice must be delivered by mail unless the enrollee and health carrier have agree on another method of notification.
(H) A group health plan or health insurance issuer is not required by this section to provide for a referral to a nonparticipating health care provider, unless the plan or issuer does not have an appropriate health care provider that is available and accessible to administer the screening exam and that is a participating health care provider with respect to the treatment.
(I) If a group health plan or health insurance issuer refers an individual to a nonparticipating health care provider pursuant to this section, services provided pursuant to the approved screening exam or resulting treatment must be provided at no additional cost to the individual beyond what the individual would otherwise pay for services received by the participating health care provider."
SECTION 2. This act takes effect upon approval by the Governor.
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