Senate Bill sb2384
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 2384
By Senator Posey
24-1774A-07
1 A bill to be entitled
2 An act relating to colon cancer screening;
3 creating s. 627.64191, F.S.; providing
4 legislative intent; requiring health insurance
5 policies to provide coverage for colorectal
6 cancer examinations; providing minimum
7 requirements for screening examinations for
8 colorectal cancer and laboratory tests;
9 providing eligibility criteria for receiving
10 insurance coverage for colorectal cancer
11 screening; requiring that screening strategies
12 be covered by the insurer; requiring insurance
13 coverage for persons who are at an average risk
14 for colorectal cancer under certain
15 circumstances; defining the phrase "individual
16 at high risk for colorectal cancer"; providing
17 that patients and health care providers are not
18 required to meet burdensome criteria in order
19 to secure insurance coverage for colorectal
20 cancer screening; providing a requirement for
21 reimbursement to health care providers for
22 colorectal cancer screening; providing that a
23 group health plan or health insurance issuer is
24 not required to provide a referral to certain
25 health care providers under certain
26 circumstances; requiring that services provided
27 as a part of an approved screening exam or
28 treatment by a nonparticipating health care
29 provider be reimbursed as provided under the
30 policy or contract; providing that the act does
31
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 2384
24-1774A-07
1 not apply to certain insurance policies;
2 providing an effective date.
3
4 Be It Enacted by the Legislature of the State of Florida:
5
6 Section 1. Section 627.64191, Florida Statutes, is
7 created to read:
8 627.64191 Colon cancer screening insurance coverage;
9 required options; cost-sharing; benefit notification;
10 referrals; payment of nonparticipating providers.--
11 (1) LEGISLATIVE INTENT.--It is the intent of the
12 Legislature to reduce the incidence and mortality of
13 colorectal cancers in this state through better screening,
14 thereby enhancing early detection and in many cases prevention
15 of the disease.
16 (2) COVERAGE.--Any individual and group health
17 insurance policy providing coverage on an expense-incurred
18 basis, any individual or group service or indemnity type
19 contract issued by a health maintenance organization, any
20 state medical-assistance program and its contracted insurers,
21 whether providing services on a managed care or
22 fee-for-service basis, the state employees' health insurance
23 program, any self-insured group arrangement to the extent not
24 preempted by federal law, and any managed health care delivery
25 entity of any type or description which delivered, issued for
26 delivery, continued, or renewed on or after January 1, 2008,
27 and which provides coverage to any resident of this state
28 shall provide benefits or coverage for all colorectal cancer
29 examinations and laboratory tests specified in paragraph (a)
30 for colorectal cancer screenings of asymptomatic individuals.
31
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 2384
24-1774A-07
1 (a) A colorectal screening examination and laboratory
2 test to be covered under this section must include, at a
3 minimum:
4 1. A fecal occult blood test conducted annually.
5 2. A flexible sigmoidoscopy conducted every 5 years.
6 3. A combination of a fecal occult blood test
7 conducted annually along with a flexible sigmoidoscopy
8 conducted every 5 years.
9 4. The screening contained in the guidelines from the
10 United States Preventive Services Task Force or a double
11 contrast barium enema every 5 years as an alternative when
12 indicated by a licensed physician.
13 5. The screening contained in the guidelines from the
14 United States Preventive Services Task Force or a colonoscopy
15 every 10 years as an alternative when indicated by a licensed
16 physician.
17 (b) Benefits shall be provided under this section for
18 a covered individual who is:
19 1. At least 50 years of age; or
20 2. Less than 50 years of age and at high risk for
21 colorectal cancer.
22 (c) Any evidenced-based screening strategy identified
23 in this section shall be covered by the insurer, with the
24 choice of strategy determined by the covered individual in
25 consultation with a licensed physician.
26 (d) For those individuals considered to be at average
27 risk for colorectal cancer, coverage or benefits shall be
28 provided for the choice of screening, if it is conducted in
29 accordance with the specified frequency prescribed in this
30 section and, for those individuals considered to be at high
31
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 2384
24-1774A-07
1 risk for colorectal cancer, provided at a frequency deemed
2 necessary by a licensed physician.
3 (e) As used in this section, the term "individual at
4 high risk for colorectal cancer" means any individual who,
5 because of family history; prior experience of cancer or
6 precursor neoplastic polyps; a history of chronic digestive
7 disease condition, including inflammatory bowel disease,
8 Crohn's disease, or ulcerative colitis; the presence of any
9 appropriate recognized gene markers for colorectal cancer; or
10 other predisposing factors, faces a higher-than-normal risk
11 for colorectal cancer.
12 (3) COST-SHARING.--To encourage colorectal cancer
13 screenings, patients and health care providers may not be
14 required to meet burdensome criteria or overcome significant
15 obstacles in order to secure such coverage. An individual may
16 not be required to pay an additional deductible or coinsurance
17 for testing which is greater than an annual deductible or
18 coinsurance established for other covered benefits.
19 (4) REFERRALS TO PARTICIPATING PROVIDERS.--A group
20 health plan or health insurance issuer is not required under
21 this section to provide a referral to a nonparticipating
22 health care provider unless the plan or issuer does not have
23 an appropriate health care provider that is available and
24 accessible to administer the screening exam and that is a
25 participating health care provider with respect to such
26 treatment.
27 (5) PAYMENT OF NONPARTICIPATING PROVIDERS.--If a plan
28 or issuer refers an individual to a nonparticipating health
29 care provider under this section, services provided as part of
30 the approved screening exam or resultant treatment shall be
31 reimbursed as provided under the policy or contract.
4
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 2384
24-1774A-07
1 (6) EXCEPTIONS.--This section does not apply to any
2 insurance policy that covers:
3 (a) A specified accident;
4 (b) A specified disease;
5 (c) Disability income;
6 (d) Medicare supplement; or
7 (e) Long-term care.
8 Section 2. This act shall take effect July 1, 2007.
9
10 *****************************************
11 SENATE SUMMARY
12 Requires health insurance policies to provide coverage
for colorectal cancer examinations. Provides minimum
13 requirements for colorectal screening examinations and
laboratory tests. Provides eligibility criteria for
14 receiving insurance coverage for colorectal screening.
Requires insurance coverage for persons who are at an
15 average risk for colorectal cancer under certain
circumstances. Defines the phrase "individual at high
16 risk for colorectal cancer." Provides that patients and
health care providers are not required to meet burdensome
17 criteria to secure insurance coverage for colorectal
cancer screening. Provides a requirement for
18 reimbursement to health care providers for colorectal
cancer screening. Provides that a group health plan or
19 health insurance issuer is not required to provide a
referral to certain health care providers under certain
20 circumstances. Provides that services provided as a part
of an approved screening exam or treatment by a
21 nonparticipating health care provider are reimbursed.
Provides for nonapplicability.
22
23
24
25
26
27
28
29
30
31
5
CODING: Words stricken are deletions; words underlined are additions.