PRINTER'S NO. 3992
No. 2783 Session of 2000
INTRODUCED BY COLAFELLA, DeLUCA, PIPPY, DeWEESE, BELARDI,
FAIRCHILD, MANDERINO, McCALL, FRANKEL, SHANER, FREEMAN,
BEBKO-JONES, GEIST, MELIO, SOLOBAY, GRUCELA, STEVENSON,
HALUSKA, HARHAI, SURRA, CAPPABIANCA, HASAY, ORIE,
E. Z. TAYLOR, HENNESSEY, CAWLEY, HERSHEY, PETRARCA, TIGUE,
HESS, HORSEY, TRELLO, TRICH, PISTELLA, M. COHEN, JAMES,
VAN HORNE, RAMOS, KENNEY, READSHAW, WALKO, LAUGHLIN,
WOJNAROSKI, YOUNGBLOOD, YUDICHAK AND SAINATO,
SEPTEMBER 27, 2000
REFERRED TO COMMITTEE ON INSURANCE, SEPTEMBER 27, 2000
AN ACT
1 Providing for certain health insurance benefits relating to
2 colorectal cancer screening.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. Short title.
6 This act shall be known and may be cited as the Colorectal
7 Cancer Screening Act.
8 Section 2. Definitions.
9 The following words and phrases when used in this act shall
10 have the meanings given to them in this section unless the
11 context clearly indicates otherwise:
12 "Colorectal cancer screening test." Any of the following
13 procedures that are furnished to an individual for the purpose
14 of early detection of colorectal cancer:
1 (1) Screening fecal-occult blood test.
2 (2) Screening flexible sigmoidoscopy.
3 (3) Screening colonoscopy, in the case of a high risk
4 individual.
5 (4) Screening barium enema, if medically necessary, as
6 an alternative to screening flexible sigmoidoscopy or
7 screening colonoscopy.
8 (5) Such other procedures as the Secretary of Health
9 deems appropriate in accordance with this act.
10 "Health insurance policy." An individual or group health
11 insurance policy, contract or plan which provides medical
12 coverage on an expense-incurred, service or prepaid basis,
13 including, but not limited to, the following:
14 (1) A health insurance policy or contract issued by a
15 corporation not-for-profit subject to 40 Pa.C.S. Ch. 61
16 (relating to hospital plans corporations).
17 (2) A benefit contract subject to the act of December
18 14, 1992 (P.L.835, No.134), known as the Fraternal Benefit
19 Societies Code.
20 (3) A health service plan operating under the act of
21 December 29, 1972 (P.L.1701, No.364), known as the Health
22 Maintenance Organization Act.
23 "High risk individual." A person who faces a high risk for
24 colorectal cancer because of:
25 (1) family history;
26 (2) prior experience of cancer or precursor neoplastic
27 polyps;
28 (3) a history of chronic digestive disease, Crohn's
29 Disease or ulcerative colitis;
30 (4) the presence of any appropriate recognized gene
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1 markers for colorectal cancer; or
2 (5) other predisposing factors.
3 "Secretary." The Secretary of Health of the Commonwealth.
4 Section 3. Insurance coverage standards.
5 (a) General rule.--Every health insurance policy that is
6 delivered, issued, executed or renewed in this Commonwealth on
7 or after the effective date of this act shall provide coverage
8 for colorectal cancer screening tests in accordance with this
9 section.
10 (b) Time and frequency limits.--
11 (1) Coverage for a screening fecal-occult blood test
12 shall be required only for an individual who is 50 years of
13 age or older and if the test is not performed on the
14 individual more frequently than every 11 months.
15 (2) Coverage for a screening flexible sigmoidoscopy
16 shall be required only for an individual who is 50 years of
17 age or older and if the procedure is not performed on the
18 individual more frequently than every 47 months.
19 (3) Coverage for a screening colonoscopy for a high risk
20 individual shall be required only if the procedure is not
21 performed on the individual more frequently than every 23
22 months.
23 Section 4. Regulations.
24 Beginning in calendar year 2003, the secretary may promulgate
25 regulations to identify procedures, other than those procedures
26 specified in section 2, that have the purpose of early detection
27 of colorectal cancer. In promulgating such regulations, the
28 secretary shall take into consideration the changes in
29 technology and standards of medical practice, availability,
30 effectiveness, costs and other factors that the secretary, in
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1 the secretary's discretion, deems appropriate.
2 Section 5. Effective date.
3 This act shall take effect in 60 days.
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