[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1285 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1285

 To amend the Employee Retirement Income Security Act of 1974, Public 
 Health Service Act, and the Internal Revenue Code of 1986 to require 
 that group and individual health insurance coverage and group health 
              plans provide coverage of cancer screening.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 25, 1999

  Mrs. Maloney of New York (for herself, Mrs. Kelly, Mr. Rangel, Mr. 
Matsui, Mr. Gilman, Mrs. Mink of Hawaii, Mrs. Morella, Ms. Schakowsky, 
 Mr. Frost, Mr. Lantos, Mr. Gutierrez, Mr. Crowley, Mr. Cummings, and 
 Mr. Sandlin) introduced the following bill; which was referred to the 
 Committee on Commerce, and in addition to the Committees on Education 
and the Workforce, and Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend the Employee Retirement Income Security Act of 1974, Public 
 Health Service Act, and the Internal Revenue Code of 1986 to require 
 that group and individual health insurance coverage and group health 
              plans provide coverage of cancer screening.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Cancer Screening Coverage Act of 
1999''.

SEC. 2. CANCER SCREENING COVERAGE.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--(A) Subpart 2 of 
        part A of title XXVII of the Public Health Service Act is 
        amended by adding at the end the following new section:

``SEC. 2707. COVERAGE OF CANCER SCREENING.

    ``(a) Requirement.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, shall provide coverage 
and payment under the plan or coverage for the following items and 
services under terms and conditions that are no less favorable than the 
terms and conditions applicable to other screening benefits otherwise 
provided under the plan or coverage:
            ``(1) Mammograms.--In the case of a female participant or 
        beneficiary who is 40 years of age or older, or is under 40 
        years of age but is at high risk (as defined in subsection (e)) 
        of developing breast cancer, an annual mammography (as defined 
        in section 1861(jj) of the Social Security Act) conducted by a 
        facility that has a certificate (or provisional certificate) 
        issued under section 354 of the Public Health Service Act.
            ``(2) Clinical breast examinations.--In the case of a 
        female participant or beneficiary who--
                    ``(A)(i) is 40 years of age or older or (ii) is at 
                least 20 (but less than 40) years of age and is at high 
                risk of developing breast cancer, an annual clinical 
                breast examination; or
                    ``(B) is at least 20, but less than 40, years of 
                age and who is not at high risk of developing breast 
                cancer, a clinical breast examination each 3 years.
            ``(3) Pap tests and pelvic examinations.--In the case of a 
        female participant or beneficiary who is 18 years of age or 
        older, or who is under 18 years of age and is or has been 
        sexually active--
                    ``(A) an annual diagnostic laboratory test 
                (popularly known as a `pap smear') consisting of a 
                routine exfoliative cytology test (Papanicolaou test) 
                provided to a woman for the purpose of early detection 
                of cervical or vaginal cancer and including an 
                interpretation by a qualified health professional of 
                the results of the test; and
                    ``(B) an annual pelvic examination.
            ``(4) Colorectal cancer screening procedures.--In the case 
        of a participant or beneficiary who is 50 years of age or 
        older, or who is under 50 years of age and is at high risk of 
        developing colorectal cancer, all of the following procedures 
        furnished to the individual for the purpose of early detection 
        of colorectal cancer:
                    ``(A) Screening fecal-occult blood test, but not to 
                exceed once every 12 months.
                    ``(B) Screening flexible sigmoidoscopy, but not to 
                exceed once every 48 months.
                    ``(C) In the case of an individual at high risk for 
                colorectal cancer, screening colonoscopy, but not to 
                exceed once every 24 months.
                    ``(D) Such other tests or procedures, and 
                modifications to tests and procedures under this 
                paragraph, with such frequency, as the Secretary 
                determines appropriate, in consultation with 
                appropriate organizations.
        Under this paragraph, a screening barium enema may be 
        substituted either for a screening flexible sigmoidoscopy or 
        for a screen colonoscopy at the attending physician's 
        discretion.
            ``(5) Prostate cancer screening.--In the case of a 
        participant or beneficiary who is 50 years of age or older, an 
        annual test consisting of any (or all) of the procedures 
        described in section 1861(oo)(2) of Social Security Act (42 
        U.S.C. 1395x(oo)(2)) provided for the purpose of early 
        detection of prostate cancer.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to individuals 
        to encourage such individuals to accept less than the minimum 
        protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant or beneficiary in a manner inconsistent 
        with this section.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to require 
        an individual who is a participant or beneficiary to undergo a 
        procedure, examination, or test described in subsection (a).
            ``(2) Nothing in this section shall be construed as 
        preventing a group health plan or issuer from imposing 
        deductibles, coinsurance, or other cost-sharing in relation to 
        benefits described in subsection (a) consistent with such 
        subsection, except that such coinsurance or other cost-sharing 
        shall not discriminate on any basis related to the coverage 
        required under this section.
    ``(d) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 714(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
of this section as if such section applied to such plan.
    ``(e) High Risk Defined.--For purposes of this section, an 
individual is considered to be at `high risk' of developing a 
particular type of cancer if, under guidelines developed or recognized 
by the Secretary based upon scientific evidence, the individual--
            ``(1) has one or more close family members who have 
        developed that type of cancer;
            ``(2) has previously had that type of cancer;
            ``(3) has the presence of an appropriate recognized gene 
        marker that is identified as putting the individual at a higher 
        risk of developing that type of cancer; or
            ``(4) has other predisposing factors that significantly 
        increases the risk of the individual contracting that type of 
        cancer.
For purposes of this subsection, the term `type of cancer' includes 
other types of cancer that the Secretary recognizes as closely related 
for purposes of establishing risk.''.
            (B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is 
        amended by striking ``section 2704'' and inserting ``sections 
        2704 and 2707''.
            (2) ERISA amendments.--(A) Subpart B of part 7 of subtitle 
        B of title I of the Employee Retirement Income Security Act of 
        1974 is amended by adding at the end the following new section:

``SEC. 714. COVERAGE OF CANCER SCREENING.

    ``(a) Requirement.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, shall provide coverage 
and payment under the plan or coverage for the following items and 
services under terms and conditions that are no less favorable than the 
terms and conditions applicable to other screening benefits otherwise 
provided under the plan or coverage:
            ``(1) Mammograms.--In the case of a female participant or 
        beneficiary who is 40 years of age or older, or is under 40 
        years of age but is at high risk (as defined in subsection (e)) 
        of developing breast cancer, an annual mammography (as defined 
        in section 1861(jj) of the Social Security Act) conducted by a 
        facility that has a certificate (or provisional certificate) 
        issued under section 354 of the Public Health Service Act.
            ``(2) Clinical breast examinations.--In the case of a 
        female participant or beneficiary who--
                    ``(A)(i) is 40 years of age or older or (ii) is at 
                least 20 (but less than 40) years of age and is at high 
                risk of developing breast cancer, an annual clinical 
                breast examination; or
                    ``(B) is at least 20, but less than 40, years of 
                age and who is not at high risk of developing breast 
                cancer, a clinical breast examination each 3 years.
            ``(3) Pap tests and pelvic examinations.--In the case of a 
        female participant or beneficiary who is 18 years of age or 
        older, or who is under 18 years of age and is or has been 
        sexually active--
                    ``(A) an annual diagnostic laboratory test 
                (popularly known as a `pap smear') consisting of a 
                routine exfoliative cytology test (Papanicolaou test) 
                provided to a woman for the purpose of early detection 
                of cervical or vaginal cancer and including an 
                interpretation by a qualified health professional of 
                the results of the test; and
                    ``(B) an annual pelvic examination.
            ``(4) Colorectal cancer screening procedures.--In the case 
        of a participant or beneficiary who is 50 years of age or 
        older, or who is under 50 years of age and is at high risk of 
        developing colorectal cancer, all of the following procedures 
        furnished to the individual for the purpose of early detection 
        of colorectal cancer:
                    ``(A) Screening fecal-occult blood test, but not to 
                exceed once every 12 months.
                    ``(B) Screening flexible sigmoidoscopy, but not to 
                exceed once every 48 months.
                    ``(C) In the case of an individual at high risk for 
                colorectal cancer, screening colonoscopy, but not to 
                exceed once every 24 months.
                    ``(D) Such other tests or procedures, and 
                modifications to tests and procedures under this 
                paragraph, with such frequency, as the Secretary of 
                Health and Human Services determines appropriate, in 
                consultation with appropriate organizations.
        Under this paragraph, a screening barium enema may be 
        substituted either for a screening flexible sigmoidoscopy or 
        for a screen colonoscopy at the attending physician's 
        discretion.
            ``(5) Prostate cancer screening.--In the case of a 
        participant or beneficiary who is 50 years of age or older, an 
        annual test consisting of any (or all) of the procedures 
        described in section 1861(oo)(2) of Social Security Act (42 
        U.S.C. 1395x(oo)(2)) provided for the purpose of early 
        detection of prostate cancer.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to individuals 
        to encourage such individuals to accept less than the minimum 
protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant or beneficiary in a manner inconsistent 
        with this section.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to require 
        an individual who is a participant or beneficiary to undergo a 
        procedure, examination, or test described in subsection (a).
            ``(2) Nothing in this section shall be construed as 
        preventing a group health plan or issuer from imposing 
        deductibles, coinsurance, or other cost-sharing in relation to 
        benefits described in subsection (a) consistent with such 
        subsection, except that such coinsurance or other cost-sharing 
        shall not discriminate on any basis related to the coverage 
        required under this section.
    ``(d) Notice Under Group Health Plan.--The imposition of the 
requirement of this section shall be treated as a material modification 
in the terms of the plan described in section 102(a)(1), for purposes 
of assuring notice of such requirements under the plan; except that the 
summary description required to be provided under the last sentence of 
section 104(b)(1) with respect to such modification shall be provided 
by not later than 60 days after the first day of the first plan year in 
which such requirement apply.
    ``(e) High Risk Defined.--For purposes of this section, an 
individual is considered to be at `high risk' of developing a 
particular type of cancer if, under guidelines developed or recognized 
by the Secretary based upon scientific evidence, the individual--
            ``(1) has one or more close family members who have 
        developed that type of cancer;
            ``(2) has previously had that type of cancer;
            ``(3) has the presence of an appropriate recognized gene 
        marker that is identified as putting the individual at a higher 
        risk of developing that type of cancer; or
            ``(4) has other predisposing factors that significantly 
        increases the risk of the individual contracting that type of 
        cancer.
For purposes of this subsection, the term `type of cancer' includes 
other types of cancer that the Secretary recognizes as closely related 
for purposes of establishing risk.''.
            (B) Section 731(c) of such Act (29 U.S.C. 1191(c)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 714''.
            (C) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 714''.
            (D) The table of contents in section 1 of such Act is 
        amended by inserting after the item relating to section 713 the 
        following new item:

``Sec. 714. Coverage of cancer screening.''.
            (3) Internal revenue code amendments.--Subchapter B of 
        chapter 100 of the Internal Revenue Code of 1986 is amended--
                    (A) in the table of sections, by inserting after 
                the item relating to section 9812 the following new 
                item:

                              ``Sec. 9813. Coverage of cancer 
                                        screening.''; and
                    (B) by inserting after section 9812 the following:

``SEC. 9813. COVERAGE OF CANCER SCREENING.

    ``(a) Requirement.--A group health plan shall provide coverage and 
payment under the plan for the following items and services under terms 
and conditions that are no less favorable than the terms and conditions 
applicable to other screening benefits otherwise provided under the 
plan:
            ``(1) Mammograms.--In the case of a female participant or 
        beneficiary who is 40 years of age or older, or is under 40 
        years of age but is at high risk (as defined in subsection (d)) 
        of developing breast cancer, an annual mammography (as defined 
        in section 1861(jj) of the Social Security Act) conducted by a 
        facility that has a certificate (or provisional certificate) 
        issued under section 354 of the Public Health Service Act.
            ``(2) Clinical breast examinations.--In the case of a 
        female participant or beneficiary who--
                    ``(A)(i) is 40 years of age or older or (ii) is at 
                least 20 (but less than 40) years of age and is at high 
                risk of developing breast cancer, an annual clinical 
                breast examination; or
                    ``(B) is at least 20, but less than 40, years of 
                age and who is not at high risk of developing breast 
                cancer, a clinical breast examination each 3 years.
            ``(3) Pap tests and pelvic examinations.--In the case of a 
        female participant or beneficiary who is 18 years of age or 
older, or who is under 18 years of age and is or has been sexually 
active--
                    ``(A) an annual diagnostic laboratory test 
                (popularly known as a `pap smear') consisting of a 
                routine exfoliative cytology test (Papanicolaou test) 
                provided to a woman for the purpose of early detection 
                of cervical or vaginal cancer and including an 
                interpretation by a qualified health professional of 
                the results of the test; and
                    ``(B) an annual pelvic examination.
            ``(4) Colorectal cancer screening procedures.--In the case 
        of a participant or beneficiary who is 50 years of age or 
        older, or who is under 50 years of age and is at high risk of 
        developing colorectal cancer, all of the following procedures 
        furnished to the individual for the purpose of early detection 
        of colorectal cancer:
                    ``(A) Screening fecal-occult blood test, but not to 
                exceed once every 12 months.
                    ``(B) Screening flexible sigmoidoscopy, but not to 
                exceed once every 48 months.
                    ``(C) In the case of an individual at high risk for 
                colorectal cancer, screening colonoscopy, but not to 
                exceed once every 24 months.
                    ``(D) Such other tests or procedures, and 
                modifications to tests and procedures under this 
                paragraph, with such frequency, as the Secretary of 
                Health and Human Services determines appropriate, in 
                consultation with appropriate organizations.
        Under this paragraph, a screening barium enema may be 
        substituted either for a screening flexible sigmoidoscopy or 
        for a screen colonoscopy at the attending physician's 
        discretion.
            ``(5) Prostate cancer screening.--In the case of a 
        participant or beneficiary who is 50 years of age or older, an 
        annual test consisting of any (or all) of the procedures 
        described in section 1861(oo)(2) of Social Security Act (42 
        U.S.C. 1395x(oo)(2)) provided for the purpose of early 
        detection of prostate cancer.
    ``(b) Prohibitions.--A group health plan may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to individuals 
        to encourage such individuals to accept less than the minimum 
        protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant or beneficiary in a manner inconsistent 
        with this section.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to require 
        an individual who is a participant or beneficiary to undergo a 
        procedure, examination, or test described in subsection (a).
            ``(2) Nothing in this section shall be construed as 
        preventing a group health plan from imposing deductibles, 
        coinsurance, or other cost-sharing in relation to benefits 
        described in subsection (a) consistent with such subsection, 
        except that such coinsurance or other cost-sharing shall not 
        discriminate on any basis related to the coverage required 
        under this section.
    ``(d) High Risk Defined.--For purposes of this section, an 
individual is considered to be at `high risk' of developing a 
particular type of cancer if, under guidelines developed or recognized 
by the Secretary based upon scientific evidence, the individual--
            ``(1) has one or more close family members who have 
        developed that type of cancer;
            ``(2) has previously had that type of cancer;
            ``(3) has the presence of an appropriate recognized gene 
        marker that is identified as putting the individual at a higher 
        risk of developing that type of cancer; or
            ``(4) has other predisposing factors that significantly 
        increases the risk of the individual contracting that type of 
        cancer.
For purposes of this subsection, the term `type of cancer' includes 
other types of cancer that the Secretary recognizes as closely related 
for purposes of establishing risk.''.
    (b) Individual Health Insurance.--(1) Part B of title XXVII of the 
Public Health Service Act is amended by inserting after section 2752 
the following new section:

``SEC. 2753. STANDARD RELATING PATIENT FREEDOM OF CHOICE.

    ``(a) In General.--The provisions of section 2707 (other than 
subsection (d)) shall apply to health insurance coverage offered by a 
health insurance issuer in the individual market with respect to an 
enrollee under such coverage in the same manner as they apply to health 
insurance coverage offered by a health insurance issuer in connection 
with a group health plan in the small or large group market to a 
participant or beneficiary in such plan.
    ``(b) Notice.--A health insurance issuer under this part shall 
comply with the notice requirement under section 714(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
referred to in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan.''.
    (2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is 
amended by striking ``section 2751'' and inserting ``sections 2751 and 
2753''.
    (c) Effective Dates.--(1) Subject to paragraph (3), the amendments 
made by subsection (a) shall apply with respect to group health plans 
for plan years beginning on or after January 1, 2000.
    (2) The amendment made by subsection (b) shall apply with respect 
to health insurance coverage offered, sold, issued, renewed, in effect, 
or operated in the individual market on or after such date.
    (3) In the case of a group health plan maintained pursuant to 1 or 
more collective bargaining agreements between employee representatives 
and 1 or more employers ratified before the date of enactment of this 
Act, the amendments made to subsection (a) shall not apply to plan 
years beginning before the later of--
            (A) the date on which the last collective bargaining 
        agreements relating to the plan terminates (determined without 
        regard to any extension thereof agreed to after the date of 
        enactment of this Act), or
            (B) January 1, 2000.
For purposes of subparagraph (A), any plan amendment made pursuant to a 
collective bargaining agreement relating to the plan which amends the 
plan solely to conform to any requirement added by subsection (a) shall 
not be treated as a termination of such collective bargaining 
agreement.
    (d) Coordinated Regulations.--Section 104(1) of Health Insurance 
Portability and Accountability Act of 1996 is amended by striking 
``this subtitle (and the amendments made by this subtitle and section 
401)'' and inserting ``the provisions of part 7 of subtitle B of title 
I of the Employee Retirement Income Security Act of 1974, the 
provisions of parts A and C of title XXVII of the Public Health Service 
Act, and chapter 100 of the Internal Revenue Code of 1986''.
                                 <all>