[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4097 Introduced in House (IH)]







108th CONGRESS
  2d Session
                                H. R. 4097

 To require group and individual health plans to provide coverage for 
                     colorectal cancer screenings.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 31, 2004

  Ms. Slaughter (for herself and Mr. King of New York) introduced the 
   following bill; which was referred to the Committee on Energy and 
    Commerce, and in addition to the Committee on Education and the 
 Workforce, 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 require group and individual health plans to provide coverage for 
                     colorectal cancer screenings.

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

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Eliminate 
Colorectal Cancer Act of 2004''.
    (b) Findings.--The Congress finds the following:
            (1) Colorectal cancer is the second leading cause of cancer 
        deaths in the United States for men and women combined.
            (2) It is estimated that in 2004, 146,940 new cases of 
        colorectal cancer will be diagnosed in men and women in the 
        United States.
            (3) Colorectal cancer is expected to kill 56,730 
        individuals in the United States in 2004.
            (4) When colorectal cancer is diagnosed early, at a 
        localized stage, more than 90 percent of patients survive for 5 
        years or more. Once the disease has metastasized, 92 percent of 
        patients die within 5 years. Yet, only 37 percent of colorectal 
        cancer cases are diagnosed while the disease is still in the 
        localized stage.
            (5) If all men and women age 50 and over practiced regular 
        colorectal cancer screening, without any new scientific 
        discoveries, the United States could see up to a 50 to 90 
        percent reduction in deaths from this disease.
            (6) Currently, many private insurance health plans are not 
        providing coverage for the full range of colorectal cancer 
        screening tests. Lack of insurance coverage can act as a 
        barrier to care.
            (7) Assuring coverage for the full range of colorectal 
        cancer tests is an important step in increasing screening rates 
        for these life saving tests.

SEC. 2. COVERAGE FOR COLORECTAL CANCER SCREENING.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--The Public 
        Health Service Act (42 U.S.C. 201 et seq.) is amended by adding 
        at the end the following:

              ``TITLE XXIX--MISCELLANEOUS HEALTH COVERAGE

``SEC. 2901. COVERAGE FOR COLORECTAL CANCER SCREENING.

    ``(a) Coverage for Colorectal Cancer Screening.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, 
        shall provide coverage for colorectal cancer screening 
        consistent with this subsection to--
                    ``(A) any participant or beneficiary age 50 or 
                over; and
                    ``(B) any participant or beneficiary under the age 
                of 50 who is at a high risk for colorectal cancer.
            ``(2) Definition of high risk.--For purposes of subsection 
        (a)(1)(B), the term `high risk for colorectal cancer' has the 
        meaning given such term in section 1861(pp)(2) of the Social 
        Security Act (42 U.S.C. 1395x(pp)(2)).
            ``(3) Requirement for screening.--The group health plan or 
        health insurance issuer shall cover methods of colorectal 
        cancer screening that--
                    ``(A) are deemed appropriate by a physician (as 
                defined in section 1861(r) of the Social Security Act 
                (42 U.S.C. 1395x(r))) treating the participant or 
                beneficiary, in consultation with the participant or 
                beneficiary;
                    ``(B) are--
                            ``(i) described in section 1861(pp)(1) of 
                        the Social Security Act (42 U.S.C. 
                        1395x(pp)(1)) or section 410.37 of title 42, 
                        Code of Federal Regulations; or
                            ``(ii) specified by the Secretary, based 
                        upon the recommendations of appropriate 
                        organizations with special expertise in the 
                        field of colorectal cancer; and
                    ``(C) are performed at a frequency not greater than 
                that--
                            ``(i) described for such method in section 
                        1834(d) of the Social Security Act (42 U.S.C. 
                        1395m(d)) or section 410.37 of title 42, Code 
                        of Federal Regulations; or
                            ``(ii) specified by the Secretary for such 
                        method, if the Secretary finds, based upon new 
                        scientific knowledge and consistent with the 
                        recommendations of appropriate organizations 
                        with special expertise in the field of 
                        colorectal cancer, that a different frequency 
                        would not adversely affect the effectiveness of 
                        such screening.
    ``(b) Notice.--A group health plan under this section shall comply 
with the notice requirement under section 714(b) 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.
    ``(c) Non-Preemption of More Protective State Law With Respect to 
Health Insurance Issuers.--This section shall not be construed to 
supersede any provision of State law which establishes, implements, or 
continues in effect any standard or requirement solely relating to 
health insurance issuers in connection with group health insurance 
coverage that provides greater protections to participants and 
beneficiaries than the protections provided under this section.
    ``(d) Definitions and Enforcement.--The definitions and enforcement 
provisions of title XXVII shall apply for purposes of this section.''.
            (2) ERISA amendments.--
                    (A) In general.--Subpart B of part 7 of subtitle B 
                of title I of the Employee Retirement Income Security 
                Act of 1974 (29 U.S.C. 1185 et seq.) is amended by 
                adding at the end the following new section:

``SEC. 714. COVERAGE FOR COLORECTAL CANCER SCREENING.

    ``(a) Coverage for Colorectal Cancer Screening.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, 
        shall provide coverage for colorectal cancer screening 
        consistent with this subsection to--
                    ``(A) any participant or beneficiary age 50 or 
                over; and
                    ``(B) any participant or beneficiary under the age 
                of 50 who is at a high risk for colorectal cancer.
            ``(2) Definition of high risk.--For purposes of subsection 
        (a)(1)(B), the term `high risk for colorectal cancer' has the 
        meaning given such term in section 1861(pp)(2) of the Social 
        Security Act (42 U.S.C. 1395x(pp)(2)).
            ``(3) Requirement for screening.--The group health plan or 
        health insurance issuer shall cover methods of colorectal 
        cancer screening that--
                    ``(A) are deemed appropriate by a physician (as 
                defined in section 1861(r) of the Social Security Act 
                (42 U.S.C. 1395x(r))) treating the participant or 
                beneficiary, in consultation with the participant or 
                beneficiary;
                    ``(B) are--
                            ``(i) described in section 1861(pp)(1) of 
                        the Social Security Act (42 U.S.C. 
                        1395x(pp)(1)) or section 410.37 of title 42, 
                        Code of Federal Regulations; or
                            ``(ii) specified by the Secretary, based 
                        upon the recommendations of appropriate 
                        organizations with special expertise in the 
                        field of colorectal cancer; and
                    ``(C) are performed at a frequency not greater than 
                that--
                            ``(i) described for such method in section 
                        1834(d) of the Social Security Act (42 U.S.C. 
                        1395m(d)) or section 410.37 of title 42, Code 
                        of Federal Regulations; or
                            ``(ii) specified by the Secretary for such 
                        method, if the Secretary finds, based upon new 
                        scientific knowledge and consistent with the 
                        recommendations of appropriate organizations 
                        with special expertise in the field of 
                        colorectal cancer, that a different frequency 
                        would not adversely affect the effectiveness of 
                        such screening.
    ``(b) Notice Under Group Health Plan.--The imposition of the 
requirements of this section shall be treated as a material 
modification in the terms of the plan described in section 102(a), for 
purposes of assuring notice of such requirements under the plan; except 
that the summary description required to be provided under the third to 
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 requirements apply.''.
                    (B) Technical and conforming amendments.--
                            (i) Section 731(c) of the Employee 
                        Retirement Income Security Act of 1974 (29 
                        U.S.C. 1191(c)) is amended by striking 
                        ``section 711'' and inserting ``sections 711 
                        and 714''.
                            (ii) Section 732(a) of the Employee 
                        Retirement Income Security Act of 1974 (29 
                        U.S.C. 1191a(a)) is amended by striking 
                        ``section 711'' and inserting ``sections 711 
                        and 714''.
                            (iii) The table of contents in section 1 of 
                        the Employee Retirement Income Security Act of 
                        1974 is amended by inserting after the item 
                        relating to section 713 the following new item:

``Sec. 714. Coverage for colorectal cancer screening.''.
    (b) Individual Health Insurance.--
            (1) In general.--Part B of title XXVII of the Public Health 
        Service Act (42 U.S.C. 300gg-41 et seq.) is amended by 
        inserting after section 2752 the following new section:

``SEC. 2753. COVERAGE FOR COLORECTAL CANCER SCREENING.

    ``(a) In General.--The provisions of section 2901(a) shall apply to 
health insurance coverage offered by a health insurance issuer in the 
individual market in the same manner as it applies to health insurance 
coverage offered by a health insurance issuer in connection with a 
group health plan in the small or large group market.
    ``(b) Notice.--A health insurance issuer under this part shall 
comply with the notice requirement under section 714(b) 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) Technical amendment.--Section 2762(b)(2) of the Public 
        Health Service 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) Group health plans.--The amendments made by subsection 
        (a) shall apply with respect to group health plans for plan 
        years beginning on or after January 1, 2005.
            (2) Individual health insurance.--The amendments 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 January 1, 2005.
    (d) Coordinated Regulations.--The Secretary of Labor and the 
Secretary of Health and Human Services shall ensure, through the 
execution of an interagency memorandum of understanding among such 
Secretaries, that--
            (1) regulations, rulings, and interpretations issued by 
        such Secretaries relating to the same matter over which both 
        Secretaries have responsibility under the provisions of this 
        section (and the amendments made thereby) are administered so 
        as to have the same effect at all times; and
            (2) coordination of policies relating to enforcing the same 
        requirements through such Secretaries in order to have a 
        coordinated enforcement strategy that avoids duplication of 
        enforcement efforts and assigns priorities in enforcement.
                                 <all>