Home > 106th Congressional Bills > H.R. 3363 (eh) For the relief of Akal Security, Incorporated. [Engrossed in House] ...H.R. 3363 (eh) For the relief of Akal Security, Incorporated. [Engrossed in House] ...
108th CONGRESS
1st Session
H. R. 3362
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 screening for breast, prostate, and
colorectal cancer.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 21, 2003
Mrs. Maloney introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce, Ways and Means, and Government Reform, 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 screening for breast, prostate, and
colorectal cancer.
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
2003''.
SEC. 2. CANCER SCREENING COVERAGE.
(a) Group Health Plans.--
(1) Public health service act amendments.--
(A) In general.--Subpart 2 of part A of title XXVII
of the Public Health Service Act (42 U.S.C. 300gg-4 et
seq.) is amended by adding at the end the following:
``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.
``(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, the procedures described in
section 1861(pp)(1) of the Social Security Act (42 U.S.C.
1395x(pp)(1)) or section 4104(a)(2) of the Balanced Budget Act
of 1997 (111 Stat. 362), shall be furnished to the individual
for the purpose of early detection of colorectal cancer. The
group health plan or health insurance issuer shall provide
coverage for the method and frequency of colorectal cancer
screening determined to be appropriate by a health care
provider treating such participant or beneficiary, in
consultation with the participant or beneficiary.
``(5) Prostate cancer screening.--In the case of a male
participant or beneficiary who is 50 years of age or older, or
who is younger than 50 years of age and is at high risk for
prostate cancer (including African American men or a male who
has a history of prostate cancer in 1 or more first degree
family members), the procedures described in section
1861(oo)(2) of Social Security Act (42 U.S.C. 1395x(oo)(2))
shall be furnished to the individual for the early detection of
prostate cancer. The group health plan or health insurance
issuer shall provide coverage for the method and frequency of
prostate cancer screening determined to be appropriate by a
health care provider treating such participant or beneficiary,
in consultation with the participant or beneficiary.
``(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, shall 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 1 or more first degree 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
increase 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.
``SEC. 2708. PATIENT ACCESS TO INFORMATION.
``(a) Disclosure Requirement.--A group health plan, and health
insurance issuer offering group health insurance coverage shall--
``(1) provide to participants and beneficiaries at the time
of initial coverage under the plan (or the effective date of
this section, in the case of individuals who are participants
or beneficiaries as of such date), and at least annually
thereafter, the information described in subsection (b) in
printed form;
``(2) provide to participants and beneficiaries, within a
reasonable period (as specified by the appropriate Secretary)
before or after the date of significant changes in the
information described in subsection (b), information in printed
form regarding such significant changes; and
``(3) upon request, make available to participants and
beneficiaries, the applicable authority, and prospective
participants and beneficiaries, the information described in
subsection (b) in printed form.
``(b) Information Provided.--The information described in
subsection (a) that shall be disclosed includes the following, as such
relates to cancer screening required under section 2707(a):
``(1) Benefits.--Benefits offered under the plan or
coverage, including--
``(A) covered benefits, including benefit limits
and coverage exclusions;
``(B) cost sharing, such as deductibles,
coinsurance, and copayment amounts, including any
liability for balance billing, any maximum limitations
on out of pocket expenses, and the maximum out of
pocket costs for services that are provided by
nonparticipating providers or that are furnished
without meeting the applicable utilization review
requirements;
``(C) the extent to which benefits may be obtained
from nonparticipating providers; and
``(D) the extent to which a participant,
beneficiary, or enrollee may select from among
participating providers and the types of providers
participating in the plan or issuer network.
``(2) Access.--A description of the following:
``(A) The number, mix, and distribution of
providers under the plan or coverage.
``(B) Out-of-network coverage (if any) provided by
the plan or coverage.
``(C) Any point-of-service option (including any
supplemental premium or cost-sharing for such option).
``(D) The procedures for participants,
beneficiaries, and enrollees to select, access, and
change participating primary and specialty providers.
``(E) The rights and procedures for obtaining
referrals (including standing referrals) to
participating and nonparticipating providers.
``(F) The name, address, and telephone number of
participating health care providers and an indication
of whether each such provider is available to accept
new patients.
``(G) How the plan or issuer addresses the needs of
participants, beneficiaries, and enrollees and others
who do not speak English or who have other special
communications needs in accessing providers under the
plan or coverage, including the provision of
information under this subsection.''.
(B) Technical amendment.--Section 2723(c) of the
Public Health Service Act (42 U.S.C. 300gg-23(c)) is
amended by striking ``section 2704'' and inserting
``sections 2704 and 2707''.
(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 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, the procedures described in
section 1861(pp)(1) of the Social Security Act (42 U.S.C.
1395x(pp)(1)) or section 4104(a)(2) of the Balanced Budget Act
of 1997 (111 Stat. 362), shall be furnished to the individual
for the purpose of early detection of colorectal cancer. The
group health plan or health insurance issuer shall provided
coverage for the method and frequency of colorectal cancer
screening determined to be appropriate by a health care
provider treating such participant or beneficiary, in
consultation with the participant or beneficiary.
``(5) Prostate cancer screening.--In the case of a male
participant or beneficiary who is 50 years of age or older, or
who is younger than 50 years of age and is at high risk for
prostate cancer (including African American men or a male who
has a history of prostate cancer in 1 or more first degree
family members), the procedures described in section
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