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       Florida Senate - 2010                                    SB 2508
       By Senator Sobel
       31-00517-10                                           20102508__
    1                        A bill to be entitled                      
    2         An act relating to insurance coverage for colorectal
    3         cancer screening; providing legislative intent;
    4         creating s. 627.64173, F.S.; requiring certain health
    5         insurance policies, health maintenance organization
    6         contracts, health insurance programs, group
    7         arrangements, and managed health care delivery
    8         entities providing coverage to state residents to
    9         provide coverage for certain colorectal cancer
   10         examinations and laboratory tests for colorectal
   11         cancer; providing requirements; specifying covered
   12         individuals; requiring coverage of certain evidence
   13         based screening strategies; providing a definition;
   14         prohibiting patients and providers from being required
   15         to meet certain requirements to secure coverage;
   16         prohibiting certain deductible or coinsurance
   17         requirements; specifying absence of any requirement to
   18         make nonparticipating provider referrals under certain
   19         circumstances; providing for payment of
   20         nonparticipating providers; excluding application to
   21         certain insurance policies; providing an effective
   22         date.
   24  Be It Enacted by the Legislature of the State of Florida:
   26         Section 1. It is the intent of the Legislature to help
   27  reduce the state’s inordinately high cancer burden through early
   28  detection and treatment of colorectal cancer by ensuring
   29  coverage for the full range of colorectal cancer screenings,
   30  including, but not limited to, colonoscopies, in health
   31  insurance policies written in this state.
   32         Section 2. Section 627.64173, Florida Statutes, is created
   33  to read:
   34         627.64173 Colorectal cancer screening coverage.—
   35         (1) Any individual or group health insurance policy
   36  providing coverage on an expense-incurred basis, any individual
   37  or group service or indemnity type contract issued by a health
   38  maintenance organization, any state medical assistance program
   39  and its contracted insurers, whether providing services on a
   40  managed care or fee-for-service basis, the state employees’
   41  health insurance program, any self-insured group arrangement to
   42  the extent not preempted by federal law, and any managed health
   43  care delivery entity of any type or description which is
   44  delivered, issued for delivery, continued, or renewed on or
   45  after January 1, 2011, and which provides coverage to any
   46  resident of this state shall provide benefits or coverage for
   47  all colorectal cancer examinations and laboratory tests
   48  specified in subsection (2) for colorectal cancer.
   49         (2) A colorectal screening examination and laboratory test
   50  to be covered under this section must include, at a minimum:
   51         (a) A fecal occult blood test conducted annually.
   52         (b) A flexible sigmoidoscopy conducted every 5 years.
   53         (c) A combination of a fecal occult blood test conducted
   54  annually along with a flexible sigmoidoscopy conducted every 5
   55  years.
   56         (d) The screening contained in the guidelines from the
   57  United States Preventive Services Task Force or a double
   58  contrast barium enema every 5 years as an alternative when
   59  indicated by a licensed physician.
   60         (e) The screening contained in the guidelines from the
   61  United States Preventive Services Task Force or a colonoscopy
   62  every 10 years as an alternative when indicated by a licensed
   63  physician.
   64         (3) Benefits under this section shall be provided to a
   65  covered individual who is:
   66         (a) At least 50 years of age; or
   67         (b) Less than 50 years of age and at high risk for
   68  colorectal cancer.
   69         (4) Any evidence-based screening strategy identified in
   70  this section shall be covered by the insurer, with the choice of
   71  strategy determined by the covered individual in consultation
   72  with a licensed physician.
   73         (5) For those individuals considered to be at average risk
   74  for colorectal cancer, coverage or benefits shall be provided
   75  for the choice of screening, if it is conducted in accordance
   76  with the specified frequency prescribed in this section and, for
   77  those individuals considered to be at high risk for colorectal
   78  cancer, provided at a frequency deemed necessary by a licensed
   79  physician.
   80         (6) As used in this section, the term “individual at high
   81  risk for colorectal cancer” means any individual who, because of
   82  family history; prior experience of cancer or precursor
   83  neoplastic polyps; a history of chronic digestive disease
   84  condition, including inflammatory bowel disease, Crohn’s
   85  disease, or ulcerative colitis; the presence of any appropriate
   86  recognized gene markers for colorectal cancer; or other
   87  predisposing factors, faces a higher than normal risk for
   88  colorectal cancer.
   89         (7) To encourage potentially lifesaving colorectal cancer
   90  screenings, patients and health care providers may not be
   91  required to meet burdensome criteria or overcome significant
   92  obstacles to secure such coverage. An individual may not be
   93  required to pay an additional deductible or coinsurance for
   94  testing that is greater than an annual deductible or coinsurance
   95  established for similar screening benefits. If the program or
   96  contract does not cover a similar benefit, a deductible or
   97  coinsurance may not be set at a level that materially diminishes
   98  the value of colorectal cancer screening benefit required under
   99  this section.
  100         (8) A group health plan or health insurance issuer is not
  101  required under this section to provide a referral to a
  102  nonparticipating health care provider unless the plan or issuer
  103  does not have an appropriate health care provider that is
  104  available and accessible to administer the screening examination
  105  and that is a participating health care provider with respect to
  106  such treatment.
  107         (9) If a plan or issuer refers an individual to a
  108  nonparticipating health care provider under this section,
  109  services provided as part of the approved screening examination
  110  or resultant treatment shall be reimbursed as provided under the
  111  policy or contract.
  112         Section 3. This act does not apply to any insurance policy
  113  that solely covers a specified accident, a specified disease,
  114  disability income, Medicare supplement, or long-term care.
  115         Section 4. This act shall take effect July 1, 2010.

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