II

106TH CONGRESS

1ST SESSION S. 1044

To require coverage for colorectal cancer screenings.

IN THE SENATE OF THE UNITED STATES

MAY 13, 1999

Mr. KENNEDY introduced the following bill; which was read twice and referred

to the Committee on Health, Education, Labor, and Pensions

A BILL

To require coverage for colorectal cancer screenings.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; FINDINGS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Eliminate Colorectal Cancer Act of 1999’’.

6 (b) FINDINGS.—The Congress finds the following:

7 (1) Colorectal cancer is the second leading

8 cause of cancer deaths in the United States for men

9 and women combined.

10 (2) It is estimated that in 1999, 129,400 new

11 cases of colorectal cancer will be diagnosed in men

12 and women in the United States.
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1 (3) Colorectal cancer is expected to kill 56,600

2 individuals in the United States in 1999.

3 (4) Research has shown that a high-fiber, low4 fat diet can significantly reduce the risk of devel5 oping colorectal cancer.

6 (5) The adoption of a healthy diet at a young

7 age can significantly reduce the risk of developing

8 colorectal cancer.

9 (6) Appropriate screenings and regular tests,

10 can save large numbers of lives by leading to earlier

11 identification of colorectal cancer.

12 (7) The Centers for Disease Control and Pre13 vention, the Health Care Financing Administration,

14 and the National Cancer Institute have initiated the

15 Screen for Life Campaign targeted to individuals

16 age 50 and older to spread the message of the im17 portance of colorectal cancer screening tests.

18 (8) Education helps to inform the public of

19 symptoms for the early detection of colorectal cancer

20 and methods of prevention.

21 SEC. 2. COVERAGE FOR COLORECTAL CANCER SCREENING.

22 (a) GROUP HEALTH PLANS.—

23 (1) PUBLIC HEALTH SERVICE ACT AMEND24 MENTS.—
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1 (A) IN GENERAL.—Subpart 2 of part A of

2 title XXVII of the Public Health Service Act

3 (42 U.S.C. 300gg–4 et seq.) is amended by

4 adding at the end the following new section:

5 ‘‘SEC. 2707. COVERAGE FOR COLORECTAL CANCER SCREEN6 ING.

7 ‘‘(a) COVERAGE FOR COLORECTAL CANCER SCREEN8 ING.—

9 ‘‘(1) IN GENERAL.—A group health plan, and a

10 health insurance issuer offering group health insur11 ance coverage, shall provide coverage for colorectal

12 cancer screening at regular intervals to—

13 ‘‘(A) any participant or beneficiary over

14 the age of 50; and

15 ‘‘(B) any participant or beneficiary under

16 the age of 50 who is at a high risk for

17 colorectal cancer, or who may have symptoms

18 or circumstances that indicate a need for

19 colorectal cancer screening.

20 ‘‘(2) DEFINITION OF HIGH RISK.—For purposes

21 of subsection (a)(1)(B), the term ‘high risk for

22 colorectal cancer’ has the meaning given such term

23 in section 1861(pp)(2) of the Social Security Act (42

24 U.S.C. 1395x(pp)(2)).
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1 ‘‘(3) METHOD OF SCREENING.—The group

2 health plan or health insurance issuer shall cover the

3 method and frequency of colorectal cancer screening

4 deemed appropriate by a health care provider treat5 ing such participant or beneficiary, in consultation

6 with the participant or beneficiary. Such coverage

7 shall include the procedures in section 1861(pp)(1)

8 of the Social Security Act (42 U.S.C. 1395x(pp)(1))

9 and section 4104(a)(2) of the Balanced Budget Act

10 of 1997.

11 ‘‘(b) NOTICE.—A group health plan under this part

12 shall comply with the notice requirement under section

13 714(b) of the Employee Retirement Income Security Act

14 of 1974 with respect to the requirements of this section

15 as if such section applied to such plan.

16 ‘‘(c) NON-PREEMPTION OF MORE PROTECTIVE

17 STATE LAW WITH RESPECT TO HEALTH INSURANCE

18 ISSUERS.—This section shall not be construed to super19 sede any provision of State law which establishes, imple20 ments, or continues in effect any standard or requirement

21 solely relating to health insurance issuers in connection

22 with group health insurance coverage that provides great23 er protections to participants and beneficiaries than the

24 protections provided under this section.’’.
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1 (B) TECHNICAL AMENDMENT.—Section

2 2723(c) of the Public Health Service Act (42

3 U.S.C. 300gg–23(c)) is amended by striking

4 ‘‘section 2704’’ and inserting ‘‘sections 2704

5 and 2707’’.

6 (2) ERISA AMENDMENTS.—

7 (A) IN GENERAL.—Subpart B of part 7 of

8 subtitle B of title I of the Employee Retirement

9 Income Security Act of 1974 (29 U.S.C. 1185

10 et seq.) is amended by adding at the end the

11 following new section:

12 ‘‘SEC. 714. COVERAGE FOR COLORECTAL CANCER SCREEN13 ING.

14 ‘‘(a) COVERAGE FOR COLORECTAL CANCER SCREEN15 ING.—

16 ‘‘(1) IN GENERAL.—A group health plan, and a

17 health insurance issuer offering group health insur18 ance coverage, shall provide coverage for colorectal

19 cancer screening at regular intervals to—

20 ‘‘(A) any participant or beneficiary over

21 the age of 50; and

22 ‘‘(B) any participant or beneficiary under

23 the age of 50 who is at a high risk for

24 colorectal cancer, or who may have symptoms
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1 or circumstances that indicate a need for

2 colorectal cancer screening.

3 ‘‘(2) DEFINITION OF HIGH RISK.—For purposes

4 of subsection (a)(1)(B), the term ‘high risk for

5 colorectal cancer’ has the meaning given such term

6 in section 1861(pp)(2) of the Social Security Act (42

7 U.S.C. 1395x(pp)(2)).

8 ‘‘(3) METHOD OF SCREENING.—The group

9 health plan or health insurance issuer shall cover the

10 method and frequency of colorectal cancer screening

11 deemed appropriate by a health care provider treat12 ing such participant or beneficiary, in consultation

13 with the participant or beneficiary. Such coverage

14 shall include the procedures in section 1861(pp)(1)

15 of the Social Security Act (42 U.S.C. 1395x(pp)(1))

16 and section 4104(a)(2) of the Balanced Budget Act

17 of 1997.

18 ‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The

19 imposition of the requirements of this section shall be

20 treated as a material modification in the terms of the plan

21 described in section 102(a), for purposes of assuring no22 tice of such requirements under the plan; except that the

23 summary description required to be provided under the

24 third to last sentence of section 104(b)(1) with respect to

25 such modification shall be provided by not later than 60
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1 days after the first day of the first plan year in which

2 such requirements apply.’’.

3 (B) TECHNICAL AND CONFORMING AMEND4 MENTS.—

5 (i) Section 731(c) of the Employee

6 Retirement Income Security Act of 1974

7 (29 U.S.C. 1191(c)) is amended by strik8 ing ‘‘section 711’’ and inserting ‘‘sections

9 711 and 714’’.

10 (ii) Section 732(a) of the Employee

11 Retirement Income Security Act of 1974

12 (29 U.S.C. 1191a(a)) is amended by strik13 ing ‘‘section 711’’ and inserting ‘‘sections

14 711 and 714’’.

15 (iii) The table of contents in section 1

16 of the Employee Retirement Income Secu17 rity Act of 1974 is amended by inserting

18 after the item relating to section 713 the

19 following new item:

‘‘Sec. 714. Coverage for colorectal cancer screening.’’.

20 (b) INDIVIDUAL HEALTH INSURANCE.—

21 (1) IN GENERAL.—Part B of title XXVII of the

22 Public Health Service Act (42 U.S.C. 300gg–41 et

23 seq.) is amended by inserting after section 2752 the

24 following new section:
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1 ‘‘SEC. 2753. COVERAGE FOR COLORECTAL CANCER SCREEN2 ING.

3 ‘‘(a) IN GENERAL.—The provisions of section

4 2707(a) shall apply to health insurance coverage offered

5 by a health insurance issuer in the individual market in

6 the same manner as it applies to health insurance coverage

7 offered by a health insurance issuer in connection with a

8 group health plan in the small or large group market.

9 ‘‘(b) NOTICE.—A health insurance issuer under this

10 part shall comply with the notice requirement under sec11 tion 714(b) of the Employee Retirement Income Security

12 Act of 1974 with respect to the requirements referred to

13 in subsection (a) as if such section applied to such issuer

14 and such issuer were a group health plan.’’.

15 (2) TECHNICAL AMENDMENT.—Section

16 2762(b)(2) of the Public Health Service Act (42

17 U.S.C. 300gg–62(b)(2)) is amended by striking

18 ‘‘section 2751’’ and inserting ‘‘sections 2751 and

19 2753’’.

20 (c) EFFECTIVE DATES.—

21 (1) GROUP HEALTH PLANS.—

22 (A) IN GENERAL.—Subject to subpara23 graph (B), the amendments made by subsection

24 (a) shall apply with respect to group health

25 plans for plan years beginning on or after Jan26 uary 1, 2001.
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1 (B) COLLECTIVE BARGAINING AGREE2 MENTS.—In the case of a group health plan

3 maintained pursuant to 1 or more collective

4 bargaining agreements between employee rep5 resentatives and 1 or more employers ratified

6 before the date of enactment of this Act, the

7 amendments made by subsection (a) shall not

8 apply to plan years beginning before the later

9 of—

10 (i) the date on which the last collec11 tive bargaining agreements relating to the

12 plan terminates (determined without re13 gard to any extension thereof agreed to

14 after the date of enactment of this Act), or

15 (ii) January 1, 2001.

16 For purposes of clause (i), any plan amendment

17 made pursuant to a collective bargaining agree18 ment relating to the plan which amends the

19 plan solely to conform to any requirement

20 added by subsection (a) shall not be treated as

21 a termination of such collective bargaining

22 agreement.

23 (2) INDIVIDUAL HEALTH INSURANCE.—The

24 amendments made by subsection (b) shall apply with

25 respect to health insurance coverage offered, sold,
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1 issued, renewed, in effect, or operated in the indi2 vidual market on or after January 1, 2001.

3 (d) COORDINATED REGULATIONS.—The Secretary of

4 Labor and the Secretary of Health and Human Services

5 shall ensure, through the execution of an interagency

6 memorandum of understanding among such Secretaries,

7 that—

8 (1) regulations, rulings, and interpretations

9 issued by such Secretaries relating to the same mat10 ter over which both Secretaries have responsibility

11 under the provisions of this section (and the amend12 ments made thereby) are administered so as to have

13 the same effect at all times; and

14 (2) coordination of policies relating to enforcing

15 the same requirements through such Secretaries in

16 order to have a coordinated enforcement strategy

17 that avoids duplication of enforcement efforts and

18 assigns priorities in enforcement.

19 SEC. 3. SENSE OF THE CONGRESS.

20 It is the sense of the Congress that—

21 (1) all Americans should be educated about the

22 risks, prevention, screening, and treatment of

23 colorectal cancer;

24 (2) the Centers for Disease Control and Preven25 tion and the Department of Health and Human
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1 Services should be commended for launching a co2 ordinated education campaign on colorectal cancer in

3 March of 1999; and

4 (3) the Centers for Disease Control and Preven5 tion and the Department of Health and Human

6 Services should track the impact of the coordinated

7 education campaign on colorectal cancer and make

8 information on its progress available to Members of

9 Congress.

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