I 

111TH CONGRESS 

1ST SESSION H. R. 1330 

To amend the Public Health Service Act, the Employee Retirement Income 

Security Act of 1974, the Internal Revenue Code of 1986, and title 

5, United States Code, to require that group and individual health 

insurance coverage and group health plans and Federal employees health 

benefit plans provide coverage of colorectal cancer screening. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 5, 2009 

Mr. BOREN introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committees on Ways 

and Means, Education and Labor, and Oversight 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 Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and title 5, United States Code, 

to require that group and individual health insurance 

coverage and group health plans and Federal employees 

health benefit plans provide coverage of colorectal cancer 

screening. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Colorectal Cancer 

3 Screening and Detection Coverage Act of 2009’’. 

4 SEC. 2. COVERAGE OF COLORECTAL CANCER SCREENING. 

5 (a) GROUP HEALTH PLANS.— 

6 (1) PUBLIC HEALTH SERVICE ACT AMEND7 MENTS.— 

8 (A) IN GENERAL.—Subpart 2 of part A of 

9 title XXVII of the Public Health Service Act 

10 (42 U.S.C. 300gg–4 et seq.) is amended by 

11 adding at the end the following new section: 

12 ‘‘SEC. 2708. COVERAGE OF COLORECTAL CANCER SCREEN13 ING. 

14 ‘‘(a) REQUIREMENT.— 

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

16 health insurance issuer offering group health insur17 ance coverage, shall provide coverage under the plan 

18 or coverage, respectively, for colorectal cancer 

19 screening for any participant or beneficiary who is 

20 50 years of age or older, or is an individual who is 

21 at high risk for colorectal cancer (as defined in sec22 tion 1861(pp)(2) of the Social Security Act (42 

23 U.S.C. 1395x(pp)(2))), under terms and conditions 

24 that are no less favorable than the terms and condi25 tions applicable to other screening benefits otherwise 


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1 provided under the plan or coverage, respectively, ex2 cept that— 

3 ‘‘(A) the amount of any coinsurance appli4 cable to such screening may not be more than 

5 5 percent of the payment amount for such 

6 screening under such plan or coverage, respec7 tively, and such coverage provided under the 

8 plan or coverage, respectively, may not be sub9 ject to any deductible; and 

10 ‘‘(B) such coverage— 

11 ‘‘(i) with respect to individuals first 

12 receiving benefits under such plan or cov13 erage after the applicable effective date de14 scribed in section 2(d) of the ‘Colorectal 

15 Cancer Screening and Detection Coverage 

16 Act of 2009’, may require a waiting period 

17 of not more than 6 months beginning on 

18 the first date of coverage; and 

19 ‘‘(ii) with respect to individuals receiv20 ing benefits under such plan or coverage 

21 before such effective date, may not require 

22 a waiting period. 

23 ‘‘(2) COLORECTAL CANCER SCREENING DE24 FINED.—For purposes of this section, the term 


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1 ‘colorectal cancer screening’ means procedures 

2 that— 

3 ‘‘(A) are deemed appropriate by a physi4 cian (as defined in section 1861(r) of the Social 

5 Security Act (42 U.S.C. 1395x(r))) treating the 

6 participant or beneficiary, in consultation with 

7 the participant or beneficiary; 

8 ‘‘(B) are— 

9 ‘‘(i) described in section 1861(pp)(1) 

10 of the Social Security Act (42 U.S.C. 

11 1395x(pp)(1)) or section 410.37 of title 

12 42, Code of Federal Regulations; 

13 ‘‘(ii) specified by the Secretary for the 

14 detection of colorectal cancer, based upon 

15 the recommendations of appropriate orga16 nizations with special expertise in the field 

17 of colorectal cancer, including the Amer18 ican Cancer Society and the American Col19 lege of Gastroenterology; or 

20 ‘‘(iii) specified by the Secretary, based 

21 upon new scientific knowledge, techno22 logical advances, or other updated medical 

23 practices with respect to detection of 

24 colorectal cancer; and 


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1 ‘‘(C) are performed at a frequency not 

2 greater than— 

3 ‘‘(i)(I) subject to subclause (II), that 

4 described for such method in section 

5 1834(d) of the Social Security Act (42 

6 U.S.C. 1395m(d)) or section 410.37 of 

7 title 42, Code of Federal Regulations; or 

8 ‘‘(II) in the case of a colorectal cancer 

9 screening test consisting of a screening 

10 colonoscopy, once every 36 months; or 

11 ‘‘(ii) that specified by the Secretary 

12 for such method, if the Secretary finds, 

13 based upon new scientific knowledge, tech14 nological advances, or other updated med15 ical practices and consistent with the rec16 ommendations of appropriate organizations 

17 with special expertise in the field of 

18 colorectal cancer, that a different fre19 quency would not adversely affect the ef20 fectiveness of such screening. 

21 ‘‘(b) PROTECTIONS.—A group health plan, and a 

22 health insurance issuer offering group health insurance 

23 coverage in connection with a group health plan, may 

24 not— 


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1 ‘‘(1) deny to an individual eligibility, or contin2 ued eligibility, to enroll or to renew coverage under 

3 the terms of the plan, solely for the purpose of 

4 avoiding the requirements of this section; 

5 ‘‘(2) provide monetary payments or rebates to 

6 individuals to encourage such individuals to accept 

7 less than the minimum protections available under 

8 this section; 

9 ‘‘(3) penalize or otherwise reduce or limit the 

10 reimbursement of a provider because such provider 

11 provided care to an individual participant or bene12 ficiary in accordance with this section; or 

13 ‘‘(4) provide incentives (monetary or otherwise) 

14 to an attending provider to induce such provider to 

15 provide care to an individual participant or bene16 ficiary in a manner inconsistent with this section. 

17 ‘‘(c) RULES OF CONSTRUCTION.— 

18 ‘‘(1) Nothing in this section shall be construed 

19 to require an individual who is a participant or bene20 ficiary to undergo colorectal cancer screening. 

21 ‘‘(2) Nothing in this section shall be construed 

22 as preventing a group health plan or issuer from im23 posing deductibles, coinsurance, or other cost-shar24 ing in relation to colorectal cancer screening under 

25 the plan (or under health insurance coverage offered 


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1 in connection with a group health plan), except that 

2 such coinsurance or other cost-sharing shall not dis3 criminate on any basis related to the coverage re4 quired under this section. 

5 ‘‘(d) NOTICE.—A group health plan under this part 

6 shall comply with the notice requirement under section 

7 715(d) of the Employee Retirement Income Security Act 

8 of 1974 with respect to the requirements of this section 

9 as if such section applied to such plan. 

10 ‘‘(e) DISCLOSURE REQUIREMENT.— 

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

12 health insurance issuer offering group health insur13 ance coverage shall— 

14 ‘‘(A) provide to participants and bene15 ficiaries at the time of initial coverage under 

16 the plan (or the effective date of this section, in 

17 the case of individuals who are participants or 

18 beneficiaries as of such date), and at least an19 nually thereafter, the information described in 

20 paragraph (2); 

21 ‘‘(B) provide to participants and bene22 ficiaries, within a reasonable period (as speci23 fied by the appropriate Secretary) before or 

24 after the date of significant changes in the inVerDate Nov 24 2008 02:03 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1330.IH H1330

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1 formation described in paragraph (2), informa2 tion regarding such significant changes; and 

3 ‘‘(C) upon request, make available to par4 ticipants and beneficiaries, the applicable au5 thority, and prospective participants and bene6 ficiaries, the information described in para7 graph (2). 

8 ‘‘(2) INFORMATION DESCRIBED.—For purposes 

9 of paragraph (1), the information described in this 

10 paragraph, with respect to colorectal cancer screen11 ing, is the following: 

12 ‘‘(A) BENEFITS.—Benefits offered under 

13 the plan or coverage, including— 

14 ‘‘(i) covered benefits, including benefit 

15 limits and coverage exclusions; 

16 ‘‘(ii) cost-sharing, such as deductibles, 

17 coinsurance, and copayment amounts, in18 cluding any liability for balance billing, any 

19 maximum limitations on out of pocket ex20 penses, and the maximum out of pocket 

21 costs for services that are provided by non22 participating providers or that are fur23 nished without meeting the applicable utili24 zation review requirements; 


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1 ‘‘(iii) the extent to which benefits may 

2 be obtained from nonparticipating pro3 viders; and 

4 ‘‘(iv) the extent to which a partici5 pant, beneficiary, or enrollee may select 

6 from among participating providers and 

7 the types of providers participating in the 

8 plan or issuer network. 

9 ‘‘(B) ACCESS.—A description of the fol10 lowing: 

11 ‘‘(i) The number, mix, and distribu12 tion of providers under the plan or cov13 erage. 

14 ‘‘(ii) Out-of-network coverage (if any) 

15 provided by the plan or coverage. 

16 ‘‘(iii) Any point-of-service option (in17 cluding any supplemental premium or cost18 sharing for such option). 

19 ‘‘(iv) The procedures for participants, 

20 beneficiaries, and enrollees to select, ac21 cess, and change participating primary and 

22 specialty providers. 

23 ‘‘(v) The rights and procedures for 

24 obtaining referrals (including standing reVerDate Nov 24 2008 02:03 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1330.IH H1330

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1 ferrals) to participating and nonpartici2 pating providers. 

3 ‘‘(vi) The name, address, and tele4 phone number of participating health care 

5 providers and an indication of whether 

6 each such provider is available to accept 

7 new patients. 

8 ‘‘(vii) How the plan or issuer address9 es the needs of participants, beneficiaries, 

10 and enrollees and others who do not speak 

11 English or who have other special commu12 nications needs in accessing providers 

13 under the plan or coverage, including the 

14 provision of information under this para15 graph.’’. 

16 (B) Section 2723(c) of such Act (42 

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

18 ‘‘section 2704’’ and inserting ‘‘sections 2704 

19 and 2708’’. 

20 (2) ERISA AMENDMENTS.— 

21 (A) Subpart B of part 7 of subtitle B of 

22 title I of the Employee Retirement Income Se23 curity Act of 1974 is amended by adding at the 

24 end the following new section: 


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1 ‘‘SEC. 715. COVERAGE OF COLORECTAL CANCER SCREEN2 ING. 

3 ‘‘(a) REQUIREMENT.— 

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

5 health insurance issuer offering group health insur6 ance coverage, shall provide coverage under the plan 

7 or coverage, respectively, for colorectal cancer 

8 screening for any participant or beneficiary who is 

9 50 years of age or older, or is an individual who is 

10 at high risk for colorectal cancer (as defined in sec11 tion 1861(pp)(2) of the Social Security Act (42 

12 U.S.C. 1395x(pp)(2)), under terms and conditions 

13 that are no less favorable than the terms and condi14 tions applicable to other screening benefits otherwise 

15 provided under the plan or coverage, respectively, ex16 cept that— 

17 ‘‘(A) the amount of any coinsurance appli18 cable to such screening may not be more than 

19 5 percent of the payment amount for such 

20 screening under such plan or coverage, respec21 tively, and such coverage provided under the 

22 plan or coverage, respectively, may not be sub23 ject to any deductible; and 

24 ‘‘(B) such coverage— 

25 ‘‘(i) with respect to individuals first 

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1 erage after the applicable effective date de2 scribed in section 2(d) of the ‘Colorectal 

3 Cancer Screening and Detection Coverage 

4 Act of 2009’, may require a waiting period 

5 of not more than 6 months beginning on 

6 the first date of coverage; and 

7 ‘‘(ii) with respect to individuals receiv8 ing benefits under such plan or coverage 

9 before such effective date, may not require 

10 a waiting period. 

11 ‘‘(2) COLORECTAL CANCER SCREENING DE12 FINED.—For purposes of this section, the term 

13 ‘colorectal cancer screening’ means procedures 

14 that— 

15 ‘‘(A) are deemed appropriate by a physi16 cian (as defined in section 1861(r) of the Social 

17 Security Act (42 U.S.C. 1395x(r))) treating the 

18 participant or beneficiary, in consultation with 

19 the participant or beneficiary; 

20 ‘‘(B) are— 

21 ‘‘(i) described in section 1861(pp)(1) 

22 of the Social Security Act (42 U.S.C. 

23 1395x(pp)(1)) or section 410.37 of title 

24 42, Code of Federal Regulations; 


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1 ‘‘(ii) specified by the Secretary for the 

2 detection of colorectal cancer, based upon 

3 the recommendations of appropriate orga4 nizations with special expertise in the field 

5 of colorectal cancer, including the Amer6 ican Cancer Society and the American Col7 lege of Gastroenterology; or 

8 ‘‘(iii) specified by the Secretary, based 

9 upon new scientific knowledge, techno10 logical advances, or other updated medical 

11 practices with respect to detection of 

12 colorectal cancer; and 

13 ‘‘(C) are performed at a frequency not 

14 greater than— 

15 ‘‘(i)(I) subject to subclause (II), that 

16 described for such method in section 

17 1834(d) of the Social Security Act (42 

18 U.S.C. 1395m(d)) or section 410.37 of 

19 title 42, Code of Federal Regulations; or 

20 ‘‘(II) in the case of a colorectal cancer 

21 screening test consisting of a screening 

22 colonoscopy, once every 36 months; or 

23 ‘‘(ii) that specified by the Secretary 

24 for such method, if the Secretary finds, 

25 based upon new scientific knowledge, techVerDate Nov 24 2008 02:03 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1330.IH H1330

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1 nological advances, or other updated med2 ical practices and consistent with the rec3 ommendations of appropriate organizations 

4 with special expertise in the field of 

5 colorectal cancer, that a different fre6 quency would not adversely affect the ef7 fectiveness of such screening. 

8 ‘‘(b) PROTECTIONS.—A group health plan, and a 

9 health insurance issuer offering group health insurance 

10 coverage in connection with a group health plan, may 

11 not— 

12 ‘‘(1) deny to an individual eligibility, or contin13 ued eligibility, to enroll or to renew coverage under 

14 the terms of the plan, solely for the purpose of 

15 avoiding the requirements of this section; 

16 ‘‘(2) provide monetary payments or rebates to 

17 individuals to encourage such individuals to accept 

18 less than the minimum protections available under 

19 this section; 

20 ‘‘(3) penalize or otherwise reduce or limit the 

21 reimbursement of a provider because such provider 

22 provided care to an individual participant or bene23 ficiary in accordance with this section; or 

24 ‘‘(4) provide incentives (monetary or otherwise) 

25 to an attending provider to induce such provider to 


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1 provide care to an individual participant or bene2 ficiary in a manner inconsistent with this section. 

3 ‘‘(c) RULES OF CONSTRUCTION.— 

4 ‘‘(1) Nothing in this section shall be construed 

5 to require an individual who is a participant or bene6 ficiary to undergo colorectal cancer screening. 

7 ‘‘(2) Nothing in this section shall be construed 

8 as preventing a group health plan or issuer from im9 posing deductibles, coinsurance, or other cost-shar10 ing in relation to colorectal cancer screening under 

11 the plan (or under health insurance coverage offered 

12 in connection with a group health plan), except that 

13 such coinsurance or other cost-sharing shall not dis14 criminate on any basis related to the coverage re15 quired under this section. 

16 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The 

17 imposition of the requirements of this section shall be 

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

19 described in section 102(a), for purposes of assuring no20 tice of such requirements under the plan; except that the 

21 summary description required to be provided under the 

22 fourth sentence of section 104(b)(1) with respect to such 

23 modification shall be provided by not later than 60 days 

24 after the first day of the first plan year in which such 

25 requirements apply. 


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1 ‘‘(e) DISCLOSURE REQUIREMENT.— 

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

3 health insurance issuer offering group health insur4 ance coverage shall— 

5 ‘‘(A) provide to participants and bene6 ficiaries at the time of initial coverage under 

7 the plan (or the effective date of this section, in 

8 the case of individuals who are participants or 

9 beneficiaries as of such date), and at least an10 nually thereafter, the information described in 

11 paragraph (2); 

12 ‘‘(B) provide to participants and bene13 ficiaries, within a reasonable period (as speci14 fied by the appropriate Secretary) before or 

15 after the date of significant changes in the in16 formation described in paragraph (2), informa17 tion regarding such significant changes; and 

18 ‘‘(C) upon request, make available to par19 ticipants and beneficiaries, the applicable au20 thority, and prospective participants and bene21 ficiaries, the information described in para22 graph (2). 

23 ‘‘(2) INFORMATION DESCRIBED.—For purposes 

24 of paragraph (1), the information described in this 


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1 paragraph, with respect to colorectal cancer screen2 ing, is the following: 

3 ‘‘(A) BENEFITS.—Benefits offered under 

4 the plan or coverage, including— 

5 ‘‘(i) covered benefits, including benefit 

6 limits and coverage exclusions; 

7 ‘‘(ii) cost-sharing, such as deductibles, 

8 coinsurance, and copayment amounts, in9 cluding any liability for balance billing, any 

10 maximum limitations on out of pocket ex11 penses, and the maximum out of pocket 

12 costs for services that are provided by non13 participating providers or that are fur14 nished without meeting the applicable utili15 zation review requirements; 

16 ‘‘(iii) the extent to which benefits may 

17 be obtained from nonparticipating pro18 viders; and 

19 ‘‘(iv) the extent to which a partici20 pant, beneficiary, or enrollee may select 

21 from among participating providers and 

22 the types of providers participating in the 

23 plan or issuer network. 

24 ‘‘(B) ACCESS.—A description of the fol25 lowing: 


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1 ‘‘(i) The number, mix, and distribu2 tion of providers under the plan or cov3 erage. 

4 ‘‘(ii) Out-of-network coverage (if any) 

5 provided by the plan or coverage. 

6 ‘‘(iii) Any point-of-service option (in7 cluding any supplemental premium or cost8 sharing for such option). 

9 ‘‘(iv) The procedures for participants, 

10 beneficiaries, and enrollees to select, ac11 cess, and change participating primary and 

12 specialty providers. 

13 ‘‘(v) The rights and procedures for 

14 obtaining referrals (including standing re15 ferrals) to participating and nonpartici16 pating providers. 

17 ‘‘(vi) The name, address, and tele18 phone number of participating health care 

19 providers and an indication of whether 

20 each such provider is available to accept 

21 new patients. 

22 ‘‘(vii) How the plan or issuer address23 es the needs of participants, beneficiaries, 

24 and enrollees and others who do not speak 

25 English or who have other special commuVerDate Nov 24 2008 02:03 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H1330.IH H1330

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1 nications needs in accessing providers 

2 under the plan or coverage, including the 

3 provision of information under this para4 graph.’’. 

5 (B) Section 731(c) of such Act (29 U.S.C. 

6 1191(c)) is amended by striking ‘‘section 711’’ 

7 and inserting ‘‘sections 711 and 715’’. 

8 (C) Section 732(a) of such Act (29 U.S.C. 

9 1191a(a)) is amended by striking ‘‘section 711’’ 

10 and inserting ‘‘sections 711 and 715’’. 

11 (D) The table of contents in section 1 of 

12 such Act is amended by inserting after the item 

13 relating to section 714 the following new item: 

‘‘Sec. 715. Coverage of colorectal cancer screening.’’. 

14 (3) INTERNAL REVENUE CODE AMEND15 MENTS.— 

16 (A) Subchapter B of chapter 100 of the 

17 Internal Revenue Code of 1986 is amended by 

18 inserting after section 9813 the following new 

19 section: 

20 ‘‘SEC. 9814. COVERAGE OF COLORECTAL CANCER SCREEN21 ING. 

22 ‘‘(a) REQUIREMENT.— 

23 ‘‘(1) IN GENERAL.—A group health plan shall 

24 provide coverage under the plan for colorectal cancer 

25 screening for any participant or beneficiary who is 


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1 50 years of age or older, or is an individual who is 

2 at high risk for colorectal cancer (as defined in sec3 tion 1861(pp)(2) of the Social Security Act (42 

4 U.S.C. 1395x(pp)(2))), under terms and conditions 

5 that are no less favorable than the terms and condi6 tions applicable to other screening benefits otherwise 

7 provided under the plan, except that— 

8 ‘‘(A) the amount of any coinsurance appli9 cable to such screening may not be more than 

10 5 percent of the payment amount for such 

11 screening under such plan and such coverage 

12 provided under the plan may not be subject to 

13 any deductible; and 

14 ‘‘(B) such coverage— 

15 ‘‘(i) with respect to individuals first 

16 receiving benefits under such plan after the 

17 applicable effective date described in sec18 tion 2(d) of the ‘Colorectal Cancer Screen19 ing and Detection Coverage Act of 2009’, 

20 may require a waiting period of not more 

21 than 6 months beginning on the first date 

22 of coverage; and 

23 ‘‘(ii) with respect to individuals receiv24 ing benefits under such plan before such 


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1 effective date, may not require a waiting 

2 period. 

3 ‘‘(2) COLORECTAL CANCER SCREENING DE4 FINED.—For purposes of this section, the term 

5 ‘colorectal cancer screening’ means procedures 

6 that— 

7 ‘‘(A) are deemed appropriate by a physi8 cian (as defined in section 1861(r) of the Social 

9 Security Act (42 U.S.C. 1395x(r))) treating the 

10 participant or beneficiary, in consultation with 

11 the participant or beneficiary; 

12 ‘‘(B) are— 

13 ‘‘(i) described in section 1861(pp)(1) 

14 of the Social Security Act (42 U.S.C. 

15 1395x(pp)(1)) or section 410.37 of title 

16 42, Code of Federal Regulations; 

17 ‘‘(ii) specified by the Secretary of 

18 Health and Human Services for the detec19 tion of colorectal cancer, based upon the 

20 recommendations of appropriate organiza21 tions with special expertise in the field of 

22 colorectal cancer, including the American 

23 Cancer Society and the American College 

24 of Gastroenterology; or 


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1 ‘‘(iii) specified by the Secretary of 

2 Health and Human Services, based upon 

3 new scientific knowledge, technological ad4 vances, or other updated medical practices 

5 with respect to detection of colorectal can6 cer; and 

7 ‘‘(C) are performed at a frequency not 

8 greater than— 

9 ‘‘(i)(I) subject to subclause (II), that 

10 described for such method in section 

11 1834(d) of the Social Security Act (42 

12 U.S.C. 1395m(d)) or section 410.37 of 

13 title 42, Code of Federal Regulations; or 

14 ‘‘(II) in the case of a colorectal cancer 

15 screening test consisting of a screening 

16 colonoscopy, once every 36 months; or 

17 ‘‘(ii) that specified by the Secretary 

18 for such method, if the Secretary finds, 

19 based upon new scientific knowledge, tech20 nological advances, or other updated med21 ical practices and consistent with the rec22 ommendations of appropriate organizations 

23 with special expertise in the field of 

24 colorectal cancer, that a different freVerDate Nov 24 2008 02:03 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H1330.IH H1330

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1 quency would not adversely affect the ef2 fectiveness of such screening. 

3 ‘‘(b) PROTECTIONS.—A group health plan may not— 

4 ‘‘(1) deny to an individual eligibility, or contin5 ued eligibility, to enroll or to renew coverage under 

6 the terms of the plan, solely for the purpose of 

7 avoiding the requirements of this section; 

8 ‘‘(2) provide monetary payments or rebates to 

9 individuals to encourage such individuals to accept 

10 less than the minimum protections available under 

11 this section; 

12 ‘‘(3) penalize or otherwise reduce or limit the 

13 reimbursement of a provider because such provider 

14 provided care to an individual participant or bene15 ficiary in accordance with this section; or 

16 ‘‘(4) provide incentives (monetary or otherwise) 

17 to an attending provider to induce such provider to 

18 provide care to an individual participant or bene19 ficiary in a manner inconsistent with this section. 

20 ‘‘(c) RULES OF CONSTRUCTION.— 

21 ‘‘(1) Nothing in this section shall be construed 

22 to require an individual who is a participant or bene23 ficiary to undergo colorectal cancer screening. 

24 ‘‘(2) Nothing in this section shall be construed 

25 as preventing a group health plan from imposing 


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1 deductibles, coinsurance, or other cost-sharing in re2 lation to colorectal cancer screening under the plan, 

3 except that such coinsurance or other cost-sharing 

4 shall not discriminate on any basis related to the 

5 coverage required under this section. 

6 ‘‘(d) DISCLOSURE REQUIREMENT.— 

7 ‘‘(1) IN GENERAL.—A group health plan 

8 shall— 

9 ‘‘(A) provide to participants and bene10 ficiaries at the time of initial coverage under 

11 the plan (or the effective date of this section, in 

12 the case of individuals who are participants or 

13 beneficiaries as of such date), and at least an14 nually thereafter, the information described in 

15 paragraph (2); 

16 ‘‘(B) provide to participants and bene17 ficiaries, within a reasonable period (as speci18 fied by the appropriate Secretary) before or 

19 after the date of significant changes in the in20 formation described in paragraph (2), informa21 tion regarding such significant changes; and 

22 ‘‘(C) upon request, make available to par23 ticipants and beneficiaries, the applicable au24 thority, and prospective participants and beneVerDate Nov 24 2008 02:03 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H1330.IH H1330

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1 ficiaries, the information described in para2 graph (2). 

3 ‘‘(2) INFORMATION DESCRIBED.—For purposes 

4 of paragraph (1), the information described in this 

5 paragraph, with respect to colorectal cancer screen6 ing, is the following: 

7 ‘‘(A) BENEFITS.—Benefits offered under 

8 the plan, including— 

9 ‘‘(i) covered benefits, including benefit 

10 limits and coverage exclusions; 

11 ‘‘(ii) cost-sharing, such as deductibles, 

12 coinsurance, and copayment amounts, in13 cluding any liability for balance billing, any 

14 maximum limitations on out of pocket ex15 penses, and the maximum out of pocket 

16 costs for services that are provided by non17 participating providers or that are fur18 nished without meeting the applicable utili19 zation review requirements; 

20 ‘‘(iii) the extent to which benefits may 

21 be obtained from nonparticipating pro22 viders; and 

23 ‘‘(iv) the extent to which a partici24 pant, beneficiary, or enrollee may select 

25 from among participating providers and 


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1 the types of providers participating in the 

2 plan or issuer network. 

3 ‘‘(B) ACCESS.—A description of the fol4 lowing: 

5 ‘‘(i) The number, mix, and distribu6 tion of providers under the plan. 

7 ‘‘(ii) Out-of-network coverage (if any) 

8 provided by the plan. 

9 ‘‘(iii) Any point-of-service option (in10 cluding any supplemental premium or cost11 sharing for such option). 

12 ‘‘(iv) The procedures for participants, 

13 beneficiaries, and enrollees to select, ac14 cess, and change participating primary and 

15 specialty providers. 

16 ‘‘(v) The rights and procedures for 

17 obtaining referrals (including standing re18 ferrals) to participating and nonpartici19 pating providers. 

20 ‘‘(vi) The name, address, and tele21 phone number of participating health care 

22 providers and an indication of whether 

23 each such provider is available to accept 

24 new patients. 


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1 ‘‘(vii) How the plan or issuer address2 es the needs of participants, beneficiaries, 

3 and enrollees and others who do not speak 

4 English or who have other special commu5 nications needs in accessing providers 

6 under the plan, including the provision of 

7 information under this paragraph.’’. 

8 (B) The table of sections of such sub9 chapter of such Code is amended by inserting 

10 after the item relating to section 9813 the fol11 lowing new item: 

‘‘Sec. 9814. Coverage of colorectal cancer screening.’’. 

12 (C) Section 4980D(d)(1) of such Code is 

13 amended by striking ‘‘section 9811’’ and insert14 ing ‘‘sections 9811 and 9814’’. 

15 (b) INDIVIDUAL HEALTH INSURANCE.— 

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

17 Public Health Service Act is amended by inserting 

18 after section 2753 the following new section: 

19 ‘‘SEC. 2754. COVERAGE OF COLORECTAL CANCER SCREEN20 ING. 

21 ‘‘(a) IN GENERAL.—The provisions of section 2708 

22 (other than subsection (d)) shall apply to health insurance 

23 coverage offered by a health insurance issuer in the indi24 vidual market in the same manner as it applies to health 

25 insurance coverage offered by a health insurance issuer 


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•HR 1330 IH

1 in connection with a group health plan in the small or 

2 large group market. 

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

4 part shall comply with the notice requirement under sec5 tion 715(d) of the Employee Retirement Income Security 

6 Act of 1974 with respect to the requirements referred to 

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

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

9 (2) CONFORMING AMENDMENT.—Section 

10 2762(b)(2) of such Act (42 U.S.C. 300gg–63(b)(2)) 

11 is amended by striking ‘‘section 2751’’ and inserting 

12 ‘‘sections 2751 and 2754’’. 

13 (c) APPLICATION UNDER FEDERAL EMPLOYEES

14 HEALTH BENEFITS PROGRAM (FEHBP).—Section 8902 

15 of title 5, United States Code, is amended by adding at 

16 the end the following new subsection: 

17 ‘‘(p) A contract may not be made or a plan approved 

18 which does not comply with the requirements of section 

19 2708 of the Public Health Service Act.’’. 

20 (d) EFFECTIVE DATES.— 

21 (1) GROUP HEALTH PLANS AND HEALTH BEN22 EFIT PLANS.—The amendments made by subsections 

23 (a) and (c) shall apply with respect to group health 

24 plans (and health insurance coverage offered in con25 nection with group health plans) and health benefit 


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•HR 1330 IH

1 plans, respectively, for plan years beginning on or 

2 after January 1, 2010. 

3 (2) INDIVIDUAL HEALTH INSURANCE.—The 

4 amendments made by subsection (b) shall apply with 

5 respect to health insurance coverage offered, sold, 

6 issued, or renewed in the individual market on or 

7 after January 1, 2010. 

8 (e) COORDINATION OF ADMINISTRATION.—The Sec9 retary of Health and Human Services, the Secretary of 

10 Labor, and the Secretary of the Treasury shall ensure, 

11 through the execution of an interagency memorandum of 

12 understanding among such Secretaries, that— 

13 (1) regulations, rulings, and interpretations 

14 issued by such Secretaries relating to the same mat15 ter over which two or more such Secretaries have re16 sponsibility under the provisions of this section (and 

17 the amendments made thereby) are administered so 

18 as to have the same effect at all times; and 

19 (2) coordination of policies relating to enforcing 

20 the same requirements through such Secretaries in 

21 order to have a coordinated enforcement strategy 

22 that avoids duplication of enforcement efforts and 

23 assigns priorities in enforcement. 

Æ 


wwoods2 on PRODPC68 with BILLS