I

106TH CONGRESS

1ST SESSION H. R. 1816

To require coverage for colorectal cancer screenings.

IN THE HOUSE OF REPRESENTATIVES

MAY 13, 1999

Ms. SLAUGHTER (for herself, Mrs. MORELLA, Mr. SISISKY, and Mr.

HASTINGS of Florida) introduced the following bill; which was referred

to the Committee on 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 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.
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1 (2) It is estimated that in 1999, 129,400 new

2 cases of colorectal cancer will be diagnosed in men

3 and women in the United States.

4 (3) Colorectal cancer is expected to kill 56,600

5 individuals in the United States in 1999.

6 (4) Research has shown that a high-fiber, low7 fat diet can significantly reduce the risk of devel8 oping colorectal cancer.

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

10 age can significantly reduce the risk of developing

11 colorectal cancer.

12 (6) Appropriate screenings and regular tests

13 can save large numbers of lives by leading to earlier

14 identification of colorectal cancer.

15 (7) The Centers for Disease Control and Pre16 vention, the Health Care Financing Administration,

17 and the National Cancer Institute have initiated the

18 Screen for Life Campaign targeted to individuals

19 age 50 and older to spread the message of the im20 portance of colorectal cancer screening tests.

21 (8) Education helps to inform the public of

22 symptoms for the early detection of colorectal cancer

23 and methods of prevention.

24 SEC. 2. COVERAGE FOR COLORECTAL CANCER SCREENING.

25 (a) GROUP HEALTH PLANS.—
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1 (1) PUBLIC HEALTH SERVICE ACT AMEND2 MENTS.—(A) Subpart 2 of part A of title XXVII of

3 the Public Health Service Act is amended by adding

4 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) Section 2723(c) of such Act (42 U.S.C.

2 300gg–23(c)) is amended by striking ‘‘section 2704’’

3 and inserting ‘‘sections 2704 and 2707’’.

4 (2) ERISA AMENDMENTS.—(A) Subpart B of

5 part 7 of subtitle B of title I of the Employee Re6 tirement Income Security Act of 1974 is amended by

7 adding at the end the following new section:

8 ‘‘SEC. 714. COVERAGE FOR COLORECTAL CANCER SCREEN9 ING.

10 ‘‘(a) COVERAGE FOR COLORECTAL CANCER SCREEN11 ING.—

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

13 health insurance issuer offering group health insur14 ance coverage, shall provide coverage for colorectal

15 cancer screening at regular intervals to—

16 ‘‘(A) any participant or beneficiary over

17 the age of 50; and

18 ‘‘(B) any participant or beneficiary under

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

20 colorectal cancer, or who may have symptoms

21 or circumstances that indicate a need for

22 colorectal cancer screening.

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

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

25 colorectal cancer’ has the meaning given such term
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1 in section 1861(pp)(2) of the Social Security Act (42

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

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

4 health plan or health insurance issuer shall cover the

5 method and frequency of colorectal cancer screening

6 deemed appropriate by a health care provider treat7 ing such participant or beneficiary, in consultation

8 with the participant or beneficiary. Such coverage

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

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

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

12 of 1997.

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

14 imposition of the requirements of this section shall be

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

16 described in section 102(a), for purposes of assuring no17 tice of such requirements under the plan; except that the

18 summary description required to be provided under the

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

20 such modification shall be provided by not later than 60

21 days after the first day of the first plan year in which

22 such requirements apply.’’.

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

24 1191(c)) is amended by striking ‘‘section 711’’ and

25 inserting ‘‘sections 711 and 714’’.
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1 (C) Section 732(a) of such Act (29 U.S.C.

2 1191a(a)) is amended by striking ‘‘section 711’’ and

3 inserting ‘‘sections 711 and 714’’.

4 (D) The table of contents in section 1 of such

5 Act is amended by inserting after the item relating

6 to section 713 the following new item:

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

7 (b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B

8 of title XXVII of the Public Health Service Act is amend9 ed by inserting after section 2752 the following new sec10 tion:

11 ‘‘SEC. 2753. COVERAGE FOR COLORECTAL CANCER SCREEN12 ING.

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

14 2707(a) shall apply to health insurance coverage offered

15 by a health insurance issuer in the individual market in

16 the same manner as it applies to health insurance coverage

17 offered by a health insurance issuer in connection with a

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

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

20 part shall comply with the notice requirement under sec21 tion 714(b) of the Employee Retirement Income Security

22 Act of 1974 with respect to the requirements referred to

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

24 and such issuer were a group health plan.’’.
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1 (c) EFFECTIVE DATES.—(1)(A) Subject to subpara2 graph (B), the amendments made by subsection (a) shall

3 apply with respect to group health plans for plan years

4 beginning on or after January 1, 2001.

5 (B) In the case of a group health plan maintained

6 pursuant to 1 or more collective bargaining agreements

7 between employee representatives and 1 or more employ8 ers ratified before the date of enactment of this Act, the

9 amendments made by subsection (a) shall not apply to

10 plan years beginning before the later of—

11 (i) the date on which the last collective bar12 gaining agreements relating to the plan terminates

13 (determined without regard to any extension thereof

14 agreed to after the date of enactment of this Act),

15 or

16 (ii) January 1, 2001.

17 For purposes of clause (i), any plan amendment made pur18 suant to a collective bargaining agreement relating to the

19 plan which amends the plan solely to conform to any re20 quirement added by subsection (a) shall not be treated as

21 a termination of such collective bargaining agreement.

22 (2) The amendments made by subsection (b) shall

23 apply with respect to health insurance coverage offered,

24 sold, issued, renewed, in effect, or operated in the indi25 vidual market on or after January 1, 2001.
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1 (3) The amendment made by subsection (c) shall

2 apply to contracts for contract periods beginning on or

3 after January 1, 2001.

4 (d) COORDINATED REGULATIONS.—The Secretary of

5 Labor and the Secretary of Health and Human Services

6 shall ensure, through the execution of an interagency

7 memorandum of understanding among such Secretaries,

8 that—

9 (1) regulations, rulings, and interpretations

10 issued by such Secretaries relating to the same mat11 ter over which both Secretaries have responsibility

12 under the provisions of this section (and the amend13 ments made thereby) are administered so as to have

14 the same effect at all times; and

15 (2) coordination of policies relating to enforcing

16 the same requirements through such Secretaries in

17 order to have a coordinated enforcement strategy

18 that avoids duplication of enforcement efforts and

19 assigns priorities in enforcement.

20 SEC. 3. SENSE OF THE CONGRESS.

21 It is the sense of the Congress that—

22 (1) all Americans should be educated about the

23 risks, prevention, screening, and treatment of

24 colorectal cancer;
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1 (2) the Centers for Disease Control and Preven2 tion and the Department of Health and Human

3 Services should be commended for launching a co4 ordinated education campaign on colorectal cancer in

5 March of 1999; and

6 (3) the Centers for Disease Control and Preven7 tion and the Department of Health and Human

8 Services should track the impact of the coordinated

9 education campaign on colorectal cancer and make

10 information on its progress available to Members of

11 Congress.

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