I

107TH CONGRESS

1ST SESSION H. R. 1520

To amend the Public Health Service Act and the Employee Retirement

Income Security Act of 1974 to require coverage for colorectal cancer

screenings for group health plans and group and individual health insurance coverage.

IN THE HOUSE OF REPRESENTATIVES

APRIL 4, 2001

Ms. SLAUGHTER (for herself, Mrs. MORELLA, Mr. HASTINGS of Florida, Mr.

ALLEN, Mr. BACA, Mr. BALDACCI, Mr. BLAGOJEVICH, Mr. BONIOR, Mr.

BORSKI, Mr. BRADY of Pennsylvania, Mr. CAPUANO, Ms. CARSON of Indiana, Mr. COYNE, Mr. CRAMER, Mr. DOYLE, Ms. ESHOO, Mr. FILNER,

Mr. FOLEY, Mr. FROST, Mr. GONZALEZ, Mr. GREEN of Texas, Mr.

GUTIERREZ, Mr. HILLIARD, Mr. HINCHEY, Mr. KANJORSKI, Mr. LANTOS, Mrs. LOWEY, Mrs. MALONEY of New York, Mr. MCINTYRE, Mr.

MCNULTY, Ms. MILLENDER-MCDONALD, Mrs. MINK of Hawaii, Mr.

MOORE, Mr. MORAN of Virginia, Mr. PASCRELL, Mr. PAYNE, Mr.

PLATTS, Mr. RANGEL, Mr. RUSH, Ms. SANCHEZ, Mr. SANDLIN, Ms.

SCHAKOWSKY, Mr. SHERMAN, Mr. SPRATT, Mr. STARK, Mrs. THURMAN,

Mr. TIERNEY, Mr. TOWNS, and Ms. WOOLSEY) introduced the following

bill; which was referred to the Committee on Energy and 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 amend the Public Health Service Act and the Employee

Retirement Income Security Act of 1974 to require coverage for colorectal cancer screenings for group health

plans and group and individual health insurance coverage.
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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 2001’’.

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 2001, 135,400 new

11 cases of colorectal cancer will be diagnosed in men

12 and women in the United States.

13 (3) Colorectal cancer is expected to kill 56,700

14 individuals in the United States in 2001.

15 (4) Research has shown that a high-fiber, low16 fat diet can significantly reduce the risk of devel17 oping colorectal cancer.

18 (5) The adoption of a healthy lifestyle at a

19 young age can significantly reduce the risk of devel20 oping colorectal cancer.

21 (6) Appropriate screenings and regular tests,

22 including fecal occult blood tests, sigmoidoscopy, and

23 colonoscopy, can save large numbers of lives by lead24 ing to earlier identification of colorectal cancer.
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1 (7) The Centers for Disease Control and Pre2 vention, the Health Care Financing Administration,

3 and the National Cancer Institute have initiated the

4 Screen for Life Campaign targeted to individuals

5 age 50 and older to spread the message of the im6 portance of colorectal cancer screening tests.

7 (8) Education helps to inform the public of

8 symptoms for the early detection of colorectal cancer

9 and methods of prevention.

10 SEC. 2. COVERAGE FOR COLORECTAL CANCER SCREENING.

11 (a) GROUP HEALTH PLANS.—

12 (1) PUBLIC HEALTH SERVICE ACT AMEND13 MENTS.—(A) Subpart 2 of part A of title XXVII of

14 the Public Health Service Act is amended by adding

15 at the end the following new section:

16 ‘‘SEC. 2707. COVERAGE FOR COLORECTAL CANCER SCREEN17 ING.

18 ‘‘(a) COVERAGE FOR COLORECTAL CANCER SCREEN19 ING.—

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

21 health insurance issuer offering group health insur22 ance coverage, shall provide coverage for colorectal

23 cancer screening at regular intervals to—

24 ‘‘(A) any participant or beneficiary age 50

25 or over; and
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1 ‘‘(B) any participant or beneficiary under

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

3 colorectal cancer, or who may have symptoms

4 or circumstances that indicate a need for

5 colorectal cancer screening.

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

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

8 colorectal cancer’ has the meaning given such term

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

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

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

12 health plan or health insurance issuer shall cover the

13 method and frequency of colorectal cancer screening

14 deemed appropriate by a health care provider treat15 ing such participant or beneficiary, in consultation

16 with the participant or beneficiary. Such coverage

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

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

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

20 of 1997.

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

22 shall comply with the notice requirement under section

23 714(b) of the Employee Retirement Income Security Act

24 of 1974 with respect to the requirements of this section

25 as if such section applied to such plan.
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1 ‘‘(c) NON-PREEMPTION OF MORE PROTECTIVE

2 STATE LAW WITH RESPECT TO HEALTH INSURANCE

3 ISSUERS.—This section shall not be construed to super4 sede any provision of State law which establishes, imple5 ments, or continues in effect any standard or requirement

6 solely relating to health insurance issuers in connection

7 with group health insurance coverage that provides great8 er protections to participants and beneficiaries than the

9 protections provided under this section.’’.

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

11 300gg–23(c)) is amended by striking ‘‘section 2704’’

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

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

14 part 7 of subtitle B of title I of the Employee Re15 tirement Income Security Act of 1974 is amended by

16 adding at the end the following new section:

17 ‘‘SEC. 714. COVERAGE FOR COLORECTAL CANCER SCREEN18 ING.

19 ‘‘(a) COVERAGE FOR COLORECTAL CANCER SCREEN20 ING.—

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

22 health insurance issuer offering group health insur23 ance coverage, shall provide coverage for colorectal

24 cancer screening at regular intervals to—
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1 ‘‘(A) any participant or beneficiary age 50

2 or over; and

3 ‘‘(B) any participant or beneficiary under

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

5 colorectal cancer, or who may have symptoms

6 or circumstances that indicate a need for

7 colorectal cancer screening.

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

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

10 colorectal cancer’ has the meaning given such term

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

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

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

14 health plan or health insurance issuer shall cover the

15 method and frequency of colorectal cancer screening

16 deemed appropriate by a health care provider treat17 ing such participant or beneficiary, in consultation

18 with the participant or beneficiary. Such coverage

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

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

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

22 of 1997.

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

24 imposition of the requirements of this section shall be

25 treated as a material modification in the terms of the plan
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1 described in section 102(a), for purposes of assuring no2 tice of such requirements under the plan; except that the

3 summary description required to be provided under the

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

5 such modification shall be provided by not later than 60

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

7 such requirements apply.’’.

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

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

10 inserting ‘‘sections 711 and 714’’.

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

12 1191a(a)) is amended by striking ‘‘section 711’’ and

13 inserting ‘‘sections 711 and 714’’.

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

15 Act is amended by inserting after the item relating

16 to section 713 the following new item:

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

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

18 of title XXVII of the Public Health Service Act is amend19 ed by inserting after section 2752 the following new sec20 tion:

21 ‘‘SEC. 2753. COVERAGE FOR COLORECTAL CANCER SCREEN22 ING.

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

24 2707(a) shall apply to health insurance coverage offered

25 by a health insurance issuer in the individual market in
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1 the same manner as it applies to health insurance coverage

2 offered by a health insurance issuer in connection with a

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

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

5 part shall comply with the notice requirement under sec6 tion 714(b) of the Employee Retirement Income Security

7 Act of 1974 with respect to the requirements referred to

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

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

10 (c) EFFECTIVE DATES.—(1)(A) Subject to subpara11 graph (B), the amendments made by subsection (a) shall

12 apply with respect to group health plans for plan years

13 beginning on or after January 1, 2003.

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

15 pursuant to 1 or more collective bargaining agreements

16 between employee representatives and 1 or more employ17 ers ratified before the date of enactment of this Act, the

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

19 plan years beginning before the later of—

20 (i) the date on which the last collective bar21 gaining agreements relating to the plan terminates

22 (determined without regard to any extension thereof

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

24 or

25 (ii) January 1, 2003.
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1 For purposes of clause (i), any plan amendment made pur2 suant to a collective bargaining agreement relating to the

3 plan which amends the plan solely to conform to any re4 quirement added by subsection (a) shall not be treated as

5 a termination of such collective bargaining agreement.

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

7 apply with respect to health insurance coverage offered,

8 sold, issued, renewed, in effect, or operated in the indi9 vidual market on or after January 1, 2003.

10 (d) COORDINATED REGULATIONS.—The Secretary of

11 Labor and the Secretary of Health and Human Services

12 shall ensure, through the execution of an interagency

13 memorandum of understanding among such Secretaries,

14 that—

15 (1) regulations, rulings, and interpretations

16 issued by such Secretaries relating to the same mat17 ter over which both Secretaries have responsibility

18 under the provisions of this section (and the amend19 ments made thereby) are administered so as to have

20 the same effect at all times; and

21 (2) coordination of policies relating to enforcing

22 the same requirements through such Secretaries in

23 order to have a coordinated enforcement strategy
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1 that avoids duplication of enforcement efforts and

2 assigns priorities in enforcement.

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