II 

108TH CONGRESS 

2D SESSION S. 2265 

To require group and individual health plans to provide coverage for colorectal 

cancer screenings. 

IN THE SENATE OF THE UNITED STATES 

MARCH 31, 2004 

Mr. ROBERTS (for himself and 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 group and individual health plans to provide 

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 2004’’. 

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 2004, 146,940 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 56,730 

5 individuals in the United States in 2004. 

6 (4) When colorectal cancer is diagnosed early, 

7 at a localized stage, more than 90 percent of pa8 tients survive for 5 years or more. Once the disease 

9 has metastasized, 92 percent of patients die within 

10 5 years. Yet, only 37 percent of colorectal cancer 

11 cases are diagnosed while the disease is still in the 

12 localized stage. 

13 (5) If all men and women age 50 and over prac14 ticed regular colorectal cancer screening, without 

15 any new scientific discoveries, the United States 

16 could see up to a 50 to 90 percent reduction in 

17 deaths from this disease. 

18 (6) Currently, many private insurance health 

19 plans are not providing coverage for the full range 

20 of colorectal cancer screening tests. Lack of insur21 ance coverage can act as a barrier to care. 

22 (7) Assuring coverage for the full range of 

23 colorectal cancer tests is an important step in in24 creasing screening rates for these life saving tests. 
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1 SEC. 2. COVERAGE FOR COLORECTAL CANCER SCREENING. 

2 (a) GROUP HEALTH PLANS.— 

3 (1) PUBLIC HEALTH SERVICE ACT AMEND4 MENTS.—The Public Health Service Act (42 U.S.C. 

5 201 et seq.) is amended by adding at the end the 

6 following: 

7 ‘‘TITLE XXIX—MISCELLANEOUS 

8 HEALTH COVERAGE 

9 ‘‘SEC. 2901. COVERAGE FOR COLORECTAL CANCER SCREEN10 ING. 

11 ‘‘(a) COVERAGE FOR COLORECTAL CANCER SCREEN12 ING.— 

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

14 health insurance issuer offering group health insur15 ance coverage, shall provide coverage for colorectal 

16 cancer screening consistent with this subsection to— 

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

18 or over; and 

19 ‘‘(B) any participant or beneficiary under 

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

21 colorectal cancer. 

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

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

24 colorectal cancer’ has the meaning given such term 

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

26 U.S.C. 1395x(pp)(2)). 
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1 ‘‘(3) REQUIREMENT FOR SCREENING.—The 

2 group health plan or health insurance issuer shall 

3 cover methods of colorectal cancer screening that— 

4 ‘‘(A) are deemed appropriate by a physi5 cian (as defined in section 1861(r) of the Social 

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

7 participant or beneficiary, in consultation with 

8 the participant or beneficiary; 

9 ‘‘(B) are— 

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

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

12 1395x(pp)(1)) or section 410.37 of title 

13 42, Code of Federal Regulations; or 

14 ‘‘(ii) specified by the Secretary, based 

15 upon the recommendations of appropriate 

16 organizations with special expertise in the 

17 field of colorectal cancer; and 

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

19 greater than that— 

20 ‘‘(i) described for such method in sec21 tion 1834(d) of the Social Security Act (42 

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

23 title 42, Code of Federal Regulations; or 

24 ‘‘(ii) specified by the Secretary for 

25 such method, if the Secretary finds, based 
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1 upon new scientific knowledge and con2 sistent with the recommendations of appro3 priate organizations with special expertise 

4 in the field of colorectal cancer, that a dif5 ferent frequency would not adversely affect 

6 the effectiveness of such screening. 

7 ‘‘(b) NOTICE.—A group health plan under this sec8 tion shall comply with the notice requirement under sec9 tion 714(b) of the Employee Retirement Income Security 

10 Act of 1974 with respect to the requirements of this sec11 tion as if such section applied to such plan. 

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

13 STATE LAW WITH RESPECT TO HEALTH INSURANCE

14 ISSUERS.—This section shall not be construed to super15 sede any provision of State law which establishes, imple16 ments, or continues in effect any standard or requirement 

17 solely relating to health insurance issuers in connection 

18 with group health insurance coverage that provides great19 er protections to participants and beneficiaries than the 

20 protections provided under this section. 

21 ‘‘(d) DEFINITIONS AND ENFORCEMENT.—The defini22 tions and enforcement provisions of title XXVII shall 

23 apply for purposes of this section.’’. 

24 (2) ERISA AMENDMENTS.— 
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1 (A) IN GENERAL.—Subpart B of part 7 of 

2 subtitle B of title I of the Employee Retirement 

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

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

5 following new section: 

6 ‘‘SEC. 714. COVERAGE FOR COLORECTAL CANCER SCREEN7 ING. 

8 ‘‘(a) COVERAGE FOR COLORECTAL CANCER SCREEN9 ING.— 

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

11 health insurance issuer offering group health insur12 ance coverage, shall provide coverage for colorectal 

13 cancer screening consistent with this subsection to— 

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

15 or over; and 

16 ‘‘(B) any participant or beneficiary under 

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

18 colorectal cancer. 

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

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

21 colorectal cancer’ has the meaning given such term 

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

23 U.S.C. 1395x(pp)(2)). 
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1 ‘‘(3) REQUIREMENT FOR SCREENING.—The 

2 group health plan or health insurance issuer shall 

3 cover methods of colorectal cancer screening that— 

4 ‘‘(A) are deemed appropriate by a physi5 cian (as defined in section 1861(r) of the Social 

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

7 participant or beneficiary, in consultation with 

8 the participant or beneficiary; 

9 ‘‘(B) are— 

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

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

12 1395x(pp)(1)) or section 410.37 of title 

13 42, Code of Federal Regulations; or 

14 ‘‘(ii) specified by the Secretary, based 

15 upon the recommendations of appropriate 

16 organizations with special expertise in the 

17 field of colorectal cancer; and 

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

19 greater than that— 

20 ‘‘(i) described for such method in sec21 tion 1834(d) of the Social Security Act (42 

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

23 title 42, Code of Federal Regulations; or 

24 ‘‘(ii) specified by the Secretary for 

25 such method, if the Secretary finds, based 
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1 upon new scientific knowledge and con2 sistent with the recommendations of appro3 priate organizations with special expertise 

4 in the field of colorectal cancer, that a dif5 ferent frequency would not adversely affect 

6 the effectiveness of such screening. 

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

8 imposition of the requirements of this section shall be 

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

10 described in section 102(a), for purposes of assuring no11 tice of such requirements under the plan; except that the 

12 summary description required to be provided under the 

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

14 such modification shall be provided by not later than 60 

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

16 such requirements apply.’’. 

17 (B) TECHNICAL AND CONFORMING AMEND18 MENTS.— 

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

20 Retirement Income Security Act of 1974 

21 (29 U.S.C. 1191(c)) is amended by strik22 ing ‘‘section 711’’ and inserting ‘‘sections 

23 711 and 714’’. 

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

25 Retirement Income Security Act of 1974 
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1 (29 U.S.C. 1191a(a)) is amended by strik2 ing ‘‘section 711’’ and inserting ‘‘sections 

3 711 and 714’’. 

4 (iii) The table of contents in section 1 

5 of the Employee Retirement Income Secu6 rity Act of 1974 is amended by inserting 

7 after the item relating to section 713 the 

8 following new item: 

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

9 (b) INDIVIDUAL HEALTH INSURANCE.— 

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

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

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

13 following new section: 

14 ‘‘SEC. 2753. COVERAGE FOR COLORECTAL CANCER SCREEN15 ING. 

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

17 2901(a) shall apply to health insurance coverage offered 

18 by a health insurance issuer in the individual market in 

19 the same manner as it applies to health insurance coverage 

20 offered by a health insurance issuer in connection with a 

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

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

23 part shall comply with the notice requirement under sec24 tion 714(b) of the Employee Retirement Income Security 

25 Act of 1974 with respect to the requirements referred to 
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1 in subsection (a) as if such section applied to such issuer 

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

3 (2) TECHNICAL AMENDMENT.—Section 

4 2762(b)(2) of the Public Health Service Act (42 

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

6 ‘‘section 2751’’ and inserting ‘‘sections 2751 and 

7 2753’’. 

8 (c) EFFECTIVE DATES.— 

9 (1) GROUP HEALTH PLANS.—The amendments 

10 made by subsection (a) shall apply with respect to 

11 group health plans for plan years beginning on or 

12 after January 1, 2005. 

13 (2) INDIVIDUAL HEALTH INSURANCE.—The 

14 amendments made by subsection (b) shall apply with 

15 respect to health insurance coverage offered, sold, 

16 issued, renewed, in effect, or operated in the indi17 vidual market on or after January 1, 2005. 

18 (d) COORDINATED REGULATIONS.—The Secretary of 

19 Labor and the Secretary of Health and Human Services 

20 shall ensure, through the execution of an interagency 

21 memorandum of understanding among such Secretaries, 

22 that— 

23 (1) regulations, rulings, and interpretations 

24 issued by such Secretaries relating to the same mat25 ter over which both Secretaries have responsibility 
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1 under the provisions of this section (and the amend2 ments made thereby) are administered so as to have 

3 the same effect at all times; and 

4 (2) coordination of policies relating to enforcing 

5 the same requirements through such Secretaries in 

6 order to have a coordinated enforcement strategy 

7 that avoids duplication of enforcement efforts and 

8 assigns priorities in enforcement. 

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