I 

108TH CONGRESS 

2D SESSION H. R. 4097 

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

cancer screenings. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 31, 2004 

Ms. SLAUGHTER (for herself and Mr. KING of New York) 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 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: 
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1 (1) Colorectal cancer is the second leading 

2 cause of cancer deaths in the United States for men 

3 and women combined. 

4 (2) It is estimated that in 2004, 146,940 new 

5 cases of colorectal cancer will be diagnosed in men 

6 and women in the United States. 

7 (3) Colorectal cancer is expected to kill 56,730 

8 individuals in the United States in 2004. 

9 (4) When colorectal cancer is diagnosed early, 

10 at a localized stage, more than 90 percent of pa11 tients survive for 5 years or more. Once the disease 

12 has metastasized, 92 percent of patients die within 

13 5 years. Yet, only 37 percent of colorectal cancer 

14 cases are diagnosed while the disease is still in the 

15 localized stage. 

16 (5) If all men and women age 50 and over prac17 ticed regular colorectal cancer screening, without 

18 any new scientific discoveries, the United States 

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

20 deaths from this disease. 

21 (6) Currently, many private insurance health 

22 plans are not providing coverage for the full range 

23 of colorectal cancer screening tests. Lack of insur24 ance coverage can act as a barrier to care. 
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1 (7) Assuring coverage for the full range of 

2 colorectal cancer tests is an important step in in3 creasing screening rates for these life saving tests. 

4 SEC. 2. COVERAGE FOR COLORECTAL CANCER SCREENING. 

5 (a) GROUP HEALTH PLANS.— 

6 (1) PUBLIC HEALTH SERVICE ACT AMEND7 MENTS.—The Public Health Service Act (42 U.S.C. 

8 201 et seq.) is amended by adding at the end the 

9 following: 

10 ‘‘TITLE XXIX—MISCELLANEOUS 

11 HEALTH COVERAGE 

12 ‘‘SEC. 2901. 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 consistent with this subsection to— 

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

21 or over; and 

22 ‘‘(B) any participant or beneficiary under 

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

24 colorectal cancer. 
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1 ‘‘(2) DEFINITION OF HIGH RISK.—For purposes 

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

3 colorectal cancer’ has the meaning given such term 

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

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

6 ‘‘(3) REQUIREMENT FOR SCREENING.—The 

7 group health plan or health insurance issuer shall 

8 cover methods of colorectal cancer screening that— 

9 ‘‘(A) are deemed appropriate by a physi10 cian (as defined in section 1861(r) of the Social 

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

12 participant or beneficiary, in consultation with 

13 the participant or beneficiary; 

14 ‘‘(B) are— 

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

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

17 1395x(pp)(1)) or section 410.37 of title 

18 42, Code of Federal Regulations; or 

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

20 upon the recommendations of appropriate 

21 organizations with special expertise in the 

22 field of colorectal cancer; and 

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

24 greater than that— 
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1 ‘‘(i) described for such method in sec2 tion 1834(d) of the Social Security Act (42 

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

4 title 42, Code of Federal Regulations; or 

5 ‘‘(ii) specified by the Secretary for 

6 such method, if the Secretary finds, based 

7 upon new scientific knowledge and con8 sistent with the recommendations of appro9 priate organizations with special expertise 

10 in the field of colorectal cancer, that a dif11 ferent frequency would not adversely affect 

12 the effectiveness of such screening. 

13 ‘‘(b) NOTICE.—A group health plan under this sec14 tion shall comply with the notice requirement under sec15 tion 714(b) of the Employee Retirement Income Security 

16 Act of 1974 with respect to the requirements of this sec17 tion as if such section applied to such plan. 

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

19 STATE LAW WITH RESPECT TO HEALTH INSURANCE

20 ISSUERS.—This section shall not be construed to super21 sede any provision of State law which establishes, imple22 ments, or continues in effect any standard or requirement 

23 solely relating to health insurance issuers in connection 

24 with group health insurance coverage that provides great-
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1 er protections to participants and beneficiaries than the 

2 protections provided under this section. 

3 ‘‘(d) DEFINITIONS AND ENFORCEMENT.—The defini4 tions and enforcement provisions of title XXVII shall 

5 apply for purposes of this section.’’. 

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 consistent with this subsection to— 

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

21 or over; and 

22 ‘‘(B) any participant or beneficiary under 

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

24 colorectal cancer. 
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1 ‘‘(2) DEFINITION OF HIGH RISK.—For purposes 

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

3 colorectal cancer’ has the meaning given such term 

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

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

6 ‘‘(3) REQUIREMENT FOR SCREENING.—The 

7 group health plan or health insurance issuer shall 

8 cover methods of colorectal cancer screening that— 

9 ‘‘(A) are deemed appropriate by a physi10 cian (as defined in section 1861(r) of the Social 

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

12 participant or beneficiary, in consultation with 

13 the participant or beneficiary; 

14 ‘‘(B) are— 

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

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

17 1395x(pp)(1)) or section 410.37 of title 

18 42, Code of Federal Regulations; or 

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

20 upon the recommendations of appropriate 

21 organizations with special expertise in the 

22 field of colorectal cancer; and 

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

24 greater than that— 
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1 ‘‘(i) described for such method in sec2 tion 1834(d) of the Social Security Act (42 

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

4 title 42, Code of Federal Regulations; or 

5 ‘‘(ii) specified by the Secretary for 

6 such method, if the Secretary finds, based 

7 upon new scientific knowledge and con8 sistent with the recommendations of appro9 priate organizations with special expertise 

10 in the field of colorectal cancer, that a dif11 ferent frequency would not adversely affect 

12 the effectiveness of such screening. 

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) TECHNICAL AND CONFORMING AMEND24 MENTS.— 
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1 (i) Section 731(c) of the Employee 

2 Retirement Income Security Act of 1974 

3 (29 U.S.C. 1191(c)) is amended by strik4 ing ‘‘section 711’’ and inserting ‘‘sections 

5 711 and 714’’. 

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

7 Retirement Income Security Act of 1974 

8 (29 U.S.C. 1191a(a)) is amended by strik9 ing ‘‘section 711’’ and inserting ‘‘sections 

10 711 and 714’’. 

11 (iii) The table of contents in section 1 

12 of the Employee Retirement Income Secu13 rity Act of 1974 is amended by inserting 

14 after the item relating to section 713 the 

15 following new item: 

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

16 (b) INDIVIDUAL HEALTH INSURANCE.— 

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

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

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

20 following new section: 

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

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

24 2901(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 (2) TECHNICAL AMENDMENT.—Section 

11 2762(b)(2) of the Public Health Service Act (42 

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

13 ‘‘section 2751’’ and inserting ‘‘sections 2751 and 

14 2753’’. 

15 (c) EFFECTIVE DATES.— 

16 (1) GROUP HEALTH PLANS.—The amendments 

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

18 group health plans for plan years beginning on or 

19 after January 1, 2005. 

20 (2) INDIVIDUAL HEALTH INSURANCE.—The 

21 amendments made by subsection (b) shall apply with 

22 respect to health insurance coverage offered, sold, 

23 issued, renewed, in effect, or operated in the indi24 vidual market on or after January 1, 2005. 
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1 (d) COORDINATED REGULATIONS.—The Secretary of 

2 Labor and the Secretary of Health and Human Services 

3 shall ensure, through the execution of an interagency 

4 memorandum of understanding among such Secretaries, 

5 that— 

6 (1) regulations, rulings, and interpretations 

7 issued by such Secretaries relating to the same mat8 ter over which both Secretaries have responsibility 

9 under the provisions of this section (and the amend10 ments made thereby) are administered so as to have 

11 the same effect at all times; and 

12 (2) coordination of policies relating to enforcing 

13 the same requirements through such Secretaries in 

14 order to have a coordinated enforcement strategy 

15 that avoids duplication of enforcement efforts and 

16 assigns priorities in enforcement. 

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