SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Colorectal Cancer 
Screening and Detection Coverage Act of 2009’’. 
SEC. 2. COVERAGE OF COLORECTAL CANCER SCREENING. 
(a) GROUP HEALTH PLANS.— 
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.— 
(A) IN GENERAL.—Subpart 2 of part A of 
title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg–4 et seq.) is amended by 
adding at the end the following new section: 
‘‘SEC. 2708. COVERAGE OF COLORECTAL CANCER SCREEN-
ING. 
‘‘(a) REQUIREMENT.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, shall provide coverage under the plan 
or coverage, respectively, for colorectal cancer 
screening for any participant or beneficiary who is 
50 years of age or older, or is an individual who is 
at high risk for colorectal cancer (as defined in sec-
tion 1861(pp)(2) of the Social Security Act (42 
U.S.C. 1395x(pp)(2))), under terms and conditions 
that are no less favorable than the terms and condi-
tions applicable to other screening benefits otherwise 
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provided under the plan or coverage, respectively, ex-
cept that— 
‘‘(A) the amount of any coinsurance appli-
cable to such screening may not be more than 
5 percent of the payment amount for such 
screening under such plan or coverage, respec-
tively, and such coverage provided under the 
plan or coverage, respectively, may not be sub-
ject to any deductible; and 
‘‘(B) such coverage— 
‘‘(i) with respect to individuals first 
receiving benefits under such plan or cov-
erage after the applicable effective date de-
scribed in section 2(d) of the ‘Colorectal 
Cancer Screening and Detection Coverage 
Act of 2009’, may require a waiting period 
of not more than 6 months beginning on 
the first date of coverage; and 
‘‘(ii) with respect to individuals receiv-
ing benefits under such plan or coverage 
before such effective date, may not require 
a waiting period. 
‘‘(2) COLORECTAL
CANCER
SCREENING
DE-
FINED.—For purposes of this section, the term 
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‘colorectal cancer screening’ means procedures 
that— 
‘‘(A) are deemed appropriate by a physi-
cian (as defined in section 1861(r) of the Social 
Security Act (42 U.S.C. 1395x(r))) treating the 
participant or beneficiary, in consultation with 
the participant or beneficiary; 
‘‘(B) are— 
‘‘(i) described in section 1861(pp)(1) 
of the Social Security Act (42 U.S.C. 
1395x(pp)(1)) or section 410.37 of title 
42, Code of Federal Regulations; 
‘‘(ii) specified by the Secretary for the 
detection of colorectal cancer, based upon 
the recommendations of appropriate orga-
nizations with special expertise in the field 
of colorectal cancer, including the Amer-
ican Cancer Society and the American Col-
lege of Gastroenterology; or 
‘‘(iii) specified by the Secretary, based 
upon new scientific knowledge, techno-
logical advances, or other updated medical 
practices with respect to detection of 
colorectal cancer; and 
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‘‘(C) are performed at a frequency not 
greater than— 
‘‘(i)(I) subject to subclause (II), that 
described for such method in section 
1834(d) of the Social Security Act (42 
U.S.C. 1395m(d)) or section 410.37 of 
title 42, Code of Federal Regulations; or 
‘‘(II) in the case of a colorectal cancer 
screening test consisting of a screening 
colonoscopy, once every 36 months; or 
‘‘(ii) that specified by the Secretary 
for such method, if the Secretary finds, 
based upon new scientific knowledge, tech-
nological advances, or other updated med-
ical practices and consistent with the rec-
ommendations of appropriate organizations 
with special expertise in the field of 
colorectal cancer, that a different fre-
quency would not adversely affect the ef-
fectiveness of such screening. 
‘‘(b) PROTECTIONS.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage in connection with a group health plan, may 
not— 
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‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under 
the terms of the plan, solely for the purpose of 
avoiding the requirements of this section; 
‘‘(2) provide monetary payments or rebates to 
individuals to encourage such individuals to accept 
less than the minimum protections available under 
this section; 
‘‘(3) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided care to an individual participant or bene-
ficiary in accordance with this section; or 
‘‘(4) provide incentives (monetary or otherwise) 
to an attending provider to induce such provider to 
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section. 
‘‘(c) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
to require an individual who is a participant or bene-
ficiary to undergo colorectal cancer screening. 
‘‘(2) Nothing in this section shall be construed 
as preventing a group health plan or issuer from im-
posing deductibles, coinsurance, or other cost-shar-
ing in relation to colorectal cancer screening under 
the plan (or under health insurance coverage offered 
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in connection with a group health plan), except that 
such coinsurance or other cost-sharing shall not dis-
criminate on any basis related to the coverage re-
quired under this section. 
‘‘(d) NOTICE.—A group health plan under this part 
shall comply with the notice requirement under section 
715(d) of the Employee Retirement Income Security Act 
of 1974 with respect to the requirements of this section 
as if such section applied to such plan. 
‘‘(e) DISCLOSURE REQUIREMENT.— 
‘‘(1) IN GENERAL.—A group health plan, and 
health insurance issuer offering group health insur-
ance coverage shall— 
‘‘(A) provide to participants and bene-
ficiaries at the time of initial coverage under 
the plan (or the effective date of this section, in 
the case of individuals who are participants or 
beneficiaries as of such date), and at least an-
nually thereafter, the information described in 
paragraph (2); 
‘‘(B) provide to participants and bene-
ficiaries, within a reasonable period (as speci-
fied by the appropriate Secretary) before or 
after the date of significant changes in the in-
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formation described in paragraph (2), informa-
tion regarding such significant changes; and 
‘‘(C) upon request, make available to par-
ticipants and beneficiaries, the applicable au-
thority, and prospective participants and bene-
ficiaries, the information described in para-
graph (2). 
‘‘(2) INFORMATION DESCRIBED.—For purposes 
of paragraph (1), the information described in this 
paragraph, with respect to colorectal cancer screen-
ing, is the following: 
‘‘(A) BENEFITS.—Benefits offered under 
the plan or coverage, including— 
‘‘(i) covered benefits, including benefit 
limits and coverage exclusions; 
‘‘(ii) cost-sharing, such as deductibles, 
coinsurance, and copayment amounts, in-
cluding any liability for balance billing, any 
maximum limitations on out of pocket ex-
penses, and the maximum out of pocket 
costs for services that are provided by non-
participating providers or that are fur-
nished without meeting the applicable utili-
zation review requirements; 
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‘‘(iii) the extent to which benefits may 
be obtained from nonparticipating pro-
viders; and 
‘‘(iv) the extent to which a partici-
pant, beneficiary, or enrollee may select 
from among participating providers and 
the types of providers participating in the 
plan or issuer network. 
‘‘(B) ACCESS.—A description of the fol-
lowing: 
‘‘(i) The number, mix, and distribu-
tion of providers under the plan or cov-
erage. 
‘‘(ii) Out-of-network coverage (if any) 
provided by the plan or coverage. 
‘‘(iii) Any point-of-service option (in-
cluding any supplemental premium or cost- 
sharing for such option). 
‘‘(iv) The procedures for participants, 
beneficiaries, and enrollees to select, ac-
cess, and change participating primary and 
specialty providers. 
‘‘(v) The rights and procedures for 
obtaining referrals (including standing re-
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ferrals) to participating and nonpartici-
pating providers. 
‘‘(vi) The name, address, and tele-
phone number of participating health care 
providers and an indication of whether 
each such provider is available to accept 
new patients. 
‘‘(vii) How the plan or issuer address-
es the needs of participants, beneficiaries, 
and enrollees and others who do not speak 
English or who have other special commu-
nications needs in accessing providers 
under the plan or coverage, including the 
provision of information under this para-
graph.’’. 
(B) Section 2723(c) of such Act (42 
U.S.C. 300gg–23(c)) is amended by striking 
‘‘section 2704’’ and inserting ‘‘sections 2704 
and 2708’’. 
(2) ERISA AMENDMENTS.— 
(A) Subpart B of part 7 of subtitle B of 
title I of the Employee Retirement Income Se-
curity Act of 1974 is amended by adding at the 
end the following new section: 
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‘‘SEC. 715. COVERAGE OF COLORECTAL CANCER SCREEN-
ING. 
‘‘(a) REQUIREMENT.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, shall provide coverage under the plan 
or coverage, respectively, for colorectal cancer 
screening for any participant or beneficiary who is 
50 years of age or older, or is an individual who is 
at high risk for colorectal cancer (as defined in sec-
tion 1861(pp)(2) of the Social Security Act (42 
U.S.C. 1395x(pp)(2)), under terms and conditions 
that are no less favorable than the terms and condi-
tions applicable to other screening benefits otherwise 
provided under the plan or coverage, respectively, ex-
cept that— 
‘‘(A) the amount of any coinsurance appli-
cable to such screening may not be more than 
5 percent of the payment amount for such 
screening under such plan or coverage, respec-
tively, and such coverage provided under the 
plan or coverage, respectively, may not be sub-
ject to any deductible; and 
‘‘(B) such coverage— 
‘‘(i) with respect to individuals first 
receiving benefits under such plan or cov-
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erage after the applicable effective date de-
scribed in section 2(d) of the ‘Colorectal 
Cancer Screening and Detection Coverage 
Act of 2009’, may require a waiting period 
of not more than 6 months beginning on 
the first date of coverage; and 
‘‘(ii) with respect to individuals receiv-
ing benefits under such plan or coverage 
before such effective date, may not require 
a waiting period. 
‘‘(2) COLORECTAL
CANCER
SCREENING
DE-
FINED.—For purposes of this section, the term 
‘colorectal cancer screening’ means procedures 
that— 
‘‘(A) are deemed appropriate by a physi-
cian (as defined in section 1861(r) of the Social 
Security Act (42 U.S.C. 1395x(r))) treating the 
participant or beneficiary, in consultation with 
the participant or beneficiary; 
‘‘(B) are— 
‘‘(i) described in section 1861(pp)(1) 
of the Social Security Act (42 U.S.C. 
1395x(pp)(1)) or section 410.37 of title 
42, Code of Federal Regulations; 
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‘‘(ii) specified by the Secretary for the 
detection of colorectal cancer, based upon 
the recommendations of appropriate orga-
nizations with special expertise in the field 
of colorectal cancer, including the Amer-
ican Cancer Society and the American Col-
lege of Gastroenterology; or 
‘‘(iii) specified by the Secretary, based 
upon new scientific knowledge, techno-
logical advances, or other updated medical 
practices with respect to detection of 
colorectal cancer; and 
‘‘(C) are performed at a frequency not 
greater than— 
‘‘(i)(I) subject to subclause (II), that 
described for such method in section 
1834(d) of the Social Security Act (42 
U.S.C. 1395m(d)) or section 410.37 of 
title 42, Code of Federal Regulations; or 
‘‘(II) in the case of a colorectal cancer 
screening test consisting of a screening 
colonoscopy, once every 36 months; or 
‘‘(ii) that specified by the Secretary 
for such method, if the Secretary finds, 
based upon new scientific knowledge, tech-
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nological advances, or other updated med-
ical practices and consistent with the rec-
ommendations of appropriate organizations 
with special expertise in the field of 
colorectal cancer, that a different fre-
quency would not adversely affect the ef-
fectiveness of such screening. 
‘‘(b) PROTECTIONS.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage in connection with a group health plan, may 
not— 
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under 
the terms of the plan, solely for the purpose of 
avoiding the requirements of this section; 
‘‘(2) provide monetary payments or rebates to 
individuals to encourage such individuals to accept 
less than the minimum protections available under 
this section; 
‘‘(3) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided care to an individual participant or bene-
ficiary in accordance with this section; or 
‘‘(4) provide incentives (monetary or otherwise) 
to an attending provider to induce such provider to 
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provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section. 
‘‘(c) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
to require an individual who is a participant or bene-
ficiary to undergo colorectal cancer screening. 
‘‘(2) Nothing in this section shall be construed 
as preventing a group health plan or issuer from im-
posing deductibles, coinsurance, or other cost-shar-
ing in relation to colorectal cancer screening under 
the plan (or under health insurance coverage offered 
in connection with a group health plan), except that 
such coinsurance or other cost-sharing shall not dis-
criminate on any basis related to the coverage re-
quired under this section. 
‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The 
imposition of the requirements of this section shall be 
treated as a material modification in the terms of the plan 
described in section 102(a), for purposes of assuring no-
tice of such requirements under the plan; except that the 
summary description required to be provided under the 
fourth sentence of section 104(b)(1) with respect to such 
modification shall be provided by not later than 60 days 
after the first day of the first plan year in which such 
requirements apply. 
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‘‘(e) DISCLOSURE REQUIREMENT.— 
‘‘(1) IN GENERAL.—A group health plan, and 
health insurance issuer offering group health insur-
ance coverage shall— 
‘‘(A) provide to participants and bene-
ficiaries at the time of initial coverage under 
the plan (or the effective date of this section, in 
the case of individuals who are participants or 
beneficiaries as of such date), and at least an-
nually thereafter, the information described in 
paragraph (2); 
‘‘(B) provide to participants and bene-
ficiaries, within a reasonable period (as speci-
fied by the appropriate Secretary) before or 
after the date of significant changes in the in-
formation described in paragraph (2), informa-
tion regarding such significant changes; and 
‘‘(C) upon request, make available to par-
ticipants and beneficiaries, the applicable au-
thority, and prospective participants and bene-
ficiaries, the information described in para-
graph (2). 
‘‘(2) INFORMATION DESCRIBED.—For purposes 
of paragraph (1), the information described in this 
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paragraph, with respect to colorectal cancer screen-
ing, is the following: 
‘‘(A) BENEFITS.—Benefits offered under 
the plan or coverage, including— 
‘‘(i) covered benefits, including benefit 
limits and coverage exclusions; 
‘‘(ii) cost-sharing, such as deductibles, 
coinsurance, and copayment amounts, in-
cluding any liability for balance billing, any 
maximum limitations on out of pocket ex-
penses, and the maximum out of pocket 
costs for services that are provided by non-
participating providers or that are fur-
nished without meeting the applicable utili-
zation review requirements; 
‘‘(iii) the extent to which benefits may 
be obtained from nonparticipating pro-
viders; and 
‘‘(iv) the extent to which a partici-
pant, beneficiary, or enrollee may select 
from among participating providers and 
the types of providers participating in the 
plan or issuer network. 
‘‘(B) ACCESS.—A description of the fol-
lowing: 
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‘‘(i) The number, mix, and distribu-
tion of providers under the plan or cov-
erage. 
‘‘(ii) Out-of-network coverage (if any) 
provided by the plan or coverage. 
‘‘(iii) Any point-of-service option (in-
cluding any supplemental premium or cost- 
sharing for such option). 
‘‘(iv) The procedures for participants, 
beneficiaries, and enrollees to select, ac-
cess, and change participating primary and 
specialty providers. 
‘‘(v) The rights and procedures for 
obtaining referrals (including standing re-
ferrals) to participating and nonpartici-
pating providers. 
‘‘(vi) The name, address, and tele-
phone number of participating health care 
providers and an indication of whether 
each such provider is available to accept 
new patients. 
‘‘(vii) How the plan or issuer address-
es the needs of participants, beneficiaries, 
and enrollees and others who do not speak 
English or who have other special commu-
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nications needs in accessing providers 
under the plan or coverage, including the 
provision of information under this para-
graph.’’. 
(B) Section 731(c) of such Act (29 U.S.C. 
1191(c)) is amended by striking ‘‘section 711’’ 
and inserting ‘‘sections 711 and 715’’. 
(C) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ 
and inserting ‘‘sections 711 and 715’’. 
(D) The table of contents in section 1 of 
such Act is amended by inserting after the item 
relating to section 714 the following new item: 
‘‘Sec. 715. Coverage of colorectal cancer screening.’’. 
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.— 
(A) Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended by 
inserting after section 9813 the following new 
section: 
‘‘SEC. 9814. COVERAGE OF COLORECTAL CANCER SCREEN-
ING. 
‘‘(a) REQUIREMENT.— 
‘‘(1) IN GENERAL.—A group health plan shall 
provide coverage under the plan for colorectal cancer 
screening for any participant or beneficiary who is 
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