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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Eliminate Colorectal Cancer Act of 1999’’.
(b) FINDINGS.—The Congress finds the following:
(1) Colorectal cancer is the second leading
cause of cancer deaths in the United States for men
and women combined.
(2) It is estimated that in 1999, 129,400 new
cases of colorectal cancer will be diagnosed in men
and women in the United States.
(3) Colorectal cancer is expected to kill 56,600
individuals in the United States in 1999.
(4) Research has shown that a high-fiber, low-
fat diet can significantly reduce the risk of devel-
oping colorectal cancer.
(5) The adoption of a healthy diet at a young
age can significantly reduce the risk of developing
colorectal cancer.
(6) Appropriate screenings and regular tests
can save large numbers of lives by leading to earlier
identification of colorectal cancer.
(7) The Centers for Disease Control and Pre-
vention, the Health Care Financing Administration,
and the National Cancer Institute have initiated the
Screen for Life Campaign targeted to individuals
age 50 and older to spread the message of the im-
portance of colorectal cancer screening tests.
(8) Education helps to inform the public of
symptoms for the early detection of colorectal cancer
and methods of prevention.
SEC. 2. COVERAGE FOR COLORECTAL CANCER SCREENING.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of
the Public Health Service Act is amended by adding
at the end the following new section:
‘‘SEC. 2707. COVERAGE FOR COLORECTAL CANCER SCREEN-
ING.
‘‘(a) COVERAGE FOR COLORECTAL CANCER SCREEN-
ING.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, shall provide coverage for colorectal
cancer screening at regular intervals to—
‘‘(A) any participant or beneficiary over
the age of 50; and
‘‘(B) any participant or beneficiary under
the age of 50 who is at a high risk for
colorectal cancer, or who may have symptoms
or circumstances that indicate a need for
colorectal cancer screening.
‘‘(2) DEFINITION OF HIGH RISK.—For purposes
of subsection (a)(1)(B), the term ‘high risk for
colorectal cancer’ has the meaning given such term
in section 1861(pp)(2) of the Social Security Act (42
U.S.C. 1395x(pp)(2)).
‘‘(3) METHOD
OF
SCREENING.—The group
health plan or health insurance issuer shall cover the
method and frequency of colorectal cancer screening
deemed appropriate by a health care provider treat-
ing such participant or beneficiary, in consultation
with the participant or beneficiary. Such coverage
shall include the procedures in section 1861(pp)(1)
of the Social Security Act (42 U.S.C. 1395x(pp)(1))
and section 4104(a)(2) of the Balanced Budget Act
of 1997.
‘‘(b) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
714(b) 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.
‘‘(c) NON-PREEMPTION
OF
MORE
PROTECTIVE
STATE LAW WITH RESPECT
TO HEALTH INSURANCE
ISSUERS.—This section shall not be construed to super-
sede any provision of State law which establishes, imple-
ments, or continues in effect any standard or requirement
solely relating to health insurance issuers in connection
with group health insurance coverage that provides great-
er protections to participants and beneficiaries than the
protections provided under this section.’’.
(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 2707’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 is amended by
adding at the end the following new section:
‘‘SEC. 714. COVERAGE FOR COLORECTAL CANCER SCREEN-
ING.
‘‘(a) COVERAGE FOR COLORECTAL CANCER SCREEN-
ING.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, shall provide coverage for colorectal
cancer screening at regular intervals to—
‘‘(A) any participant or beneficiary over
the age of 50; and
‘‘(B) any participant or beneficiary under
the age of 50 who is at a high risk for
colorectal cancer, or who may have symptoms
or circumstances that indicate a need for
colorectal cancer screening.
‘‘(2) DEFINITION OF HIGH RISK.—For purposes
of subsection (a)(1)(B), the term ‘high risk for
colorectal cancer’ has the meaning given such term
in section 1861(pp)(2) of the Social Security Act (42
U.S.C. 1395x(pp)(2)).
‘‘(3) METHOD
OF
SCREENING.—The group
health plan or health insurance issuer shall cover the
method and frequency of colorectal cancer screening
deemed appropriate by a health care provider treat-
ing such participant or beneficiary, in consultation
with the participant or beneficiary. Such coverage
shall include the procedures in section 1861(pp)(1)
of the Social Security Act (42 U.S.C. 1395x(pp)(1))
and section 4104(a)(2) of the Balanced Budget Act
of 1997.
‘‘(b) 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
third to last 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.’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 713 the following new item:
‘‘Sec. 714. Coverage for colorectal cancer screening.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act is amend-
ed by inserting after section 2752 the following new sec-
tion:
‘‘SEC. 2753. COVERAGE FOR COLORECTAL CANCER SCREEN-
ING.
‘‘(a) IN
GENERAL.—The provisions of section
2707(a) shall apply to health insurance coverage offered
by a health insurance issuer in the individual market in
the same manner as it applies to health insurance coverage
offered by a health insurance issuer in connection with a
group health plan in the small or large group market.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 714(b) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements referred to
in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.’’.
(c) EFFECTIVE DATES.—(1)(A) Subject to subpara-
graph (B), the amendments made by subsection (a) shall
apply with respect to group health plans for plan years
beginning on or after January 1, 2001.
(B) In the case of a group health plan maintained
pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employ-
ers ratified before the date of enactment of this Act, the
amendments made by subsection (a) shall not apply to
plan years beginning before the later of—
(i) the date on which the last collective bar-
gaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act),
or
(ii) January 1, 2001.
For purposes of clause (i), any plan amendment made pur-
suant to a collective bargaining agreement relating to the
plan which amends the plan solely to conform to any re-
quirement added by subsection (a) shall not be treated as
a termination of such collective bargaining agreement.
(2) The amendments made by subsection (b) shall
apply with respect to health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the indi-
vidual market on or after January 1, 2001.
(3) The amendment made by subsection (c) shall
apply to contracts for contract periods beginning on or
after January 1, 2001.
(d) COORDINATED REGULATIONS.—The Secretary of
Labor and the Secretary of Health and Human Services
shall ensure, through the execution of an interagency
memorandum of understanding among such Secretaries,
that—
(1) regulations, rulings, and interpretations
issued by such Secretaries relating to the same mat-
ter over which both Secretaries have responsibility
under the provisions of this section (and the amend-
ments made thereby) are administered so as to have
the same effect at all times; and
(2) coordination of policies relating to enforcing
the same requirements through such Secretaries in
order to have a coordinated enforcement strategy
that avoids duplication of enforcement efforts and
assigns priorities in enforcement.
SEC. 3. SENSE OF THE CONGRESS.
It is the sense of the Congress that—
(1) all Americans should be educated about the
risks, prevention, screening, and treatment of
colorectal cancer;