I 
110TH CONGRESS 
1ST SESSION H. R. 3060 
To amend the Public Health Service Act, the Employee Retirement Income 
Security Act of 1974, the Internal Revenue Code of 1986, and title 
5, United States Code, to require that group and individual health 
insurance coverage and group health plans and Federal employees health 
benefit plans provide coverage of colorectal cancer screening. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 17, 2007 
Mr. BOREN (for himself and Mr. HALL of Texas) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committees on Ways and Means, Education and Labor, 
and Oversight and Government Reform, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Public Health Service Act, the Employee Re-
tirement Income Security Act of 1974, the Internal Rev-
enue Code of 1986, and title 5, United States Code, 
to require that group and individual health insurance 
coverage and group health plans and Federal employees 
health benefit plans provide coverage of colorectal cancer 
screening. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Colorectal Cancer 
Screening and Detection Coverage Act of 2007’’. 
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. 2707. 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. 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
‘‘(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; 
‘‘(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 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
practices with respect to detection of 
colorectal cancer; and 
‘‘(C) are performed at a frequency not 
greater than that— 
‘‘(i) described for such method in sec-
tion 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) specified by the Secretary for 
such method, if the Secretary finds, based 
upon new scientific knowledge, techno-
logical advances, or other updated medical 
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 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
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 
in connection with a group health plan), except that 
such coinsurance or other cost-sharing shall not dis-
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
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 
714(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-
formation described in paragraph (2), informa-
tion regarding such significant changes; and 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
‘‘(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; 
‘‘(iii) the extent to which benefits may 
be obtained from nonparticipating pro-
viders; and 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
‘‘(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-
ferrals) to participating and nonpartici-
pating providers. 
‘‘(vi) The name, address, and tele-
phone number of participating health care 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
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 2707’’. 
(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: 
‘‘SEC. 714. COVERAGE OF COLORECTAL CANCER SCREEN-
ING. 
‘‘(a) REQUIREMENT.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
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. 
‘‘(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; 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
‘‘(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 that— 
‘‘(i) described for such method in sec-
tion 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) specified by the Secretary for 
such method, if the Secretary finds, based 
upon new scientific knowledge, techno-
logical advances, or other updated medical 
practices and consistent with the rec-
ommendations of appropriate organizations 
with special expertise in the field of 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
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 
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section. 
‘‘(c) RULES OF CONSTRUCTION.— 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
‘‘(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. 
‘‘(e) DISCLOSURE REQUIREMENT.— 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
‘‘(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 
paragraph, with respect to colorectal cancer screen-
ing, is the following: 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
‘‘(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: 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
‘‘(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-
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
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 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 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 9812 the following new 
section: 
‘‘SEC. 9813. 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 
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
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. 
‘‘(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; 
‘‘(ii) specified by the Secretary of 
Health and Human Services for the detec-
tion of colorectal cancer, based upon the 
recommendations of appropriate organiza-
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS
tions with special expertise in the field of 
colorectal cancer, including the American 
Cancer Society and the American College 
of Gastroenterology; or 
‘‘(iii) specified by the Secretary of 
Health and Human Services, based upon 
new scientific knowledge, technological ad-
vances, or other updated medical practices 
with respect to detection of colorectal can-
cer; and 
‘‘(C) are performed at a frequency not 
greater than that— 
‘‘(i) described for such method in sec-
tion 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) specified by the Secretary of 
Health and Human Services for such 
method, if such Secretary finds, based 
upon new scientific knowledge, techno-
logical advances, or other updated medical 
practices and consistent with the rec-
ommendations of appropriate organizations 
with special expertise in the field of 
colorectal cancer, that a different fre-
VerDate Aug 31 2005 
05:15 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H3060.IH
H3060
ccoleman on PROD1PC69 with BILLS