PSA Screening for HIM Act
Bill: H.R.1176 | Sponsor: Rep. Rush, Bobby L. (D-IL)
Policy area: Health

Summary:
Prostate-Specific Antigen Screening for High-risk Insured Men Act or the PSA Screening for HIM Act  This bill requires private health insurance plans to cover preventive prostate cancer screenings that are not already covered under the recommendations of the U.S. Preventive Services Task Force for men with a family history of prostate cancer, without imposing any cost-sharing requirement.

To amend title XXVII of the Public Health Service Act to require group 
health plans and health insurance issuers offering group or individual 
   health insurance coverage to provide coverage for prostate cancer 
screenings without the imposition of cost-sharing requirements, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Prostate-Specific Antigen Screening 
for High-risk Insured Men Act'' or the ``PSA Screening for HIM Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Prostate cancer is the second leading cause of cancer 
        death in men in the United States with 1 in 41 men dying from 
        prostate cancer and more than 31,600 men estimated to die from 
        prostate cancer in 2019.
            (2) Prostate cancer is the second most commonly diagnosed 
        cancer in the Nation with 1 in 9 men being diagnosed in their 
        lifetimes, 3.1 million men in the United States living with a 
        diagnosis, and over 174,000 men estimated to be diagnosed in 
        2019.
            (3) The survival rate for prostate cancer diagnosed in 
        early stage is near 100 percent but prostate cancer diagnosed 
        in late stage has only a 30-percent survival rate.
            (4) There are few, if any, symptoms of prostate cancer 
        before it reaches late stage.
            (5) African-American men have a disproportionately higher 
        rate of prostate cancer and are 70 percent more likely to be 
        diagnosed with prostate cancer than White men, with 1 in 6 
        African-American men developing prostate cancer in their 
        lifetimes.
            (6) African-American men are 2.3 times more likely to die 
        from prostate cancer than White men.
            (7) Men with a father or brother with prostate cancer are 
        more than twice as likely to be diagnosed with prostate cancer 
        than men without a family history.
            (8) The common clinical definition for men at high-risk of 
        prostate cancer includes African-American men and men with a 
        family history.
            (9) Most of the major cancer and urological societies 
        recommend beginning screening discussions earlier for African-
        American men and those with a family history of prostate 
        cancer.
            (10) The United States Preventive Services Task Force has 
        encouraged research on screening African-American men, 
        including whether to screen African-American men at younger 
        ages, and has identified this research as a high-priority 
        cancer research gap.
            (11) Barriers to screening should be minimized for high-
        risk men in order to catch asymptomatic prostate cancer before 
        it metastasizes and the survival rate is dramatically reduced.
            (12) The cost of treating metastatic prostate cancer in the 
        United States health care system is hundreds of millions of 
        dollars more annually than the cost of treating localized, 
        early-stage cancer.

SEC. 3. REQUIREMENT FOR GROUP HEALTH PLANS AND HEALTH INSURANCE ISSUERS 
              OFFERING GROUP OR INDIVIDUAL HEALTH INSURANCE COVERAGE TO 
              PROVIDE COVERAGE FOR PROSTATE CANCER SCREENINGS WITHOUT 
              IMPOSITION OF COST-SHARING REQUIREMENTS.

    (a) In General.--Subsection (a) of section 2713 of the Public 
Health Service Act (42 U.S.C. 300gg-13) is amended to read as follows:
    ``(a) Coverage of Preventive Health Services.--
            ``(1) In general.--A group health plan and a health 
        insurance issuer offering group or individual health insurance 
        coverage shall, at a minimum, provide coverage for and shall 
        not impose any cost-sharing requirements for--
                    ``(A) evidence-based items or services that have in 
                effect a rating of `A' or `B' in the current 
                recommendations of the United States Preventive 
                Services Task Force;
                    ``(B) immunizations that have in effect a 
                recommendation from the Advisory Committee on 
                Immunization Practices of the Centers for Disease 
                Control and Prevention with respect to the individual 
                involved;
                    ``(C) with respect to infants, children, and 
                adolescents, evidence-informed preventive care and 
                screenings provided for in the comprehensive guidelines 
                supported by the Health Resources and Services 
                Administration;
                    ``(D) with respect to women, such additional 
                preventive care and screenings not described in 
                subparagraph (A) as provided for in comprehensive 
                guidelines supported by the Health Resources and 
                Services Administration for purposes of this 
                subparagraph; and
                    ``(E) with respect to men who are at high risk of 
                developing prostate cancer (including African-American 
                men and men with a family history of prostate cancer 
                (as defined in paragraph (2))), such additional 
                preventive care and screenings not described in 
                subparagraph (A) for prostate cancer.
            ``(2) Men with a family history of prostate cancer 
        defined.--For purposes of paragraph (1)(E), the term `men with 
        a family history of prostate cancer' means men who have a 
        first-degree relative--
                    ``(A) who was diagnosed with metastatic prostate 
                cancer;
                    ``(B) who developed metastatic prostate cancer; or
                    ``(C) whose death was a result of prostate cancer.
            ``(3) Clarification regarding breast cancer screening, 
        mammography, and prevention recommendations.--For the purposes 
        of this Act, and for the purposes of any other provision of 
        law, the current recommendations of the United States 
        Preventive Service Task Force regarding breast cancer 
        screening, mammography, and prevention shall be considered the 
        most current other than those issued in or around November 
        2009.
            ``(4) Rule of construction.--Nothing in this subsection 
        shall be construed to prohibit a plan or issuer from providing 
        coverage for services in addition to those recommended by the 
        United States Preventive Services Task Force or to deny 
        coverage for services that are not recommended by such Task 
        Force.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to plan years beginning on or after January 1, 2022.
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