20250AB__053698AMD INTRODUCED 2025-02-11 AMENDED_ASSEMBLY 2025-03-24 2025 AB AMD Introduced by Assembly Member Patterson LEAD_AUTHOR ASSEMBLY Patterson

An act to amend

Section 1367.668 of the Health and Safety Code, and to amend

Section 10123.207 of the Insurance Code, relating to health care coverage. health care coverage Health care coverage: colorectal cancer screening. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law provides for the regulation of health insurers by the Department of Insurance.

Existing law generally requires a health care service plan contract or a health insurance policy issued, amended, or renewed on or after January 1, 2022, to provide coverage without cost sharing for a colorectal cancer screening test assigned either a grade of A or a grade of B by the United States Preventive Services Task Force and for a required colonoscopy for a positive result on a test with those grades.

This bill would make technical, nonsubstantive changes to those provisions. </xhtml:p>"?> This bill would additionally require that coverage if the screening test is approved by the United States Food and Drug Administration and either meets requirements for coverage established by the federal Centers for Medicare and Medicaid Services, as specified, or is included in the most recently published guidelines from the American Cancer Society. MAJORITY NO YES NO NO NO NO NO NO NO NO The people of the State of California do enact as follows:

SECTION

Section 1367.668 of the Health and Safety Code is amended to read: 1367.668. (

a) Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2022, shall provide coverage without cost sharing for a colorectal cancer screening test that meets any of the following conditions:

(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.

(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.

(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. (

b) The required colonoscopy for a positive result on a test or procedure, other than a colonoscopy, that is a colorectal cancer screening examination or laboratory test that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (

a) shall also be provided without cost sharing. (b)</xhtml:p>"?> (

c) This

section does not preclude a health care service plan that has coverage for out-of-network benefits from imposing cost-sharing requirements for the items or services described in this

section that are delivered by an out-of-network provider.

SEC.

Section 10123.207 of the Insurance Code is amended to read: 10123.207. (

a) Every health insurance policy, except a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2022, shall provide coverage without cost sharing for a colorectal cancer screening test that meets any of the following conditions:

(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.

(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.

(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. (

b) The required colonoscopy for a positive result on a test or procedure, other than a colonoscopy, that is a colorectal cancer screening examination or laboratory test that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (

a) shall also be provided without cost sharing. (b)</xhtml:p>"?> (

c) This

section does not preclude a health insurer that has a network of providers from imposing cost-sharing requirements for the items or services described in this

section that are delivered by an out-of-network provider.