[atlas:bill]

AN ACT Relating to insurance coverage for colorectal cancer early detection; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; and adding a new section to chapter 48.46 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. A new section is added to chapter 48.21 RCW to read as follows:

(1) All group disability insurance contracts and blanket disability insurance contracts, issued or renewed on or after the effective date of this section, must provide benefits or coverage for colorectal cancer examinations and laboratory tests specified in current American cancer society guidelines for colorectal cancer screening of asymptomatic individuals. Coverage or benefits must be provided for all colorectal screening examinations and tests that are administered at a frequency identified in the American cancer society guidelines for colorectal cancer.

(2) Benefits under this section must be provided to a covered individual who is:

(a) At least fifty years old; or

(b) Less than fifty years old and at high risk for colorectal cancer according to current colorectal cancer screening guidelines of the American cancer society.

(3) To encourage colorectal cancer screenings, patients and health care providers must not be required to meet burdensome criteria or overcome significant obstacles to secure such coverage. An individual may not be required to pay an additional deductible or coinsurance for testing that is greater than an annual deductible or coinsurance established for similar benefits. If the contract does not cover a similar benefit, a deductible or coinsurance may not be set at a level that materially diminishes the value of the colorectal cancer benefit required. Reimbursement to health care providers for colorectal cancer screenings provided under this section must be equal to or greater than reimbursement to health care providers provided under Title XVII of the social security act (medicare).

(4) A health insurance issuer is not required under this section to provide for a referral to a nonparticipating health care provider, unless the issuer does not have an appropriate health care provider that is available and accessible to administer the screening exam and that is a participating health care provider with respect to such treatment.

(5) If a health insurance issuer refers an individual to a nonparticipating health care provider pursuant to this section, services provided pursuant to the approved screening exam or resulting treatment, if any, must be provided at no additional cost to the individual beyond what the individual would otherwise pay for services received by such a participating health care provider.

NEW SECTION. Sec. 2. A new section is added to chapter 48.44 RCW to read as follows:

(1) All health benefit plans offered by health care service contractors, issued or renewed on or after the effective date of this section, must provide benefits or coverage for colorectal cancer examinations and laboratory tests specified in current American cancer society guidelines for colorectal cancer screening of asymptomatic individuals. Coverage or benefits must be provided for all colorectal screening examinations and tests that are administered at a frequency identified in the American cancer society guidelines for colorectal cancer.

(2) Benefits under this section must be provided to a covered individual who is:

(a) At least fifty years old; or

(b) Less than fifty years old and at high risk for colorectal cancer according to current colorectal cancer screening guidelines of the American cancer society.

(3) To encourage colorectal cancer screenings, patients and health care providers must not be required to meet burdensome criteria or overcome significant obstacles to secure such coverage. An individual may not be required to pay an additional deductible or coinsurance for testing that is greater than an annual deductible or coinsurance established for similar benefits. If the group contract or individual contract does not cover a similar benefit, a deductible or coinsurance may not be set at a level that materially diminishes the value of the colorectal cancer benefit required. Reimbursement to providers for colorectal cancer screenings provided under this section must be equal to or greater than reimbursement to health care providers provided under Title XVII of the social security act (medicare).

(4) A carrier is not required under this section to provide for a referral to a nonparticipating health care provider, unless the carrier does not have an appropriate health care provider that is available and accessible to administer the screening exam and that is a participating health care provider with respect to such treatment.

(5) If a carrier refers an individual to a nonparticipating health care provider pursuant to this section, services provided pursuant to the approved screening exam or resulting treatment, if any, must be provided at no additional cost to the individual beyond what the individual would otherwise pay for services received by such a participating health care provider.

NEW SECTION. Sec. 3. A new section is added to chapter 48.46 RCW to read as follows:

(1) All health benefit plans offered by health maintenance organizations, issued on or after the effective date of this section, must provide benefits or coverage for colorectal cancer examinations and laboratory tests specified in current American cancer society guidelines for colorectal cancer screening of asymptomatic individuals. Coverage or benefits must be provided for all colorectal screening examinations and tests that are administered at a frequency identified in the American cancer society guidelines for colorectal cancer.

(2) Benefits under this section must be provided to a covered individual who is:

(a) At least fifty years old; or

(b) Less than fifty years old and at high risk for colorectal cancer according to current colorectal cancer screening guidelines of the American cancer society.

(3) To encourage colorectal cancer screenings, consumers and health maintenance organizations must not be required to meet burdensome criteria or overcome significant obstacles to secure such coverage. A consumer may not be required to pay an additional deductible or coinsurance for testing that is greater than an annual deductible or coinsurance established for similar benefits. If the health maintenance agreement does not cover a similar benefit, a deductible or coinsurance may not be set at a level that materially diminishes the value of the colorectal cancer benefit required. Reimbursement to health professionals for colorectal cancer screenings provided under this section must be equal to or greater than reimbursement to health care providers provided under Title XVII of the social security act (medicare).

(4) A health maintenance organization is not required under this section to provide for a referral to a nonparticipating health care provider, unless the health maintenance organization does not have an appropriate health care provider that is available and accessible to administer the screening exam and that is a participating health care provider with respect to such treatment.

(5) If a health maintenance organization refers a consumer to a nonparticipating health care provider pursuant to this section, services provided pursuant to the approved screening exam or resulting treatment, if any, must be provided at no additional cost to the consumer beyond what the consumer would otherwise pay for services received by a health maintenance organization.