FirstHB1301_S_HHS.001 RegularNOT SessionAMENDED Seventy-secondSENATE GeneralCOMMITTEE AssemblyOF STATEREFERENCE OFREPORT COLORADO_______________________________ REENGROSSEDApril This25, Version2019 IncludesChair Allof AmendmentsCommittee AdoptedDate inCommittee theon HouseHealth of& IntroductionHuman LLSServices NO..

19-1039.02After Kristenconsideration Forrestalon x4217the HOUSEmerits, BILLthe 19-1301Committee HOUSErecommends SPONSORSHIPthe MichaelsonJenetandBuckner,following: Buentello,Caraveo,Cutter,Duran,Galindo,Gonzales- Gutierrez, Hooton, Kipp, Sirota, Arndt, Becker, Benavidez, Bird, Coleman, Esgar, Exum, Froelich, Gray, Hansen, Herod, Jackson, Kennedy, Kraft-Tharp, Landgraf, Lontine, McCluskie, McLachlan, Melton, Mullica, Roberts, Singer, Snyder, Tipper, Titone, Valdez A., Valdez D.

SENATEHB19-1301 SPONSORSHIPbe Williamsreferred A.,to Todd,the StoryCommittee Houseof Committeesthe SenateWhole Committeeswith Healthfavorable &recommendation Insuranceand Awith BILLa FORrecommendation ANthat ACTit Cbe ONCERNINGplaced HEALTHon INSURANCEthe COVERAGEconsent FORcalendar. BREAST IMAGING .

Bill** Summary*** (Note:** *** ** *HB1301_S_HHS.001*

This summary applies to this bill as introduced and does notreflectanyamendmentsthatmaybesubsequentlyadopted.Ifthisbill passes third reading in the house of introduction, a bill summary that e applies to the reengrossed version of this bill will be available at n m 1 http://leg.colorado.gov.) E n 2 U U 6 Current law requires health care coverage for one breast cancer O i i H a p screeningstudywithmammographyperyear.Thebillrequireshealthcare R A coverage for breast cancer screening studies and subsequent breast r imaging using the noninvasive imaging modality appropriate for each individual, as determined by the individual's health care provider, and within the appropriate use guidelines as determined by the American i College of Radiology.

a 1 E e 2 U d 2 O 2 i Shading denotes HOUSE amendment.

Double underlining denotes SENATE amendment.

H d p Capital letters or bold & italic numbers indicate new material to be added to existing statude.

Dashes through the words indicate deletions from existing statute.

e A Be it enacted by the General Assembly of the State of Colorado:

SECTION1.

Legislativedeclaration.(1) Thegeneralassembly hereby finds and declares that:

(a) Colorado recognizes cancer as a public health burden that affects families, businesses, and communities throughout the state, with one in two men and two in five women diagnosed with the disease at some point in their lifetimes;

(b) The American Cancer Society estimates that in 2019, twenty-sixthousandeighthundredColoradanswillbediagnosedwiththe diseaseandeight thousand one hundredtwentyColoradanswilldiefrom the disease;

(c) The agency for health care research and qualityof the United States department of health and human services estimates that direct medical costs for cancer in the United States in 2011 were eighty-eight billion seven hundred million dollars;

(d) Nationalresearchindicatesthat,whenthediseaseisdiagnosed atlaterstages,cancertreatmentbecomesmorecostly,invasive,andlikely tocontributetoworkplaceabsenteeismattributabletosideeffectsofmore intensive treatment protocols and the time necessary to obtain care;

(e) While cancer is not wholly preventable, when it is detected early, the likelihood of survival increases and expenses incurred by individuals, families, and the health care system are reduced;

(f) Advances in medical and scientific research have:

(I) Led to evidenced-based strategies to prevent some cancers, reducing the burden of the disease;

and (II) Diversified and increased the screening modalities that are -2- 1301 available to identify each person's unique risk of cancer and corresponding recommended surveillance to detect the disease at its earliest stages;

(g) Current law requires health insurance plans to provide coverage for cancer screening to promote early detection of the disease;

and (h) Coloradans purchasing health insurance plans in this state should have the peace of mind of knowing that their policies include coverage for the most recent medical and scientific advances in cancer screeningproceduresthathave been showntoincreaseearlydetectionof cancer.

SECTION 2.

In Colorado Revised Statutes, 10-16-104, repeal (18)(b)(III);

and add (18)(b.5) and (18)(c)(III.5) as follows:

10-16-104.

Mandatory coverage provisions - definitions - rules.

(18) Preventive health care services.

(b) The coverage required by this subsection (18) must include preventive health care services for thefollowing,inaccordancewiththeAorBrecommendationsofthetask force for the particular preventive health care service:

(III) (A) One breast cancer screening with mammography per year, covering the actual charge for the screening with mammography.

(B) (Deleted by amendment, L.

2013.) (C) Benefits for preventive mammography screenings are determinedonacalendaryearoracontractyearbasis,whichfactmustbe specified in the policy or contract.

The preventive and diagnostic coveragesprovidedpursuanttothissubparagraph(III)donotdiminishor limit diagnostic benefits otherwise allowable under a policy or contract.

If the covered person receives more than one screening in a given -3- 1301 calendar year or contract year, the other benefit provisions in the policy or contract apply with respect to the additional screenings.

(D) Notwithstanding the A or B recommendations of the task force, a policy or contract subject to this subsection (18) must cover an annual breast cancer screening with mammography for all individuals possessing at least one risk factor, including a family history of breast cancer, being forty years of age or older, or a genetic predisposition to breast cancer.

(b.5)(I) TCOVERAGEREQUIREDBYTHISSUBSECTION (18)MUST INCLUDE A PREVENTIVE BREAST CANCER SCREENING STUDY THAT IS WITHINAPPROPRIATEUSEGUIDELINESASDETERMINEDBYTHE AMERICAN C OLLEGE OF R ADIOLOGY ,THE NATIONAL COMPREHENSIVE CANCER NETWORK OR THEIR SUCCESSOR ENTITIE,FOR THE ACTUAL COST OF AN ANNUAL BREAST CANCER SCREENING USING THE NONINVASIVE IMAGING MODALITY APPROPRIATE FOR THE COVERED PERSON 'S BREAST HEALTH NEEDS ,AS DETERMINED BY THE COVERED PERSONS PROVIDER.

(II)(A) FRANYBREASTIMAGINGPERFORMEDAFTERTHEBREAST CANCERSCREENINGSTUDY WHETHERIT ISDIAGNOSTICBREAST IMAGING FOR FURTHER EVALUATION OR SUPPLEMENTAL BREAST IMAGING WITHIN THE SAME CALENDAR YEAR BASED ON FACTORS INCLUDING A HIGH LIFETIME RISK FOR BREAST CANCER OR HIGH BREAST DENSITY , THE NONINVASIVE IMAGING MODALITY OR MODALITIES USED MUST BE THE SAME AS,OR COMPARABLE TO ,THE MODALITY OR MODALITIES USED FOR THE BREAST CANCER SCREENING STUDY.

(B) ITHENONINVASIVEIMAGINGMODALITYISRECOMMENDEDBY THE COVERED PERSON S PROVIDER AND THE BREAST IMAGING IS WITHIN APPROPRIATE USE GUIDELINES AS DETERMINED BY THE AMERICAN -4- 1301 C OLLEGE OF R ADIOLOGY ,THE NATIONAL COMPREHENSIVE CANCER NETWORK OR THEIR SUCCESSOR ENTITIE,THE COVERED PERSON IS NOT RESPONSIBLE FOR ANY COSTSHARING AMOUNTS .

(C) IF THE COVERED PERSON RECEIVES MORE THAN ONE BREAST IMAGING THAT IS IN EXCESS OF WHAT IS RECOMMENDED BY THE A MERICAN COLLEGE OF R ADIOLOGY ,THE NATIONAL COMPREHENSIVE CANCERNETWORK ORTHEIRSUCCESSORENTITIES ,INAGIVENCALENDAR YEARORCONTRACTYEAR ,THEOTHERBENEFITPROVISIONSINTHEPOLICY ORCONTRACTAPPLYWITHRESPECTTOTHEADDITIONALBREASTIMAGING .

(III) BENEFITS FOR PREVENTIVE BREAST CANCER SCREENING STUDIESANDBREASTIMAGINGAREDETERMINEDONACALENDARYEAROR ACONTRACTYEARBASIS .THEPREVENTIVEANDDIAGNOSTICCOVERAGES PROVIDEDPURSUANT TO THISSUBSECTION (18)(b.5DONOT DIMINISHOR LIMITDIAGNOSTICBENEFITSOTHERWISEALLOWABLEUNDERAPOLICYOR CONTRACT .