New Jersey 2020-2021 Regular Session Status: Introduced

A5034 —

  1. 1
    Introduced
  2. 2
    In Committee
  3. 3
    Passed General Assembly
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2020-2021 Regular Session. It reached “Introduced” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Identical bill: S3282 —

Bill Text

What changed in the latest version

109 added · 367 removed

Plain-language change summary

The amendment to A5034 changes the age at which health benefit plans are required to cover colorectal cancer screenings from 50 to 45. This adjustment means that individuals starting at the age of 45 will now be eligible for these screenings under their health plans, potentially impacting health outcomes for a broader age group. Additionally, it is expected to lead to increased state and local government expenditures related to these benefits.

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A5034 1R [First Reprint] ASSEMBLY, No.
A5034 1R FISCAL ESTIMATE   LEGISLATIVE FISCAL ESTIMATE [First Reprint] ASSEMBLY, No.
5034 STATE OF NEW JERSEY 219th LEGISLATURE   INTRODUCED NOVEMBER 19, 2020     Sponsored by:
5034 STATE OF NEW JERSEY 219th LEGISLATURE   DATED:
Assemblyman  DANIEL R.
JULY 2, 2021     SUMMARY   Synopsis:
BENSON District 14 (Mercer and Middlesex) Assemblywoman  CAROL A.
Reduces age at which health benefit plans cover colorectal cancer screenings from 50 to 45.
MURPHY District 7 (Burlington) Assemblyman  HERB CONAWAY, JR.
Type of Impact:
District 7 (Burlington)   Co-Sponsored by:
Increase in State General Fund and local government expenditures.
Assemblymen Verrelli, Holley, Chiaravalloti, Dancer, Assemblywomen Reynolds-Jackson, Chaparro, Jasey, Assemblyman Wimberly, Assemblywomen Vainieri Huttle, Quijano, Assemblymen DePhillips, Johnson, Giblin and Assemblywoman Speight         SYNOPSIS      Reduces age at which health benefit plans cover colorectal cancer screenings from 50 to 45.
Agencies Affected:
  CURRENT VERSION OF TEXT      As reported by the Assembly Health Committee on June 2, 2021, with amendments.
Division of Pensions and Benefits, Department of the Treasury;
   An Act concerning health benefits for colorectal cancer screenings, amending P.L.2001, c.295, and supplementing P.L.1961, c.49.
local government entities.
       Be It Enacted by the Senate and General Assembly of the State of New Jersey:
    Office of Legislative Services Estimate Fiscal Impact Year 1  Year 2  Year 3          State Cost Increase in SHBP-State expenditures for colorectal cancer for anyone commencing at 45 years of age, not just those medically necessary.
       1.    Section 1 of P.L.2001, c.295 (C.17:48-6y) is amended to read as follows:
        Local Cost Increase in SHBP-local and SEHBP expenditures for colorectal cancer screenings for anyone commencing at 45 years of age, not just those medically necessary.
     1.    Every hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
        ·         The Office of Legislative Services (OLS) notes that in accordance with the New Jersey Colorectal Cancer Screening law, Horizon’s published medical policy guiding coverage for the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP) provides 100 percent coverage for colorectal cancer screening for persons who are 50 years of age and older and for persons of any age with a letter of medical necessity from their doctor.
a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
  ·         The bill will increase costs to the SHBP and the SEHBP by the number of plan participants between 45 and 49 years of age who will be newly eligible for regular colorectal cancer screenings commencing at 45 years of age.
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
  ·         Without information from Horizon, through the Administration, regarding the employer cost for these procedures and the number of plan participants who would become eligible for colorectal cancer screenings, a numerical estimate of the cost cannot be calculated.      BILL DESCRIPTION         This bill reduces the age in which health benefit plans are required to cover regular colorectal cancer screenings from 50 to 45.
     As used in this section, “high risk for colorectal cancer” means a person has:
      The New Jersey Colorectal Cancer Screening law (P.L.
     a.     a family history of:
2001, c.295) requires that benefits under affected contracts must be provided for colorectal cancer screening at regular intervals for persons age 50 and over, and for persons of any age who are considered to be at a higher risk for colorectal cancer and for whom the procedure is determined to be medically necessary by the covered person’s doctor.  The method and frequency is required to follow the most recently published guidelines of the American Cancer Society.
familial adenomatous polyposis;
      The American Cancer Society recommends, if it is determined to be medically necessary, that regular colorectal cancer screening should start at age 45 years in individuals with an average risk of colorectal cancer and that people who are at a high risk of colorectal cancer may need to start colorectal cancer screening before 45 years of age, be screened more often, and get specific tests.
hereditary non-polyposis colon cancer;
      Under this bill, the age at which a regular colorectal cancer screening will be covered by health benefit plans is lowered from 50 years of age to 45 years of age.
or breast, ovarian, endometrial or colon cancer or polyps;
Additionally, the bill requires that contracts purchased by the State Health Benefits Commission and School Employees’ Health Benefits Commission are to include coverage for colorectal cancer screenings commencing at 45 years of age and for persons of any age with a letter of medical necessity from their doctor.
     b.    chronic inflammatory bowel disease;
 The bill’s provisions apply only to future policies and contracts.
or      c.     a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
    FISCAL ANALYSIS   EXECUTIVE BRANCH         None received.
     The benefits shall be provided to the same extent as for any other medical condition under the contract.
  OFFICE OF LEGISLATIVE SERVICES         Horizon’s published medical policy guiding coverage for the SHBP and the SEHBP provides 100 percent coverage for colorectal cancer screening for persons who are 50 years of age and older and for persons of any age with a letter of medical necessity from their doctor.
     The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
      This bill will expand the coverage for regular colorectal cancer screenings that are not deemed medically necessary to persons who are at least 45 years of age.  The increase in costs to the SHBP and the SEHBP will depend on the number of plan participants between 45 and 49 years of age who will be newly eligible for regular colorectal cancer screenings, the type of colorectal cancer screening to be performed, and the cost of the screenings.
(cf:
 The average cost of all types of colorectal cancer screenings depends on the procedures to be performed and their costs.  These costs can vary depending on whether the procedure is performed in-network or out-of-network, in an inpatient setting or an outpatient setting, geographic location, medical equipment and supplies, and pre-procedure care and post procedure follow-up care.  Without information from Horizon, through the Administration, regarding the employer cost for these procedures and the number of plan participants who would become eligible for colorectal cancer screenings commencing at age 45, a numerical estimate of the cost of this bill cannot be calculated.  In addition, no information regarding the total cost of colorectal cancer screening costs and the ratio of total colorectal cancer screening costs to total medical expenditures in prior years was available either.      Section:
P.L.2001, c.295, s.1)        2.    Section 2 of P.L.2001, c.295 (C.17:48A-7x) is amended to read as follows:
State Government Analyst:
     2.    Every medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
Kimberly M.
a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
Clemmensen Lead Fiscal Analyst Approved:
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
Thomas Koenig Legislative Budget and Finance Officer     This legislative fiscal estimate has been produced by the Office of Legislative Services due to the failure of the Executive Branch to respond to our request for a fiscal note.
     As used in this section, “high risk for colorectal cancer” means a person has:
  This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).
     a.     a family history of:
familial adenomatous polyposis;
hereditary non-polyposis colon cancer;
or breast, ovarian, endometrial or colon cancer or polyps;
     b.    chronic inflammatory bowel disease;
or      c.     a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
     The benefits shall be provided to the same extent as for any other medical condition under the contract.
     The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
(cf:
P.L.2001, c.295, s.2)        3.    Section 3 of P.L.2001, c.295 (C.17:48E-35.23) is amended to read as follows:
     3.    Every health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
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a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
     As used in this section, “high risk for colorectal cancer” means a person has:
     a.     a family history of:
familial adenomatous polyposis;
hereditary non-polyposis colon cancer;
or breast, ovarian, endometrial or colon cancer or polyps;
     b.    chronic inflammatory bowel disease;
or      c.     a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
     The benefits shall be provided to the same extent as for any other medical condition under the contract.
     The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
(cf:
P.L.2001, c.295, s.3)        4.    Section 4 of P.L.2001, c.295 (C.17B:26-2.1u) is amended to read as follows:
     4.    Every individual policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:23-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named insured or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
     As used in this section, “high risk for colorectal cancer” means a person has:
     a.     a family history of:
familial adenomatous polyposis;
hereditary nonpolyposis colon cancer;
or breast, ovarian, endometrial or colon cancer or polyps;
     b.    chronic inflammatory bowel disease;
or      c.     a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
     The benefits shall be provided to the same extent as for any other medical condition under the policy.
     The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
(cf:
P.L.2001, c.295, s.4)        5.    Section 5 of P.L.2001, c.295 (C.17B:27-46.1y) is amended to read as follows:
     5.    Every group policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named insured or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
     As used in this section, “high risk for colorectal cancer” means a person has:
     a.     a family history of:
familial adenomatous polyposis;
hereditary nonpolyposis colon cancer;
or breast, ovarian, endometrial or colon cancer or polyps;
     b.    chronic inflammatory bowel disease;
or      c.     a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
     The benefits shall be provided to the same extent as for any other medical condition under the policy.
     The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
(cf:
P.L.2001, c.295, s.5)        6.    Section 8 of P.L.2001, c.295 (C.26:2J-4.24) is amended to read as follows:
     8.    Every enrollee agreement that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide health care services to any enrollee or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
     As used in this section, “high risk for colorectal cancer” means a person has:
     a.     a family history of:
familial adenomatous polyposis;
hereditary non-polyposis colon cancer;
or breast, ovarian, endometrial or colon cancer or polyps;
     b.    chronic inflammatory bowel disease;
or      c.     a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
     The health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement.
     The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.
(cf:
P.L.2012, c.17, s.273)        7.    Section 6 of P.L.2001, c.295 (C.17B:27A-7.7) is amended to read as follows:
     6.    Every individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
     As used in this section, “high risk for colorectal cancer” means a person has:
     a.     a family history of:
familial adenomatous polyposis;
hereditary non-polyposis colon cancer;
or breast, ovarian, endometrial or colon cancer or polyps;
     b.    chronic inflammatory bowel disease;
or      c.     a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
     The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
     The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
(cf:
P.L.2001, c.295, s.6)        8.    Section 7 of P.L.2001, c.295 (C.17B:27A-19.9) is amended to read as follows:
     7.    Every small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age [50] 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
     As used in this section, “high risk for colorectal cancer” means a person has:
     a.     a family history of:
familial adenomatous polyposis;
hereditary non-polyposis colon cancer;
or breast, ovarian, endometrial or colon cancer or polyps;
     b.    chronic inflammatory bowel disease;
or      c.     a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
     The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
     The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
(cf:
P.L.2001, c.295, s.7)        9.    (New Section)    1[Every State Health Benefits plan] The State Health Benefits Commission shall ensure that every contract, purchased by the commission on or after the effective date of this act,1 that provides hospital or medical expense benefits 1[and is delivered, issued, executed or renewed in this State pursuant to P.L.1961, c.49 (C.52:14-17.25 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act,]1 shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
     As used in this section, “high risk for colorectal cancer” means a person has:
     a.     a family history of:
familial adenomatous polyposis;
hereditary non-polyposis colon cancer;
or breast, ovarian, endometrial or colon cancer or polyps;
     b.    chronic inflammatory bowel disease;
or      c.     a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
     The benefits shall be provided to the same extent as for any other medical condition under the State Health Benefits plan.
        110.
(New Section) The School Employees’ Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide benefits to any person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 45 and over and for persons of any age who are considered to be at high risk for colorectal cancer.  The methods of screening for which benefits shall be provided shall include:
a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof;
or the most reliable, medically recognized screening test available.  The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person’s physician, in consultation with the covered person.
     As used in this section, “high risk for colorectal cancer” means a person has:
     a.
a family history of:
familial adenomatous polyposis;
hereditary non-polyposis colon cancer;
or breast, ovarian, endometrial or colon cancer or polyps;
     b.
chronic inflammatory bowel disease;
or      c.
a background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.
     The benefits shall be provided to the same extent as for any other medical condition under the State Health Benefits plan.1        1[10] 111.  This act shall take effect 1[immediately] on the first day of the fourth month next following enactment and shall only apply to policies and contracts that are delivered, issued, executed, or renewed or approved for issuance or renewal in the State on or after the effective date1.
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Frequently asked questions

What is the current status of A5034?
This bill died with 2020-2021 Regular Session. It reached “Introduced” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
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