Bill Text: IA SF417 | 2025-2026 | 91st General Assembly | Introduced

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Bill Title: A bill for an act relating to insurance coverage and Medicaid coverage for annual lung cancer screenings for at-risk individuals.

Spectrum: Partisan Bill (Democrat 11-0)

Status: (Introduced) 2025-02-24 - Introduced, referred to Commerce. [SF417 Detail]

Download: Iowa-2025-SF417-Introduced.html

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Senate File 417 - Introduced
SENATE FILE 417
BY DONAHUE , STAED , TOWNSEND ,
CELSI , PETERSEN , WAHLS ,
DOTZLER , WEINER , BISIGNANO ,
TRONE GARRIOTT , and
WINCKLER
A BILL FOR
An Act relating to insurance coverage and Medicaid coverage for
annual lung cancer screenings for at-risk individuals.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. NEW SECTION . 249A.34 Annual lung cancer
screenings.
1. As used in this section, unless the context requires
otherwise:
a. “At-risk individual” means a recipient fifty years of age
or older to which any of the following circumstances apply:
(1) The individual has smoked cigarettes regularly or
experienced secondhand smoke regularly.
(2) The individual has an immediate family member diagnosed
with lung cancer.
(3) The individual has been regularly exposed to asbestos,
radon, arsenic, nickel, chromium, tar, or soot in the
individual’s home or workplace.
b. “Lung cancer screening” means a scan of the lungs using
low-dose computed tomography.
2. The department shall seek any federal waiver necessary
for the medical assistance program to provide coverage for
an annual lung cancer screening for at-risk individuals.
Contingent on receiving approval of a federal waiver, and
effective immediately upon receiving approval of a federal
waiver, the medical assistance program shall provide coverage
for annual lung cancer screenings for at-risk individuals.
Sec. 2. NEW SECTION . 514C.37 Annual lung cancer screening
—— coverage.
1. As used in this section, unless the context otherwise
requires:
a. “At-risk individual” means a covered person fifty years
of age or older to which any of the following circumstances
apply:
(1) The individual has smoked cigarettes regularly or
experienced secondhand smoke regularly.
(2) The individual has an immediate family member diagnosed
with lung cancer.
(3) The individual has been regularly exposed to asbestos,
radon, arsenic, nickel, chromium, tar, or soot in the
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individual’s home or workplace.
b. “Cost-sharing” means any coverage limit, copayment,
coinsurance, deductible, or other out-of-pocket expense
obligation imposed on a covered person by a policy, contract,
or plan providing for third-party payment or prepayment of
health or medical expenses.
c. “Covered person” means a policyholder, subscriber, or
other person participating in a policy, contract, or plan that
provides for third-party payment or prepayment of health or
medical expenses.
d. “Lung cancer screening” means a scan of the lungs using
low-dose computed tomography.
2. Notwithstanding the uniformity of treatment requirements
of section 514C.6, a policy, contract, or plan providing for
third-party payment or prepayment of health or medical expenses
shall provide coverage for an annual lung cancer screening for
an at-risk individual.
3. Cost-sharing shall not be imposed by a health carrier for
coverage required under this section.
4. a. This section applies to the following classes of
third-party payment provider contracts, policies, or plans
delivered, issued for delivery, continued, or renewed in this
state on or after January 1, 2026:
(1) Individual or group accident and sickness insurance
providing coverage on an expense-incurred basis.
(2) An individual or group hospital or medical service
contract issued pursuant to chapter 509, 514, or 514A.
(3) An individual or group health maintenance organization
contract regulated under chapter 514B.
(4) A plan established for public employees pursuant to
chapter 509A.
b. This section shall not apply to accident-only, specified
disease, short-term hospital or medical, hospital confinement
indemnity, credit, dental, vision, Medicare supplement,
long-term care, basic hospital and medical-surgical expense
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coverage as defined by the commissioner of insurance,
disability income insurance coverage, coverage issued as a
supplement to liability insurance, workers’ compensation or
similar insurance, or automobile medical payment insurance.
5. The commissioner of insurance may adopt rules pursuant to
chapter 17A to administer this section.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill relates to insurance coverage and medical
assistance program (Medicaid) coverage for annual lung cancer
screenings for at-risk individuals.
The bill defines “at-risk individual” as a recipient or
covered person 50 years of age or older that either has smoked
cigarettes regularly or experienced secondhand smoke regularly,
has an immediate family member diagnosed with lung cancer, or
has been regularly exposed to asbestos, radon, arsenic, nickel,
chromium, tar, or soot in the individual’s home or workplace.
The bill defines “lung cancer screening” as a scan of the lungs
using low-dose computed tomography.
Under the bill, the department of health and human services
shall seek any federal waiver necessary for Medicaid to
provide coverage for an annual lung cancer screening for
at-risk individuals. Contingent on receiving approval of, and
effective immediately upon receiving approval of, a federal
waiver, Medicaid shall provide coverage for annual lung cancer
screenings for at-risk individuals.
The bill requires a policy, contract, or plan providing for
third-party payment or prepayment of health or medical expenses
to provide coverage for an annual lung cancer screening for an
at-risk individual. Cost-sharing shall not be imposed by a
health carrier for coverage required under the bill.
Coverage required under the bill shall not be less favorable
than coverage a health carrier offers for screening mammograms.
The bill applies to third-party payment providers enumerated
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S.F. 417
in the bill, and the commissioner of insurance may adopt rules
to administer the requirements of the bill applying to such
third-party payment providers.
The bill specifies the types of specialized health-related
insurance which are not subject to the coverage requirements
of the bill.
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