Bill Text: OH SB64 | 2009-2010 | 128th General Assembly | Introduced
Bill Title: To require certain health care policies, contracts, agreements, and plans, as well as the state's Medicaid program, to provide benefits for colorectal examinations and laboratory tests for cancer.
Spectrum: Moderate Partisan Bill (Democrat 5-1)
Status: (Introduced - Dead) 2009-03-04 - To Insurance, Commerce, & Labor [SB64 Detail]
Download: Ohio-2009-SB64-Introduced.html
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Senator Coughlin
Cosponsors:
Senators Fedor, Miller, D., Morano, Sawyer, Turner
| To enact sections 1751.69, 3923.651, and 5111.0210 of | 1 |
| the Revised Code to require certain health care | 2 |
| policies, contracts, agreements, and plans, as | 3 |
| well as the state's Medicaid program, to provide | 4 |
| benefits for colorectal examinations and | 5 |
| laboratory tests for cancer. | 6 |
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
| Section 1. That sections 1751.69, 3923.651, and 5111.0210 of | 7 |
| the Revised Code be enacted to read as follows: | 8 |
| Sec. 1751.69. (A) Notwithstanding section 3901.71 of the | 9 |
| Revised Code, each individual or group health insuring corporation | 10 |
| policy, contract, or agreement providing basic health care | 11 |
| services that is delivered, issued for delivery, or renewed in | 12 |
| this state shall provide benefits for the expenses of colorectal | 13 |
| cancer examinations and laboratory tests for colorectal cancer for | 14 |
| any nonsymptomatic individual who is either of the following: | 15 |
| (1) Fifty years of age or older; | 16 |
| (2) Less than fifty years of age and at high risk for | 17 |
| colorectal cancer due to one of the following: | 18 |
| (a) A personal history of colorectal cancer or adenomatous | 19 |
| polyps; | 20 |
| (b) A personal history of chronic inflammatory bowel disease, | 21 |
| such as Crohn's disease or ulcerative colitis; | 22 |
| (c) A family history of colorectal cancer or polyps, | 23 |
| determined by cancer or polyps in a first degree relative less | 24 |
| than sixty years of age or two or more first degree relatives of | 25 |
| any age; | 26 |
| (d) A known family history of hereditary colorectal cancer | 27 |
| syndromes such as familial adenomatous polyposis or hereditary | 28 |
| nonpolyposis colon cancer. | 29 |
| (B) The benefits provided under division (A) of this section | 30 |
| shall include coverage of all of the following: | 31 |
| (1) Flexible sigmoidoscopy every five years; | 32 |
| (2) Colonoscopy every ten years; | 33 |
| (3) Double contrast barium enema every five years; | 34 |
| (4) CT colonography every five years; | 35 |
| (5) A stool DNA test with high sensitivity for cancer every | 36 |
| five years or one of the following screening tests annually: | 37 |
| (a) Guaiac-based fecal occult blood test with high test | 38 |
| sensitivity for cancer; | 39 |
| (b) Fecal immunochemical test with high test sensitivity for | 40 |
| cancer; | 41 |
| (c) Any combination of the most reliable, medically | 42 |
| recognized screening tests available. | 43 |
| (C) The benefits provided under division (A) of this section | 44 |
| shall be subject to all terms, conditions, restrictions, | 45 |
| exclusions, and limitations that apply to any other coverage | 46 |
| under the policy, contract, or agreement for services performed | 47 |
| by participating and nonparticipating providers. Nothing in this | 48 |
| section shall be construed as requiring reimbursement to a | 49 |
| provider or facility providing the examination or test that does | 50 |
| not have a health care contract with the health insuring | 51 |
| corporation, or as prohibiting a health insuring corporation that | 52 |
| does not have a health care contract with the provider or | 53 |
| facility providing the examination or test from negotiating a | 54 |
| single case or other agreement for coverage. | 55 |
| Sec. 3923.651. (A) Notwithstanding section 3901.71 of the | 56 |
| Revised Code, each policy of individual or group sickness and | 57 |
| accident insurance that is delivered, issued for delivery, or | 58 |
| renewed in this state and each public employee benefit plan that | 59 |
| is established or modified in this state shall provide benefits | 60 |
| for the expenses of colorectal cancer examinations and laboratory | 61 |
| tests for colorectal cancer for any nonsymptomatic individual who | 62 |
| is either of the following: | 63 |
| (1) Fifty years of age or older; | 64 |
| (2) Less than fifty years of age and at high risk for | 65 |
| colorectal cancer due to one of the following: | 66 |
| (a) A personal history of colorectal cancer or adenomatous | 67 |
| polyps; | 68 |
| (b) A personal history of chronic inflammatory bowel disease, | 69 |
| such as Crohn's disease or ulcerative colitis; | 70 |
| (c) A family history of colorectal cancer or polyps, | 71 |
| determined by cancer or polyps in a first degree relative less | 72 |
| than sixty years of age or two or more first degree relatives of | 73 |
| any age; | 74 |
| (d) A known family history of hereditary colorectal cancer | 75 |
| syndromes such as familial adenomatous polyposis or hereditary | 76 |
| nonpolyposis colon cancer. | 77 |
| (B) The benefits provided under division (A) of this section | 78 |
| shall include coverage of all of the following: | 79 |
| (1) Flexible sigmoidoscopy every five years; | 80 |
| (2) Colonoscopy every ten years; | 81 |
| (3) Double contrast barium enema every five years; | 82 |
| (4) CT colonography every five years; | 83 |
| (5) A stool DNA test with high sensitivity for cancer every | 84 |
| five years or one of the following screening tests annually: | 85 |
| (a) Guaiac-based fecal occult blood test with high test | 86 |
| sensitivity for cancer; | 87 |
| (b) Fecal immunochemical test with high test sensitivity for | 88 |
| cancer; | 89 |
| (c) Any combination of the most reliable, medically | 90 |
| recognized screening tests available. | 91 |
| (C) The benefits provided under division (A) of this section | 92 |
| shall be subject to all terms, conditions, restrictions, | 93 |
| exclusions, and limitations that apply to any other coverage under | 94 |
| the policy or plan for services performed by participating and | 95 |
| nonparticipating providers. Nothing in this section shall be | 96 |
| construed as requiring reimbursement to a provider or facility | 97 |
| providing the examination or test that does not have a health care | 98 |
| contract with the entity issuing the policy or plan, or as | 99 |
| prohibiting the entity issuing a policy or plan that does not have | 100 |
| a health care contract with the provider or facility providing the | 101 |
| examination or test from negotiating a single case or other | 102 |
| agreement for coverage. | 103 |
| (D) This section does not apply to any policy that provides | 104 |
| coverage for specific diseases or accidents only, or to any | 105 |
| hospital indemnity, medicare supplement, or other policy that | 106 |
| offers only supplemental benefits. | 107 |
| Sec. 5111.0210. (A) The medicaid program shall cover | 108 |
| colorectal cancer examinations and laboratory tests for colorectal | 109 |
| cancer for any nonsymptomatic medicaid recipient who is either of | 110 |
| the following: | 111 |
| (1) Fifty years of age or older; | 112 |
| (2) Less than fifty years of age and at high risk for | 113 |
| colorectal cancer due to one of the following: | 114 |
| (a) A personal history of colorectal cancer or adenomatous | 115 |
| polyps; | 116 |
| (b) A personal history of chronic inflammatory bowel disease, | 117 |
| such as Crohn's disease or ulcerative colitis; | 118 |
| (c) A family history of colorectal cancer or polyps, | 119 |
| determined by cancer or polyps in a first degree relative less | 120 |
| than sixty years of age or in two or more first degree relatives | 121 |
| of any age; | 122 |
| (d) A known family history of hereditary colorectal cancer | 123 |
| syndromes such as familial adenomatous polyposis or hereditary | 124 |
| nonpolyposis colon cancer. | 125 |
| (B) The coverage provided under division (A) of this section | 126 |
| shall include coverage of all of the following: | 127 |
| (1) Flexible sigmoidoscopy every five years; | 128 |
| (2) Colonoscopy every ten years; | 129 |
| (3) Double contrast barium enema every five years; | 130 |
| (4) CT colonography every five years; | 131 |
| (5) A stool DNA test with high sensitivity for cancer every | 132 |
| five years or one of the following screening tests annually: | 133 |
| (a) Guaiac-based fecal occult blood test with high test | 134 |
| sensitivity for cancer; | 135 |
| (b) Fecal immunochemical test with high test sensitivity for | 136 |
| cancer; | 137 |
| (c) Any combination of the most reliable, medically | 138 |
| recognized screening tests available. | 139 |
