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AB 1763
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 1763 (Gipson)
As Amended June 27, 2016
Majority vote
ASSEMBLY:
67-5
(June 2, 2016)
SENATE:
24-12
(August 18, 2016)
Original Committee Reference: HEALTH
SUMMARY: Requires health care service plan (health plan) and health insurance coverage
without cost sharing for specified colorectal cancer screening examinations and laboratory tests
for individuals at average risk, and requires coverage for additional colorectal cancer screening
examinations without cost-sharing for individuals at high risk, as specified. Prohibits the
imposition of cost sharing on colonoscopies, including the removal of polyps, for an enrollee
who is between 50 and 75 years of age and has received a positive test, as specified.
The Senate amendments add language specifying that this bill does not require a health plan or
insurer with a network of providers to provide benefits for out-of-network services nor does it
preclude a health plan or insurer with a network of providers from imposing cost-sharing
requirements for out-of-network provider services.
FISCAL EFFECT: According to the Senate Appropriations Committee:
1) No fiscal impact on the Medi-Cal program is anticipated, as program beneficiaries are not
subject to cost sharing.
2) Increased costs of $1.3 million per year to CalPERS, due to increased utilization of screening
tests (various funds). According to an analysis of a prior version of this bill by the California
Health Benefits Review Program (CHBRP), prohibiting cost sharing for specified screening
will modestly increase utilization of screening examinations. Overall, CHBRP projects that
about 2,500 additional individuals per year will receive colorectal screening exams due to the
elimination of cost sharing. The proportional impact of that increased utilization on the
CalPERS system is $1.3 million. According to CHBRP, subsequent amendments to this bill
since that analysis was prepared will not substantially change the projected costs.
3) No state cost to subsidize health care coverage through Covered California is anticipated.
Under federal law, any new mandated health benefit that exceeds the benefits in the states
essential health benefits benchmark plan would be a state responsibility. In other words, to
the extent that the state imposes a new benefit mandate that exceeds the essential health
benefits benchmark, the state would be responsible for paying for the cost to subsidize that
benefit for those individuals who receive subsidized coverage through Covered California.
Because this bill does not mandate a new benefit, but only change the terms of an existing
benefit, this bill is not expected to result in the state being responsible for subsidizing
coverage.
4) One-time costs of about $90,000 over the first two years and ongoing costs of $25,000 per
year for reviews of insurance plan compliance by the Department of Insurance (CDI
Insurance Fund).
AB 1763
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5) Ongoing costs of less than $50,000 per year for review of health plan compliance by the
Department of Managed Health Care (DMHC Managed Care Fund).
COMMENTS: According to the author, stool blood tests are an important colorectal cancer
screening option. Availability is better than for colonoscopy, the cost is lower, and they offer the
opportunity to increase the overall screening rate which would reduce incidence and mortality.
Some individuals, including those from low income communities and communities of color may
not have initial access to screening colonoscopy. Some prefer a stool blood test because the
procedure is simpler, there is lower risk of complications and it is less invasive. Screening with
stool blood tests has been shown to decrease incidence and mortality in randomized controlled
trials, and years of life saved are essentially the same as with colonoscopy screening. However,
the benefits of stool blood tests as a strategy to reach more Californians, especially in
communities with lower access to colonoscopy services are not realized when there is a cost to
patients. A co-pay or cost-sharing can be a barrier, preventing some individuals with positive
stool blood tests from getting a follow up colonoscopy to complete the colorectal cancer
screening process, defeating the purpose of screening. A policy that removes the cost to patients
will make stool blood tests a more viable screening option and will reduce costs to payers.
Patient Protection and Affordable Care Act (ACA) Preventive Services Mandate. The ACA
requires coverage for and elimination of cost-sharing on certain recommended preventive health
services, for policies renewing on or after September 23, 2010, based on guidelines from the
United States Preventive Services Task Force (USPSTF). There are 15 covered preventive
services for adults which include one-time screening for abdominal aortic aneurysm, screening
and counseling for alcohol misuse, aspirin, blood pressure screening, cholesterol screening,
depression screening, screening for Type 2 Diabetes, diet counseling, HIV screening,
immunizations, obesity screening and counseling, prevention counseling for sexually transmitted
infection, screening and cessation interventions for tobacco use, and colorectal cancer screening
for adults over 50.
Colorectal Cancer Screening. According to the National Cancer Institute, colorectal cancer is a
disease in which malignant (cancer) cells form in the tissues of the colon or the rectum.
Colorectal cancer is the second leading cause of death from cancer in the United States. For the
vast majority of adults, the most important risk factor for colorectal cancer is older age. Most
cases of colorectal cancer occur among adults older than 50 years; the median age at diagnosis is
68 years. A positive family history (excluding known inherited familial syndromes) is thought to
be linked to about 20% of cases of colorectal cancer. The final USPSTF recommendation for
colorectal cancer screening recommends screening with one of several approved methodologies
for colorectal cancer starting at age 50 years and continuing until age 75 years. The decision to
screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into
account the patients overall health and prior screening history. The screening modalities and
intervals are fecal occult blood test (FOBT), which has received an A or B recommendation from
the USPSTF and Fecal immunochemical test (FIT), which is recommended in the 2016 draft
updated guidelines. Both tests are suggested annually to detect cancer. A flexible
sigmoidoscopy is recommended every five years to detect polyps and cancer and has received an
A or B recommendation from the USPSTF. A colonoscopy is recommended every 10 years to
detect polyps and cancer and has received an A or B recommendation. It is also recommended
that a colonoscopy should be performed if test results are positive.
Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097
FN: 0004119