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Measure

AB 536

Authors

Patterson

Subject

Health care coverage: colorectal cancer screening.

Relating To

relating to health care coverage.

Title

An act to amend Section 1367.668 of the Health and Safety Code, and to amend Section 10123.207 of the Insurance Code, relating to health care coverage.

Last Action Dt

2025-03-24

State

Amended Assembly

Status

In Committee Process

Active?

Vote Required

Majority

Appropriation

Fiscal Committee

Yes

Local Program

Substantive Changes

None

Urgency

Tax Levy

Leginfo Link

Bill

Actions

2025-08-29		In committee: Held under submission.
2025-07-14		In committee: Referred to APPR. suspense file.
2025-06-26		From committee: Do pass and re-refer to Com. on APPR. (Ayes 8. Noes 1.) (June 25). Re-referred to Com. on APPR.
2025-06-11		In committee: Set, first hearing. Hearing canceled at the request of author.
2025-05-14		Referred to Com. on HEALTH.
2025-05-06		In Senate. Read first time. To Com. on RLS. for assignment.
2025-05-05		Read third time. Passed. Ordered to the Senate. (Ayes 74. Noes 0. Page 1425.)
2025-04-24		Read second time. Ordered to third reading.
2025-04-23		From committee: Do pass. (Ayes 15. Noes 0.) (April 23).
2025-04-09		From committee: Do pass and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (April 8). Re-referred to Com. on APPR.
2025-03-25		Re-referred to Com. on HEALTH.
2025-03-24		Referred to Com. on HEALTH.
2025-03-24		From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
2025-02-12		From printer. May be heard in committee March 14.
2025-02-11		Read first time. To print.

Keywords

Tags

Versions

Amended Assembly		2025-03-24
Introduced		2025-02-11

Last Version Text

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		<ns0:Title>An act to amend Section 1367.668 of the Health and Safety Code, and to amend Section 10123.207 of the Insurance Code, relating to health care coverage. </ns0:Title>
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			<ns0:Subject>Health care coverage: colorectal cancer screening.</ns0:Subject>
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			<html:p>Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally requires a health care service plan contract or a health insurance policy issued, amended, or renewed on or after January 1, 2022, to provide coverage without cost sharing for a colorectal cancer screening test assigned either a grade of A or a grade of B by the United States Preventive Services Task Force and for a required colonoscopy for a positive result on a test with those grades. </html:p>
			<html:p>This bill would additionally require that coverage if the screening test is approved by the United States Food and Drug Administration and either meets requirements for coverage established by the federal Centers for Medicare and Medicaid Services, as specified, or is included in the most recently published guidelines from the American Cancer Society.</html:p>
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		<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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				Section 1367.668 of the 
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								(a)
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								Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2022, shall provide coverage without cost sharing for a colorectal cancer screening test that meets any of the following conditions:
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								(1)
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								Approved by the United States Food and Drug Administration
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								(2)
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								Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.
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								(3)
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								Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.
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								(b)
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								The required colonoscopy for a positive result on a test or procedure, other than a colonoscopy, that is a colorectal cancer screening examination or laboratory test
						that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.
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								(c)
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								This section does not preclude a health care service plan that has coverage for out-of-network benefits from imposing cost-sharing requirements for the items or services described in this section that are delivered by an out-of-network provider.
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				Section 10123.207 of the 
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								(a)
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								Every health insurance policy, except a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2022, shall provide coverage without cost sharing for a colorectal cancer screening test that meets any of the following conditions:
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								(1)
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								Approved by the United States Food and Drug Administration (FDA)
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								(2)
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								Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.
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								(3)
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								Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.
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								(b)
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								The required colonoscopy for a positive result on a test or procedure, other than a colonoscopy, that is a colorectal cancer screening examination or laboratory test
						that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.
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								(c)
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								This section does not preclude a health insurer that has a network of providers from imposing cost-sharing requirements for the items or services described in this section that are delivered by an out-of-network provider.
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Last Version Text Digest

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally requires a health care service plan contract or a health insurance policy issued, amended, or renewed on or after January 1, 2022, to provide coverage without cost sharing for a colorectal cancer screening test assigned either a grade of A or a grade of B by the United States Preventive Services Task Force and for a required colonoscopy for a positive result on a test with those grades. This bill would additionally require that coverage if the screening test is approved by the United States Food and Drug Administration and either meets requirements for coverage established by the federal Centers for Medicare and Medicaid Services, as specified, or is included in the most recently published guidelines from the American Cancer Society.