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S. B. No. 64 As IntroducedAs Introduced
128th General Assembly | Regular Session | 2009-2010 |
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Cosponsors:
Senators Fedor, Miller, D., Morano, Sawyer, Turner
A BILL
To enact sections 1751.69, 3923.651, and
5111.0210 of
the Revised Code 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.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1751.69, 3923.651, and
5111.0210 of
the
Revised Code be enacted to read as follows:
Sec. 1751.69. (A) Notwithstanding section 3901.71 of the
Revised Code, each individual or group health insuring corporation
policy, contract, or agreement providing basic health care
services that is delivered, issued for delivery, or renewed in
this state shall provide benefits for the expenses of colorectal
cancer examinations and laboratory tests for
colorectal cancer for
any
nonsymptomatic individual who is either of the
following:
(1) Fifty years of age or older;
(2) Less than fifty years of age and at high risk for
colorectal cancer due to one of the following:
(a) A personal history of colorectal cancer or adenomatous
polyps;
(b) A personal history of chronic inflammatory bowel disease,
such as Crohn's disease or ulcerative colitis;
(c) A family history of colorectal cancer or polyps,
determined by cancer or polyps in a first degree relative less
than sixty years of age or two or more first degree relatives of
any age;
(d) A known family history of hereditary colorectal cancer
syndromes such as familial adenomatous polyposis or hereditary
nonpolyposis colon cancer.
(B) The benefits provided under division (A) of this section
shall
include coverage of all of the following:
(1) Flexible sigmoidoscopy every five years;
(2) Colonoscopy every ten years;
(3) Double contrast barium enema every five years;
(4) CT colonography every five years;
(5) A stool DNA test with high sensitivity for cancer every
five years or one of the following screening tests annually:
(a) Guaiac-based fecal occult blood test with high test
sensitivity for cancer;
(b) Fecal immunochemical test with high test sensitivity for
cancer;
(c) Any combination of the most reliable, medically
recognized screening tests available.
(C) The benefits provided under division (A) of this section
shall be subject to all terms, conditions, restrictions,
exclusions,
and limitations that apply to any other coverage
under the policy,
contract, or agreement for services performed
by participating and
nonparticipating providers. Nothing in this
section shall be
construed as requiring reimbursement to a
provider or facility
providing the examination or test that does
not have a health care
contract with the health insuring
corporation, or as prohibiting a
health insuring corporation that
does not have a health care
contract with the provider or
facility providing the examination
or test from negotiating a
single case or other agreement for
coverage.
Sec. 3923.651. (A) Notwithstanding section 3901.71 of the
Revised Code, each policy of individual or group sickness and
accident insurance that is delivered, issued for delivery, or
renewed in this state and each public employee benefit plan that
is established or modified in this state shall
provide benefits
for the expenses of colorectal cancer
examinations and laboratory
tests for colorectal
cancer for any
nonsymptomatic individual who
is either
of the
following:
(1) Fifty years of age or older;
(2) Less than fifty years of age and at high risk for
colorectal cancer due to one of the following:
(a) A personal history of colorectal cancer or adenomatous
polyps;
(b) A personal history of chronic inflammatory bowel disease,
such as Crohn's disease or ulcerative colitis;
(c) A family history of colorectal cancer or polyps,
determined by cancer or polyps in a first degree relative less
than sixty years of age or two or more first degree relatives of
any age;
(d) A known family history of hereditary colorectal cancer
syndromes such as familial adenomatous polyposis or hereditary
nonpolyposis colon cancer.
(B) The benefits provided under division (A) of this section
shall include coverage of all of the following:
(1) Flexible sigmoidoscopy every five years;
(2) Colonoscopy every ten years;
(3) Double contrast barium enema every five years;
(4) CT colonography every five years;
(5) A stool DNA test with high sensitivity for cancer every
five years or one of the following screening tests annually:
(a) Guaiac-based fecal occult blood test with high test
sensitivity for cancer;
(b) Fecal immunochemical test with high test sensitivity for
cancer;
(c) Any combination of the most reliable, medically
recognized screening tests available.
(C) The benefits provided under division (A) of this section
shall be subject to all terms, conditions, restrictions,
exclusions, and limitations that apply to any other coverage under
the policy or plan for services performed by participating and
nonparticipating providers. Nothing in this section shall be
construed as requiring reimbursement to a provider or facility
providing the examination or test that does not have a health care
contract with the entity issuing the policy or plan, or as
prohibiting the entity issuing a policy or plan that does not have
a health care contract with the provider or facility providing the
examination or test from negotiating a single case or other
agreement for coverage.
(D) This section does not apply to any policy that provides
coverage for specific diseases or accidents only, or to any
hospital indemnity, medicare supplement, or other policy that
offers only supplemental benefits.
Sec. 5111.0210. (A) The medicaid program shall cover
colorectal cancer
examinations and laboratory tests for colorectal
cancer for
any
nonsymptomatic medicaid recipient who is either of
the
following:
(1)
Fifty years of age or older;
(2) Less than fifty years of age
and at high risk for
colorectal cancer due to one of the following:
(a) A personal history of colorectal cancer or adenomatous
polyps;
(b) A personal history of chronic inflammatory bowel disease,
such as Crohn's disease or ulcerative colitis;
(c) A family history of colorectal cancer or polyps,
determined by cancer or polyps in a first degree relative less
than sixty years of age or in two or more first degree relatives
of any age;
(d) A known family history of hereditary colorectal cancer
syndromes such as familial adenomatous polyposis or hereditary
nonpolyposis colon cancer.
(B) The coverage provided under
division (A) of this section
shall include coverage of all of the following:
(1) Flexible sigmoidoscopy every five years;
(2) Colonoscopy every ten years;
(3) Double contrast barium enema every five years;
(4) CT colonography every five years;
(5) A stool DNA test with high sensitivity for cancer every
five years or one of the following screening tests annually:
(a) Guaiac-based fecal occult blood test with high test
sensitivity for cancer;
(b) Fecal immunochemical test with high test sensitivity for
cancer;
(c) Any combination of the most reliable, medically
recognized screening tests available.
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