January 20, 2022

States Address Colorectal Cancer Screening and Out-of-Network Billing Legislation

Indiana, Nebraska and New York consider measures expanding coverage of colorectal cancer screening. New York addresses bills modifying out-of-network billing provisions.

Colorectal Cancer Screening

In Indiana, Senate Bill (SB) 268 was referred to the Committee on Insurance and Financial Institutions. If enacted, carriers would be required to cover:

  • A colorectal cancer screening test assigned either an "A" or "B" grade by the U.S. Preventive Services Task Force (USPSTF).
  • A follow-up colonoscopy if the result of a noninvasive colorectal cancer screening test with an "A" or "B" grade from the USPSTF if the test is positive.

Carriers could impose a deductible requirement for a follow-up colonoscopy.

In Nebraska, Legislative Bill 739 will be considered by the Banking, Commerce and Insurance Committee. The measure would lower the age of eligibility for colorectal cancer screening coverage from 50 to 45 years of age.

In New York, SB 906 and SB 1274 were referred to the Senate Insurance Committee. If enacted, SB 906 would mandate carriers provide coverage for colorectal cancer early detection, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy performed if there is a positive result on a non-colonoscopy preventive screening test. SB 1274 would require carriers cover colorectal cancer diagnostic screening upon the prescription of a healthcare provider.

Out-Of-Network Billing

Legislation (Assembly Bill (AB) 1983 and companion bill SB 4787) in New York was referred to the Assembly and Senate Insurance Committees that, if enacted, would require notification to enrollees that an out-of-network physician may be used in their procedure, test or surgery, and services would not be covered by their insurance policy. If the enrollee does not receive notification prior to such services or procedure, the services would be covered by the carrier.

Also in New York, AB 3470 was referred to the Ways and Means Committee. If enacted, this bill would prohibit healthcare providers from seeking payment for a facility fee not covered by the enrollee’s carrier unless the patient was notified of the fee prior to the service date.

For more information about state legislative issues, please contact Tina Getachew or Eugenia Brandt. To stay current on state legislative developments relevant to radiology, view the American College of Radiology® policy map.

The ACR has partnered with FiscalNote, a legislation and regulation tracking service, to provide continuous, comprehensive updates on radiology- and healthcare-related legislation. Members can get more information about state government relations and opt in for FiscalNote reports by contacting Eugenia Brandt, ACR Director of State Governmental Affairs.