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.
Summary
AB 536 updates California’s health coverage statutes governing health care service plans and health insurance policies to clarify and expand which colorectal cancer screening tests must be covered without cost sharing. The bill amends Section 1367.668 of the Health and Safety Code and Section 10123.207 of the Insurance Code, both of which already require no-cost coverage for certain colorectal cancer screening tests and follow-up colonoscopies for plans and policies issued, amended, or renewed on or after January 1, 2022.
As amended, the bill retains coverage for tests rated A or B by the U.S. Preventive Services Task Force, and adds coverage for FDA-approved screening tests that either meet federal Medicare coverage requirements or appear in the most recently published American Cancer Society guidelines. It also continues to require no-cost coverage for a colonoscopy that follows a positive result on a qualifying screening test, while preserving the ability of plans and insurers to apply cost sharing for out-of-network services where permitted by the policy or plan.
Impact
The bill would broaden and clarify the set of colorectal cancer screening tests that must be covered without patient cost sharing under California-regulated health plans and health insurance policies. It affects both the Knox-Keene regulated health care service plans overseen by the Department of Managed Health Care and health insurance policies regulated by the Department of Insurance, but it does not create a new benefit category so much as refine the existing mandate. The practical effect is to align state coverage rules more closely with FDA approval, Medicare coverage standards, and American Cancer Society guidance, potentially increasing access to newer screening technologies and reducing out-of-pocket costs for enrollees.
Sentiment
The available voting history suggests broad support for the bill. It advanced through committee and floor votes with unanimous or near-unanimous margins, including a 74-0 Assembly third reading vote and strong committee approvals. The bill’s digest also identifies it as a majority-vote measure with no appropriation and no fiscal committee referral indicated in the digest, which is consistent with a generally noncontroversial health coverage update.
Contention
There is little evidence of substantive opposition in the materials provided. The main policy issue appears to be whether the state mandate should be expanded beyond USPSTF A/B-rated tests to include FDA-approved tests that satisfy Medicare coverage criteria or American Cancer Society guidelines. Any concern would likely center on the scope of required coverage and the potential cost implications for plans and insurers, but the bill’s movement through the Legislature indicates those concerns were not significant enough to generate recorded opposition in the available votes. The bill also preserves out-of-network cost-sharing rules, which may have reduced concern from insurers about unintended expansion of liability.