Amended IN Assembly March 24, 2025 CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Assembly Bill No. 536Introduced by Assembly Member PattersonFebruary 11, 2025An 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. LEGISLATIVE COUNSEL'S DIGESTAB 536, as amended, Patterson. Health care coverage: colorectal cancer screening.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 make technical, nonsubstantive changes to those provisions. 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NOYES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367.668 of the Health and Safety Code is amended to read:1367.668. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.SEC. 2. Section 10123.207 of the Insurance Code is amended to read:10123.207. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
Amended IN Assembly March 24, 2025 CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Assembly Bill No. 536Introduced by Assembly Member PattersonFebruary 11, 2025An 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. LEGISLATIVE COUNSEL'S DIGESTAB 536, as amended, Patterson. Health care coverage: colorectal cancer screening.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 make technical, nonsubstantive changes to those provisions. 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NOYES Local Program: NO
Amended IN Assembly March 24, 2025
Amended IN Assembly March 24, 2025
CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION
Assembly Bill
No. 536
Introduced by Assembly Member PattersonFebruary 11, 2025
Introduced by Assembly Member Patterson
February 11, 2025
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.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 536, as amended, Patterson. Health care coverage: colorectal cancer screening.
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 make technical, nonsubstantive changes to those provisions. 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.
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 make technical, nonsubstantive changes to those provisions.
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.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1367.668 of the Health and Safety Code is amended to read:1367.668. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.SEC. 2. Section 10123.207 of the Insurance Code is amended to read:10123.207. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 1367.668 of the Health and Safety Code is amended to read:1367.668. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
SECTION 1. Section 1367.668 of the Health and Safety Code is amended to read:
### SECTION 1.
1367.668. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
1367.668. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
1367.668. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
1367.668. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:
(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.
(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.
(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.
(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.
(b)
(c) 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.
SEC. 2. Section 10123.207 of the Insurance Code is amended to read:10123.207. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
SEC. 2. Section 10123.207 of the Insurance Code is amended to read:
### SEC. 2.
10123.207. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
10123.207. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
10123.207. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.(b)(c) 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.
10123.207. (a) 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 assigned either a grade of A or a grade of B by the United States Preventive Services Task Force. The that meets any of the following conditions:
(1) Approved by the United States Food and Drug Administration (FDA) and meets the requirements for coverage established by the federal Centers for Medicare and Medicaid Services National Coverage Determination 210.3.
(2) Approved by the FDA and included in the most recently published guidelines from the American Cancer Society.
(3) Assigned either a grade of A or a grade of B by the United States Preventive Services Task Force.
(b) 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 identified assigned either a grade of A or a grade of B by the United States Preventive Services Task Force that meets any of the conditions described in paragraphs (1) to (3), inclusive, of subdivision (a) shall also be provided without cost sharing.
(b)
(c) 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.