PSA Screening for HIM Act

I 117TH CONGRESS 1ST SESSION H. R. 1176 To amend title XXVII of the Public Health Service Act to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for prostate cancer screenings without the imposition of cost-sharing requirements, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 18, 2021 Mr. RUSH (for himself and Mr. BUCSHON) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XXVII of the Public Health Service Act to require group health plans and health insurance issuers offering group or individual health insurance cov- erage to provide coverage for prostate cancer screenings without the imposition of cost-sharing requirements, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Prostate-Specific Anti- 4 gen Screening for High-risk Insured Men Act’’ or the 5 ‘‘PSA Screening for HIM Act’’. 6 VerDate Sep 11 2014 18:31 Mar 13, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1176.IH H1176 khammond on DSKJM1Z7X2PROD with BILLS 2 •HR 1176 IH SEC. 2. FINDINGS. 1 Congress finds the following: 2 (1) Prostate cancer is the second leading cause 3 of cancer death in men in the United States with 1 4 in 41 men dying from prostate cancer and more 5 than 31,600 men estimated to die from prostate 6 cancer in 2019. 7 (2) Prostate cancer is the second most com- 8 monly diagnosed cancer in the Nation with 1 in 9 9 men being diagnosed in their lifetimes, 3.1 million 10 men in the United States living with a diagnosis, 11 and over 174,000 men estimated to be diagnosed in 12 2019. 13 (3) The survival rate for prostate cancer diag- 14 nosed in early stage is near 100 percent but prostate 15 cancer diagnosed in late stage has only a 30-percent 16 survival rate. 17 (4) There are few, if any, symptoms of prostate 18 cancer before it reaches late stage. 19 (5) African-American men have a disproportion- 20 ately higher rate of prostate cancer and are 70 per- 21 cent more likely to be diagnosed with prostate can- 22 cer than White men, with 1 in 6 African-American 23 men developing prostate cancer in their lifetimes. 24 (6) African-American men are 2.3 times more 25 likely to die from prostate cancer than White men. 26 VerDate Sep 11 2014 18:31 Mar 13, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1176.IH H1176 khammond on DSKJM1Z7X2PROD with BILLS 3 •HR 1176 IH (7) Men with a father or brother with prostate 1 cancer are more than twice as likely to be diagnosed 2 with prostate cancer than men without a family his- 3 tory. 4 (8) The common clinical definition for men at 5 high-risk of prostate cancer includes African-Amer- 6 ican men and men with a family history. 7 (9) Most of the major cancer and urological so- 8 cieties recommend beginning screening discussions 9 earlier for African-American men and those with a 10 family history of prostate cancer. 11 (10) The United States Preventive Services 12 Task Force has encouraged research on screening 13 African-American men, including whether to screen 14 African-American men at younger ages, and has 15 identified this research as a high-priority cancer re- 16 search gap. 17 (11) Barriers to screening should be minimized 18 for high-risk men in order to catch asymptomatic 19 prostate cancer before it metastasizes and the sur- 20 vival rate is dramatically reduced. 21 (12) The cost of treating metastatic prostate 22 cancer in the United States health care system is 23 hundreds of millions of dollars more annually than 24 the cost of treating localized, early-stage cancer. 25 VerDate Sep 11 2014 18:31 Mar 13, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1176.IH H1176 khammond on DSKJM1Z7X2PROD with BILLS 4 •HR 1176 IH SEC. 3. REQUIREMENT FOR GROUP HEALTH PLANS AND 1 HEALTH INSURANCE ISSUERS OFFERING 2 GROUP OR INDIVIDUAL HEALTH INSURANCE 3 COVERAGE TO PROVIDE COVERAGE FOR 4 PROSTATE CANCER SCREENINGS WITHOUT 5 IMPOSITION OF COST-SHARING REQUIRE- 6 MENTS. 7 (a) IN GENERAL.—Subsection (a) of section 2713 of 8 the Public Health Service Act (42 U.S.C. 300gg–13) is 9 amended to read as follows: 10 ‘‘(a) COVERAGE OF PREVENTIVE HEALTH SERV- 11 ICES.— 12 ‘‘(1) IN GENERAL.—A group health plan and a 13 health insurance issuer offering group or individual 14 health insurance coverage shall, at a minimum, pro- 15 vide coverage for and shall not impose any cost-shar- 16 ing requirements for— 17 ‘‘(A) evidence-based items or services that 18 have in effect a rating of ‘A’ or ‘B’ in the cur- 19 rent recommendations of the United States Pre- 20 ventive Services Task Force; 21 ‘‘(B) immunizations that have in effect a 22 recommendation from the Advisory Committee 23 on Immunization Practices of the Centers for 24 Disease Control and Prevention with respect to 25 the individual involved; 26 VerDate Sep 11 2014 18:31 Mar 13, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1176.IH H1176 khammond on DSKJM1Z7X2PROD with BILLS 5 •HR 1176 IH ‘‘(C) with respect to infants, children, and 1 adolescents, evidence-informed preventive care 2 and screenings provided for in the comprehen- 3 sive guidelines supported by the Health Re- 4 sources and Services Administration; 5 ‘‘(D) with respect to women, such addi- 6 tional preventive care and screenings not de- 7 scribed in subparagraph (A) as provided for in 8 comprehensive guidelines supported by the 9 Health Resources and Services Administration 10 for purposes of this subparagraph; and 11 ‘‘(E) with respect to men who are at high 12 risk of developing prostate cancer (including Af- 13 rican-American men and men with a family his- 14 tory of prostate cancer (as defined in paragraph 15 (2))), such additional preventive care and 16 screenings not described in subparagraph (A) 17 for prostate cancer. 18 ‘‘(2) MEN WITH A FAMILY HISTORY OF PROS- 19 TATE CANCER DEFINED.—For purposes of para- 20 graph (1)(E), the term ‘men with a family history 21 of prostate cancer’ means men who have a first-de- 22 gree relative— 23 ‘‘(A) who was diagnosed with metastatic 24 prostate cancer; 25 VerDate Sep 11 2014 18:31 Mar 13, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1176.IH H1176 khammond on DSKJM1Z7X2PROD with BILLS 6 •HR 1176 IH ‘‘(B) who developed metastatic prostate 1 cancer; or 2 ‘‘(C) whose death was a result of prostate 3 cancer. 4 ‘‘(3) CLARIFICATION REGARDING BREAST CAN- 5 CER SCREENING, MAMMOGRAPHY, AND PREVENTION 6 RECOMMENDATIONS.—For the purposes of this Act, 7 and for the purposes of any other provision of law, 8 the current recommendations of the United States 9 Preventive Service Task Force regarding breast can- 10 cer screening, mammography, and prevention shall 11 be considered the most current other than those 12 issued in or around November 2009. 13 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in 14 this subsection shall be construed to prohibit a plan 15 or issuer from providing coverage for services in ad- 16 dition to those recommended by the United States 17 Preventive Services Task Force or to deny coverage 18 for services that are not recommended by such Task 19 Force.’’. 20 (b) EFFECTIVE DATE.—The amendment made by 21 subsection (a) shall apply with respect to plan years begin- 22 ning on or after January 1, 2022. 23 Æ VerDate Sep 11 2014 18:31 Mar 13, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H1176.IH H1176 khammond on DSKJM1Z7X2PROD with BILLS