PSA Screening for HIM Act

I 116TH CONGRESS 1ST SESSION H. R. 5200 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 NOVEMBER 20, 2019 Mr. RUSH (for himself, Mr. BUCSHON, Mr. BABIN, Mrs. BROOKS of Indiana, Mr. CARSON of Indiana, Ms. JUDY CHU of California, Mr. COHEN, Mr. DUNN, Mr. KING of New York, Mr. MEEKS, Mr. MURPHY of North Caro- lina, Mr. PAYNE, Mr. DAVID P. ROE of Tennessee, Mr. DAVID SCOTT of Georgia, Ms. SEWELL of Alabama, and Mr. WILLIAMS) introduced the following bill; which was referred to the Committee on Energy and Com- merce 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 VerDate Sep 11 2014 23:09 Nov 29, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5200.IH H5200 kjohnson on DSK79L0C42 with BILLS 2 •HR 5200 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Prostate-Specific Anti- 2 gen Screening for High-risk Insured Men Act’’ or the 3 ‘‘PSA Screening for HIM Act’’. 4 SEC. 2. FINDINGS. 5 Congress finds the following: 6 (1) Prostate cancer is the second leading cause 7 of cancer death in men in the United States with 1 8 in 41 men dying from prostate cancer and more 9 than 31,600 men estimated to die from prostate 10 cancer in 2019. 11 (2) Prostate cancer is the second most com- 12 monly diagnosed cancer in the Nation with 1 in 9 13 men being diagnosed in their lifetimes, 3.1 million 14 men in the United States living with a diagnosis, 15 and over 174,000 men estimated to be diagnosed in 16 2019. 17 (3) The survival rate for prostate cancer diag- 18 nosed in early stage is near 100 percent but prostate 19 cancer diagnosed in late stage has only a 30-percent 20 survival rate. 21 (4) There are few, if any, symptoms of prostate 22 cancer before it reaches late stage. 23 (5) African-American men have a disproportion- 24 ately higher rate of prostate cancer and are 70 per- 25 cent more likely to be diagnosed with prostate can- 26 VerDate Sep 11 2014 23:09 Nov 29, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5200.IH H5200 kjohnson on DSK79L0C42 with BILLS 3 •HR 5200 IH cer than White men, with 1 in 6 African-American 1 men developing prostate cancer in their lifetimes. 2 (6) African-American men are 2.3 times more 3 likely to die from prostate cancer than White men. 4 (7) Men with a father or brother with prostate 5 cancer are more than twice as likely to be diagnosed 6 with prostate cancer than men without a family his- 7 tory. 8 (8) The common clinical definition for men at 9 high-risk of prostate cancer includes African-Amer- 10 ican men and men with a family history. 11 (9) Most of the major cancer and urological so- 12 cieties recommend beginning screening discussions 13 earlier for African-American men and those with a 14 family history of prostate cancer. 15 (10) The United States Preventive Services 16 Task Force has encouraged research on screening 17 African-American men, including whether to screen 18 African-American men at younger ages, and has 19 identified this research as a high-priority cancer re- 20 search gap. 21 (11) Barriers to screening should be minimized 22 for high-risk men in order to catch asymptomatic 23 prostate cancer before it metastasizes and the sur- 24 vival rate is dramatically reduced. 25 VerDate Sep 11 2014 23:09 Nov 29, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5200.IH H5200 kjohnson on DSK79L0C42 with BILLS 4 •HR 5200 IH (12) The cost of treating metastatic prostate 1 cancer in the United States health care system is 2 hundreds of millions of dollars more annually than 3 the cost of treating localized, early-stage cancer. 4 SEC. 3. REQUIREMENT FOR GROUP HEALTH PLANS AND 5 HEALTH INSURANCE ISSUERS OFFERING 6 GROUP OR INDIVIDUAL HEALTH INSURANCE 7 COVERAGE TO PROVIDE COVERAGE FOR 8 PROSTATE CANCER SCREENINGS WITHOUT 9 IMPOSITION OF COST-SHARING REQUIRE- 10 MENTS. 11 (a) IN GENERAL.—Subsection (a) of section 2713 of 12 the Public Health Service Act (42 U.S.C. 300gg–13) is 13 amended to read as follows: 14 ‘‘(a) COVERAGE OF PREVENTIVE HEALTH SERV- 15 ICES.— 16 ‘‘(1) IN GENERAL.—A group health plan and a 17 health insurance issuer offering group or individual 18 health insurance coverage shall, at a minimum, pro- 19 vide coverage for and shall not impose any cost-shar- 20 ing requirements for— 21 ‘‘(A) evidence-based items or services that 22 have in effect a rating of ‘A’ or ‘B’ in the cur- 23 rent recommendations of the United States Pre- 24 ventive Services Task Force; 25 VerDate Sep 11 2014 23:09 Nov 29, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5200.IH H5200 kjohnson on DSK79L0C42 with BILLS 5 •HR 5200 IH ‘‘(B) immunizations that have in effect a 1 recommendation from the Advisory Committee 2 on Immunization Practices of the Centers for 3 Disease Control and Prevention with respect to 4 the individual involved; 5 ‘‘(C) with respect to infants, children, and 6 adolescents, evidence-informed preventive care 7 and screenings provided for in the comprehen- 8 sive guidelines supported by the Health Re- 9 sources and Services Administration; 10 ‘‘(D) with respect to women, such addi- 11 tional preventive care and screenings not de- 12 scribed in subparagraph (A) as provided for in 13 comprehensive guidelines supported by the 14 Health Resources and Services Administration 15 for purposes of this subparagraph; and 16 ‘‘(E) with respect to men who are at high 17 risk of developing prostate cancer (including Af- 18 rican-American men and men with a family his- 19 tory of prostate cancer (as defined in paragraph 20 (2))), such additional preventive care and 21 screenings not described in subparagraph (A) 22 for prostate cancer. 23 ‘‘(2) MEN WITH A FAMILY HISTORY OF PROS- 24 TATE CANCER DEFINED.—For purposes of para- 25 VerDate Sep 11 2014 21:50 Dec 02, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5200.IH H5200 kjohnson on DSK79L0C42 with BILLS 6 •HR 5200 IH graph (1)(E), the term ‘men with a family history 1 of prostate cancer’ means men who have a first-de- 2 gree relative— 3 ‘‘(A) who was diagnosed with metastatic 4 prostate cancer; 5 ‘‘(B) who developed metastatic prostate 6 cancer; or 7 ‘‘(C) whose death was a result of prostate 8 cancer. 9 ‘‘(3) CLARIFICATION REGARDING BREAST CAN- 10 CER SCREENING, MAMMOGRAPHY, AND PREVENTION 11 RECOMMENDATIONS.—For the purposes of this Act, 12 and for the purposes of any other provision of law, 13 the current recommendations of the United States 14 Preventive Service Task Force regarding breast can- 15 cer screening, mammography, and prevention shall 16 be considered the most current other than those 17 issued in or around November 2009. 18 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in 19 this subsection shall be construed to prohibit a plan 20 or issuer from providing coverage for services in ad- 21 dition to those recommended by the United States 22 Preventive Services Task Force or to deny coverage 23 for services that are not recommended by such Task 24 Force.’’. 25 VerDate Sep 11 2014 23:09 Nov 29, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5200.IH H5200 kjohnson on DSK79L0C42 with BILLS 7 •HR 5200 IH (b) EFFECTIVE DATE.—The amendment made by 1 subsection (a) shall apply with respect to plan years begin- 2 ning on or after January 1, 2021. 3 Æ VerDate Sep 11 2014 23:09 Nov 29, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H5200.IH H5200 kjohnson on DSK79L0C42 with BILLS