What This Bill Does
This bill amends federal health insurance law to require group health plans and health insurance companies to cover prostate cancer screenings for certain men without charging them any out-of-pocket costs. The bill specifically targets men age 40 and older who are at high risk of prostate cancer, defined as African-American men and men with a family history of the disease.
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Who It Affects
- Men age 40 and older who are African-American or have a family history of prostate cancer
- Group health plans (health insurance offered through employers)
- Health insurance companies offering group or individual health insurance coverage
- Health insurance customers who purchase coverage
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Key Provisions
- Health plans and insurance companies must provide coverage for evidence-based prostate cancer screenings and preventive care for men age 40 and over at high risk of prostate cancer, including African-American men and men with a family history of prostate cancer, without imposing any cost-sharing requirements (meaning no copayments, coinsurance, or deductibles). (Sec. 3(a))
- "Men with a family history of prostate cancer" is defined as men who have a first-degree relative (parent, sibling, or child) who was diagnosed with prostate cancer, developed prostate cancer, died from prostate cancer, was diagnosed with a related cancer, or has a genetic alteration associated with increased prostate cancer risk. (Sec. 3(a))
- Nothing in this law prevents insurance plans from covering additional services beyond what is recommended or from denying coverage for services not recommended by official guidelines. (Sec. 3(a))
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What Changes
If this bill becomes law, health insurance plans and insurance companies must cover prostate cancer screenings at no cost to qualifying men starting with plan years beginning on or after January 1, 2024. Currently, insurance companies may charge patients out-of-pocket costs for these screenings.
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Important Definitions
- **Cost-sharing requirements**: Out-of-pocket payments patients must make for health care, including copayments (fixed amounts per visit), coinsurance (a percentage of the cost), and deductibles (amounts patients pay before insurance coverage begins)
- **Evidence-based**: Supported by scientific research and evidence
- **First-degree relative**: A parent, sibling, or child
- **Prostate cancer screening**: Medical testing to detect prostate cancer, typically using a PSA (prostate-specific antigen) blood test
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Effective Date
Plan years beginning on or after January 1, 2024. (Sec. 3(b))
I
118TH CONGRESS
1ST SESSION H. R. 1826
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
MARCH 28, 2023
Mr. BUCSHON (for himself, Ms. CLARKE of New York, Mr. DUNN of Florida,
and Mr. CARTER of Louisiana) 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
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•HR 1826 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 34,700 men estimated to die from prostate
10
cancer in 2023.
11
(2) Prostate cancer is the second most com-
12
monly diagnosed cancer in the Nation with 1 in 8
13
men being diagnosed in their lifetimes, 3.1 million
14
men in the United States living with a diagnosis,
15
and over 288,000 men estimated to be diagnosed in
16
2023.
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
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•HR 1826 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 2.1 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
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•HR 1826 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
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•HR 1826 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 age 40
17
and over and are at high risk of developing
18
prostate cancer (including African-American
19
men and men with a family history of prostate
20
cancer (as defined in paragraph (2))), such ad-
21
ditional evidence-based preventive care and
22
screenings not described in subparagraph (A)
23
for prostate cancer.
24
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•HR 1826 IH
‘‘(2) MEN WITH A FAMILY HISTORY OF PROS-
1
TATE
CANCER
DEFINED.—For purposes of para-
2
graph (1)(E), the term ‘men with a family history
3
of prostate cancer’ means men who have a first-de-
4
gree relative—
5
‘‘(A) who was diagnosed with prostate can-
6
cer;
7
‘‘(B) who developed prostate cancer;
8
‘‘(C) whose death was a result of prostate
9
cancer;
10
‘‘(D) who have been diagnosed with a can-
11
cer known to be associated with increased risk
12
of prostate cancer; or
13
‘‘(E) who has a genetic alteration known to
14
be associated with increased risk of prostate
15
cancer.
16
‘‘(3) CLARIFICATION REGARDING BREAST CAN-
17
CER SCREENING, MAMMOGRAPHY, AND PREVENTION
18
RECOMMENDATIONS.—For the purposes of this Act,
19
and for the purposes of any other provision of law,
20
the current recommendations of the United States
21
Preventive Service Task Force regarding breast can-
22
cer screening, mammography, and prevention shall
23
be considered the most current other than those
24
issued in or around November 2009.
25
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•HR 1826 IH
‘‘(4) RULE
OF
CONSTRUCTION.—Nothing in
1
this subsection shall be construed to prohibit a plan
2
or issuer from providing coverage for services in ad-
3
dition to those recommended by the United States
4
Preventive Services Task Force or to deny coverage
5
for services that are not recommended by such Task
6
Force.’’.
7
(b) EFFECTIVE DATE.—The amendment made by
8
subsection (a) shall apply with respect to plan years begin-
9
ning on or after January 1, 2024.
10
Æ
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