SF5217

Purpose

Mandate health plans in Minnesota to cover cancer screening tests for residents, based on American Cancer Society guidelines, and to remove cost-sharing for these screenings. The bill would update several sections of Minnesota law to specify coverage for specific cancer screenings (breast, colorectal, ovarian risk, cervical, prostate, and lung) and their required follow-up tests.

Main Provisions

• 62A.30 Subd. 2 – Routine cancer screening coverage

  • Requires every health plan that covers Minnesota residents to pay for routine cancer screening procedures. This includes:
  • Mammograms (breast cancer screening).
  • Ovarian cancer surveillance tests for women at risk (as defined in the bill).
  • Pap smears (cervical cancer screening).
  • Colorectal cancer screening for both men and women when ordered by a physician.
  • Follow-up or surveillance steps tied to these screenings (e.g., a follow-up colonoscopy after a positive test).
  • Coverage must follow current American Cancer Society guidelines for frequency.
  • Coverage must include the necessary visits and examinations without cost-sharing (no copays, deductibles, or coinsurance).

• 62Q.50 Prostate cancer screening

  • Health plans must cover prostate cancer screening for:
  • Men 40 years and older who are symptomatic or in a high-risk category.
  • All men 50 years and older.
  • Tests covered include at minimum the prostate-specific antigen (PSA) blood test and a digital rectal examination (DRE), with follow-up exams as defined by ACS guidelines.
  • No cost-sharing for this coverage.
  • The section also notes how “health plan” is defined for this coverage (to ensure it applies broadly).

• 62Q.501 Cervical cancer screening

  • Health plans must cover cervical cancer screening for women in line with ACS guidelines.
  • Coverage includes all cervical screening tests and follow-up exams used to evaluate an abnormal result. This includes tests and follow-ups even if sampling from prior or different dates is used.
  • Follow-up options may include human papillomavirus (HPV) testing with typing, cytology (including dual stain), or colposcopy with biopsy.
  • No cost-sharing for this coverage.

• 62Q.502 Lung cancer screening

  • Health plans must cover lung cancer screening per ACS guidelines.
  • Coverage includes all screening tests and follow-up examinations identified in ACS guidelines.
  • Follow-up tests may include chest imaging (e.g., chest X-ray, CT, MRI, PET) or biopsy.
  • No cost-sharing for this coverage.

• Sec. 5

  • The provided excerpt ends before Sec. 5 text; no details are shown for this section.

Significant Changes to Existing Law

• Expands mandated cancer screening coverage to a broad set of cancers (breast, colorectal, ovarian risk, cervical, prostate, lung) and requires alignment with American Cancer Society guidelines.
• Eliminates patient cost-sharing (copays, deductibles, coinsurance) for these covered screenings and their required follow-ups.
• Updates state statutes (sections 62A.30, 62Q.50, 62Q.501, 62Q.502) to codify these new coverage requirements and reference ACS guidelines for frequency and methods.
• Broadens the definition of health plan coverage to ensure these screenings and follow-ups are included across plan types, including cases where other coverage exclusions might apply.

Practical Impact

• People in Minnesota could have easier access to recommended cancer screenings at no extra out-of-pocket cost.
• Screening programs may lead to earlier detection and potentially better outcomes for several cancers.
• Health plans would need to incorporate these guidelines into their coverage and eliminate cost-sharing for the specified screenings and follow-ups.

Relevant Terms - American Cancer Society guidelines - routine screening procedures - colorectal cancer screening - mammograms - pap smears - breast cancer screening - cost-sharing - copays - deductibles - coinsurance - at-risk / high-risk (ovarian cancer risk) - prostate cancer screening - prostate-specific antigen (PSA) test - digital rectal examination (DRE) - follow-up examinations - urinary analysis - serum biomarker testing - medical imaging - biopsy - cervical cancer screening - human papillomavirus (HPV) testing with typing - cytology - dual stain - colposcopy - lung cancer screening - chest X-ray - computed tomography (CT) - magnetic resonance imaging (MRI) - positron emission tomography (PET) scan - health plan (definition in the context of coverage) - Minnesota Statutes sections 62A.30, 62Q.50, 62Q.501, 62Q.502