HF5082

Purpose

• Require health plans to cover routine cancer screening tests for Minnesota residents, following current American Cancer Society guidelines, and to do so without requiring the usual cost-sharing like copays, deductibles, or coinsurance.

Main Provisions

• 62A.30 Subd. 2 (general routine cancer screening)

  • Health plans must cover routine screening procedures and related office visits for cancer.
  • Includes: mammograms, ovarian cancer surveillance tests for women at risk, pap smears, and colorectal screening tests for all ages when ordered by a physician.
  • Colorectal screening must align with current American Cancer Society guidelines, including follow-up colonoscopy after a positive noninvasive screening test.
  • Breast cancer screening must follow ACS guidelines for average-risk and high-risk individuals, including all required breast examinations.
  • No cost-sharing (no copays, deductibles, or coinsurance) for this coverage.

• 62Q.50 Prostate cancer screening

  • Health plans must cover prostate cancer screening for:
  • Men 40+ who are symptomatic or at high risk, and
  • All men 50+,
  • In line with ACS guidelines.
  • Minimum coverage includes PSA blood test and digital rectal exam (DRE).
  • Must cover follow-up tests as identified in ACS guidelines (e.g., urinary analysis, biomarker testing, imaging, biopsy).
  • No cost-sharing for this coverage.
  • “Health plan” includes plans that might be excluded under certain other statutes.

• 62Q.501 Cervical cancer screening

  • Health plans must cover cervical cancer screening for women per ACS guidelines.
  • Coverage includes all cervical screening tests and examinations at the frequencies in ACS guidelines.
  • Follow-up exams to evaluate abnormalities are covered, including cases where samples or dates differ from the initial screening.
  • Follow-up may include HPV typing, cytology (including dual staining), and 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 related tests/exams at the frequencies identified by ACS guidelines.
  • Follow-up exams may include chest imaging (X-ray, CT, MRI, PET) or biopsy.
  • No cost-sharing for this coverage.

Significant Changes to Existing Law

• Expands required cancer screening coverage to include routine screenings for breast, colorectal, cervical, ovarian (for at-risk women), prostate, and lung cancers.
• Ties all coverage to current American Cancer Society guidelines, ensuring that what’s covered can adapt to guideline updates.
• Establishes that patients must not pay cost-sharing for these screenings and their required follow-up exams.
• Updates several Minnesota Statutes to codify these comprehensive, no-cost-sharing screening requirements into state law.

Practical Effect

• Minnesota residents with health plans will have broader, guideline-based access to cancer screening without extra out-of-pocket costs.
• Physicians’ recommended follow-up tests are covered, reducing barriers to completing required diagnostic steps after a screening result.
• Patients at higher risk (e.g., certain ages or risk groups) gain access to recommended preventive services earlier or more consistently.

Terminology Inclusion

• Key concepts present in the bill: health plan, coverage, routine screening procedures, office visit, mammograms, ovarian cancer surveillance, pap smear, colorectal screening tests, follow-up examinations, colonoscopy, breast cancer screening, average risk, high risk, cost-sharing, copays, deductibles, coinsurance, American Cancer Society guidelines, prostate cancer screening, PSA test, digital rectal exam, urinary analysis, biomarker testing, imaging, biopsy, cervical cancer screening, human papillomavirus (HPV) testing with typing, cytology, dual stain, colposcopy, at-risk, guidelines.

Relevant Terms - health plan - coverage - routine screening procedures - office visit - mammograms - ovarian cancer surveillance - pap smears - colorectal screening tests - colonoscopy - breast cancer screening - cost-sharing - copays - deductibles - coinsurance - American Cancer Society guidelines - prostate cancer screening - PSA - digital rectal exam - follow-up examinations - urinary analysis - biomarker testing - imaging - biopsy - cervical cancer screening - human papillomavirus (HPV) testing - cytology - dual stain - colposcopy - at-risk - guidelines