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F I S C A L I M P A C T R E P O R T

SPONSOR Nava

ORIGINAL DATE

LAST UPDATED

2/16/07

HB

SHORT TITLE Colorectal Cancer Screening Insurance

SB 851

ANALYST Earnest

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY07

FY08

NFI

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to House Bill 510

SOURCES OF INFORMATION

LFC Files

Responses Received From

Public Regulation Commission (PRC)

Public Education Department (PED)

Department of Health (DOH)

SUMMARY

Synopsis of Bill

Senate Bill 851 adds new sections to the insurance code to mandate that health insurers,

including HMOs and Nonprofit health care plans, provide insurance coverage for colorectal

screening. The bill does not apply to short-term travel, accident-only or limited or specified

benefit disease policies. The coverage would be subject to deductibles and coinsurance

consistent with those imposed on other benefits under the policy.

The coverage shall make available CRC screening as determined by the health care provider in

accordance with the evidence-based recommendations of the United States Preventive Services

Task Force (USPSTF).

FISCAL IMPLICATIONS

None identified.

Senate Bill 851 – Page

2

SIGNIFICANT ISSUES

According to DOH:

In 2004, nearly 38% of NM adults ages 50 and older reported never having had a CRC

exam using fecal occult blood testing, sigmoidoscopy or colonoscopy (NM Cancer Facts

and Figures, 2007). It is estimated that 860 new cases of CRC were diagnosed and 320

people died from the disease in NM [American Cancer Society (ACS), 2006

http://www.cancer.org/downloads/stt/CAFF06EsMcSt.pdf]. Screening and early

detection for CRC can diagnose cancers earlier, when they are more responsive to

treatment, and can also prevent the disease by the removal of pre-cancerous polyps.

Diagnosing and treating CRC early results in a survival rate of 90% (ACS, 2005).

An analysis by the ACS shows that CRC screening rates rose faster and are significantly

higher in states that passed coverage laws since 2001, compared to states with no laws

(ACS, National Government Relations Dept, 2006). In 2005, the National CRC Research

Alliance gave New Mexico a grade of ‘F’ in its report card due to lack of legislation

requiring insurance providers to cover CRC screening. About 17 states have legislation

mandating health plan coverage for CRC screening. The best legislation specifically

defines the types of CRC screening covered and references accepted screening

guidelines, allowing for the inclusion of coverage of future advances in screening

methods.

The United States Preventive Services Task Force (USPSTF), the leading independent

panel of private-sector experts in prevention and primary care, says that screening options

for CRC include home fecal occult blood tests (FOBT), flexible sigmoidoscopy, the

combination of home FOBT and flexible sigmoidoscopy, colonoscopy, and double-

contrast barium enema. Each option has advantages and disadvantages that vary for

individual patients and practice settings.

The United States Preventive Services Task Force recommendations are considered the

“gold standard" for preventive services, and are used by the Clinical Preventive Initiative,

a joint project of the NM Medical Society and the NM Department of Health.

PRC notes that most current health insurance coverage provides for colorectal screenings

contemplated by SB 851 and mandating the coverage may be unnecessary. PRC’s Insurance

Division has not received complaints concerning a lack of coverage for this procedure.

PERFORMANCE IMPLICATIONS

DOH finds that SB 851 supports the NM Cancer Council’s goals to increase colorectal cancer

screening among New Mexicans ages 50 years and older, and in younger New Mexicans who

may be at higher risk.

ADMINISTRATIVE IMPLICATIONS

None identified.

Senate Bill 851 – Page

3

CONFLICT, DUPLICATION, COMPANIONSHIP, RELATIONSHIP

SB 851 relates to HB 510. The bills are identical except that HB 510 references “national

medical standards" instead of “the evidence-based recommendations of the United States

Preventive Services Task Force."

TECHNICAL ISSUES

On line 25 of page 1 insert the word “with" after “accordance" and before “the".

OTHER SUBSTANTIVE ISSUES

DOH indicates that colorectal cancer incidence rates are highest among non-Hispanic white men

and lowest among American Indian women. Mortality rates are highest among black men and

lowest among American Indian women. Incidence has been steadily declining for most

racial/ethnic groups except for Hispanic and American Indian men. For Hispanic men the

incidence of colorectal cancer doubled over the last 30 years, while in American Indian men it

tripled. (NM Cancer Facts and Figures, 2007).

BE/mt