The Office of the Commissioner of Insurance (OCI) is issuing this bulletin to alert insurers about recent changes to colorectal cancer screening guidelines and their effect on the application of cost-sharing provisions to insureds between the ages of 45 and 75. On June 17, 2021, OCI alerted insurers to the expanded age range for recommended preventive services for colorectal cancer screening.1
On January 10, 2022, the United States Department of Labor issued additional frequently asked questions (FAQs) based upon the updated United States Preventive Services Task Force (USPSTF) recommendations.2 The new FAQs clarify that insurers are required to cover, as a preventive service without cost-sharing, a colonoscopy following a positive non-invasive stool-based screening test and following a positive direct visualization test (i.e. flexible sigmoidoscopy, CT colonography). The Final Recommendation Statement identified that “the benefits of screening can only be fully achieved when follow-up of abnormal screening tests is performed." The updated coverage begins for plan or policy years beginning on or after May 31, 2022.
Insurers are reminded to continue to review colorectal cancer screening guidelines issued by the USPSTF, the National Cancer Institute, or the American Cancer Society. These guidelines are used as a basis for coverage of colorectal cancer screening tests and procedures in accordance with s. 632.895 (16m), Wis. Stats., and s. Ins 3.35, Wis. Adm. Code. Benefits offered for the detection of colorectal cancer screening should be updated to be reflective of the guideline standards selected by the insurer. This will ensure that consumers are receiving the most up-to-date cancer screenings that have been determined to be effective in early detection of colon cancer.
Any questions concerning this bulletin may be directed to Sarah Smith, Director of Public Affairs, at
sarah.smith2@wisconsin.gov.
1 https://oci.wi.gov/Documents/Regulation/Bulletin20210617ColorectalCancerScreening.pdf
2
See FAQ Q7 and Q8
https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf