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Committee debates AB 536 to expand covered colorectal screening tests and close coverage gap for 45–64 age group
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Summary
Assembly Bill 536 would update California law to allow insurers to consider clinical guidelines from the American Cancer Society and CMS when determining coverage for newly FDA-approved colorectal screening tests. Supporters said it would close access gaps; insurers and health-plan groups opposed, citing process and evidentiary concerns.
Assembly Bill 536: The Senate Committee on Health heard Assemblymember Patterson present AB 536, intended to ensure that Californians retain coverage for colorectal cancer screening tests despite federal litigation affecting guideline bodies, and to broaden the set of guideline sources insurers may use when determining coverage for new FDA-approved screening tests.
Why it matters: Supporters said the measure would reduce disparities in access to innovations such as blood-based colorectal screening tests that Medicare covers, closing a coverage gap for people ages 45–64. Opponents, including insurers and industry groups, argued the bill would bypass established processes for determining preventive coverage and could compel plans to cover tests that are not yet proven to match the gold standard of colonoscopy.
Support and testimony: The author said AB 536 would add clinical guidelines developed by the American Cancer Society (ACS) and by the Centers for Medicare & Medicaid Services (CMS) to the sources that may be used to determine coverage without cost sharing. The bill would thus allow payers to consider those guideline bodies alongside the U.S. Preventive Services Task Force (USPSTF). The author and witnesses noted that Medicare beneficiaries already have access to a new FDA-approved blood test and that expanding coverage could raise California’s screening rates (currently cited in the hearing as about 53% up to a national goal of 80%). The author described personal motivation related to a friend diagnosed young and said the bill passed the Assembly unanimously.
Opposition: Stephanie Watkins, representing the Association of California Life and Health Insurance Companies, and other health-plan and insurer representatives said the bill risks bypassing the usual evidence review processes (such as USPSTF recommendations and the state task force) and could impose statutory coverage mandates before sufficient evidence of equivalency to colonoscopy exists.
Committee action and status: The author accepted committee amendments and asked for an aye vote. The committee did not have quorum to finalize a motion immediately during the presentation; later in the hearing a motion to pass as amended and refer to Appropriations was recorded. The final roll-call outcome recorded in the hearing for this item was yes 8, no 1, others 0; the measure advanced to the Committee on Appropriations.
Next steps: AB 536 will be considered further by the Senate Committee on Appropriations.
