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SCLD Update |
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| Other Topics in this Issue: Breast Cancer
Detection |
Prostate Cancer Detection Five states—Illinois, Maryland, North Dakota, Tennessee, and Texas—passed laws relating to coverage for prostate cancer screening. The laws enacted in Illinois (H.B. 1881) and North Dakota (S.B. 2115) require certain insurers, HMOs, and public employee health plans (Illinois only) to provide coverage for annual digital rectal examinations and prostate-specific antigen (PSA) tests for: (1) African-American men ages 40 and older, (2) men ages 40 and older who have a family history of cancer, and (3) asymptomatic men ages 50 and older. In Illinois, coverage is contingent upon a physician's recommendation for screening. See the additional summaries of the Illinois bill in the Breast Cancer Detection/Third-Party Reimbursement section, the Breast Cancer Detection/Inpatient Care section, and the Cervical Cancer Detection/Third-Party Reimbursement section. Maryland enacted two laws (H.B. 1040 and S.B. 428), effective October 1, 1997, that require certain insurers, including HMOs, to provide coverage for a digital rectal examination and a PSA test when the test is used for men between 40 and 75 years of age or for patients who are at high risk for prostate cancer. The coverage requirements also apply when testing for the purposes of monitoring the response to prostate cancer treatment or staging to determine the need for a bone scan in patients with prostate cancer. Benefits must be provided to the same extent as for any other medical condition. A Tennessee law (H.B. 570) requires specified insurers to provide, upon the recommendation of a physician, coverage for prostate cancer early detection services for men ages 50 and older, and other men if the services are determined by a physician to be medically necessary. Texas (S.B. 258) requires designated insurers, including HMOs, to provide coverage for an annual diagnostic exam for the detection of prostate cancer, effective January 1, 1998. At a minimum, coverage must include a physical examination and a PSA test for asymptomatic males at least 50 years of age, or males at least 40 years of age with a family history of, or risk factor for, prostate cancer. Screening Information The Grant H. Kenyon Prostate Cancer Detection Act ("Act," S.B. 1) in California requires physicians and surgeons who examine a patient's prostate gland to provide information to the patient about the availability of diagnostic procedures, including a PSA test. Information on the procedures must be provided if any of the following conditions exist: (1) the patient is over 50 years of age; (2) the patient demonstrates clinical symptoms; (3) the patient is at increased risk of prostate cancer; or (4) the provision of the information is medically necessary, in the opinion of the physician and surgeon. Violation of the Act constitutes unprofessional conduct. Treatment Options Legislation enacted in New York (S.B. 4361) requires the state Commissioner of Health to develop a standardized written summary about prostate cancer. The summary must be written in nontechnical language and explain the following: (1) symptoms and risk factors associated with prostate cancer; (2) available methods for detection and diagnosis, including information on the relative accuracy of available detection and diagnostic techniques; and (3) alternative, medically viable methods of treatment. The summary must also contain information on prostate post- treatment risks and other relevant information to aid a person in choosing a course of treatment. A health care provider may distribute the summary to male patients who are or may be at risk for, or have been diagnosed with prostate cancer. Awareness Florida adopted S.R. 2392 that recognized June 1997 as Prostate Cancer Awareness Month. The resolution urges all men, particularly those in high-risk populations, to become aware of the risks and symptoms associated with prostate cancer and to be informed about screening tests, methods for early detection, and treatment. |
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