Mandated coverage for cancer-screening services: whose guidelines do states follow?
OBJECTIVE
To determine the prevalence and nature of state coverage mandates for cancer screening.


METHODS
We contacted insurance departments in 50 states, Washington, DC, and Puerto Rico for copies of state codes that mandate coverage of screening for breast, cervical, prostate, and colorectal cancer by private insurers. We further compared mandates, when identified, with American Cancer Society (ACS) and U.S. Preventive Services Task Force (USPSTF) guidelines for likely sources of screening recommendations.


RESULTS
Forty-three states and the District of Columbia currently mandate coverage of cancer screening. Breast cancer-screening coverage was most frequently mandated (n =44), followed by cervical (n =22), prostate (n =18), and colorectal cancer screening (n =1). Twenty-three states used ACS guidelines only, 18 states used ACS and non-ACS/non-USPSTF guidelines, and 3 states used only non-ACS/non-USPSTF guidelines in development of coverage mandates. No state screening coverage mandate reflected USPSTF-screening guidelines. Of 85 mandates in place, 57 have been passed since 1990.


CONCLUSIONS
Although state mandates for insurer coverage of cancer screening are common and increasing, we found noticeable inter- and intra-state variation in coverage, selection, and use of screening guidelines.
Clinical Economics Research Unit, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
S S
SS
Rathore
J D
JD
McGreevey
K A
KA
Schulman
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D
Atkins
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D008297:Male; D008327:Mammography; D008403:Mass Screening / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D017430:Prostate-Specific Antigen / Q000097:blood; D012812:Sigmoidoscopy; D013219:State Government; D014481:United States; D014626:Vaginal Smears
D017430:Prostate-Specific Antigen