HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 241 Coverage for Skin Cancer Screenings
SPONSOR(S): Select Committee on Health Innovation, Massullo and Payne
TIED BILLS: IDEN./SIM. BILLS: CS/SB 56
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Select Committee on Health Innovation 14 Y, 0 N, As CS Lloyd Calamas
2) Appropriations Committee 24 Y, 0 N Helpling Pridgeon
3) Health & Human Services Committee 19 Y, 0 N Lloyd Calamas
SUMMARY ANALYSIS
Florida’s state employee health coverage is managed by the Division of State Group Insurance (DSGI) within
the Department of Management Services (DMS). Under the authority of s. 110.123, F.S., the DSGI procures
the benefits contracts, and manages the state’s benefits program (Program) for over 300,000 state employees,
their spouses, and dependents.
Cancer is the second leading cause of death in the United States and skin cancer deaths represent five
percent of all cancer deaths. Over 9,600 new cases of skin cancer in Florida are diagnosed every year;
however, the long term survival rates of those diagnosed are high with early detection.
CS/HB 241 requires contracted state group health insurance plans or health maintenance organizations
(HMOs) to provide coverage and payment, without the imposition of a deductible, copayment, coinsurance, or
any other cost sharing requirement, an annual skin cancer screening by a dermatologist licensed under
chapters 458 or 459, a physician assistant licensed under chapters 458 or 459, or an advanced practice
registered nurse who is under the supervision of a dermatologist licensed under chapters 458 and 459, F.S.
DSGI oversees the day to day operations of the State Group Program.
Additionally, the bill prohibits the DSGI-contracted health plans from bundling a payment for a skin cancer
screening with any other procedure or service, including an evaluation or management visit, which is
performed during the same office visit or subsequent office visit.
The bill has a significant negative fiscal impact on the state employee group health plan, and no impact on
local government.
The bill provides an effective date of July 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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DATE: 2/15/2024
 FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Skin Cancer
Cancer is the second most common cause of death in the United States after heart disease and in
2023, a total of 1.9 million new cancer cases were diagnosed. 1 Of the estimated new cancer cases in
the United States, five percent were skin cancer cases. 2
Florida’s 2023 rates show an estimated number of 162,410 total new cases and 47,410 deaths for all
cancer types. The actual number of cases is not known as skin cancer diagnoses are not required to be
reported to cancer registries.3
There are two main types of cancer: nonmelanoma or keratinocyte carcinoma which includes
squamous cell carcinoma (SCC) and basal cell carcinoma and melanoma. 4 The most common types
are the nonmelanoma types and most of these cancers can be cured.
Cutaneous melanoma can occur on any part of the skin. Unusual moles, exposure to sunlight, and
health history can affect a person’s risk of melanoma.5 In men, melanoma is often found in the area
from the shoulders to the hips, or the head and neck. In women, it is most often found on the arms and
legs.6 However, melanoma may also occur in the eyes. When it does occur in the eyes, it is known
either intraocular or ocular melanoma.
Ocular melanoma (OM) is the most common primary eye tumor in adults and nearly 2,000 new cases
are diagnosed each year in the United States, second only to cutaneous melanoma. 7 Intraocular
melanoma is a type of melanoma that forms in the tissues of the eyes and is a rare cancer.8 Risk
factors for this particular disease including having a fair complexion, being of an older age, and being
white.9 Ocular melanoma is most commonly diagnosed around age 55 and will metastasize to another
organ in about half of all cases.10 In 90 percent of cases where the tumor does metastasize, it first
spreads to the liver.11 While there is no known cure for OM, several treatment options are available
depending on the patient’s status and symptoms, including watchful waiting, surgery, or radiation
therapy.12
More than 1.4 million people were identified in the United States in 2020 as living with this cancer.13
Men and women are diagnosed with skin cancer at starkly different rates. The rate of new cases per
1 American Cancer Society, Incidence Drops for Cervical Cancer But Rises for Prostate Cancer (January 12, 2024), available at
https://www.cancer.org/research/acs-research-news/facts-and-figures-2023.html (last viewed January 13, 2024).
2 Id.
3
American Cancer Society, Cancer Facts & Figures 2023, p. 25, available at Cancer Facts & Figures 2023 (last viewed January 13,
2024).
4 National Cancer Institute, Skin Cancer Screening (PDQ) – Patient Version, available at Skin Cancer Screening - NCI (last viewed
January 10, 2024).
5 National Cancer Institute, Melanoma Treatment (PDQ) – Patient Version, available at Melanoma Treatment - NCI (cancer.gov) (last
viewed January 12, 2024).
6 Id.
7 Melanoma Research Foundation, Ocular Melanoma Fact Sheet (August 13, 2019), available at Ocular Melanoma Fact Sheet
(flippingbook.com) (last viewed January 12, 2024).
8 National Cancer Institute, Melanoma Treatment (PDQ) – Patient Version, available at Melanoma Treatment - NCI (cancer.gov) (last
viewed January 12, 2024).
9 Id.
10 Id.
11 Melanoma Research Foundation, Ocular Melanoma Patient Guide, p.14, available at https://online.flippingbook.com/view/745990/16-
17/ (last viewed January 12, 2024).
12 Supra, note 8.
13 National Cancer Institute, Cancer Stat Facts: Melanoma of the Skin, available at https://seer.cancer.gov/statfacts/html/melan.html
(last viewed January 12, 2024).
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 100,000 persons for the time period of 2016-2020 for males was 26.9 and for females was 16.7. 14
Incidence rates are higher in women than in men before age 50, but after that the incident rates are
increasingly higher in men. These trends have been associated with age differences in historical
occupational and recreational exposure to ultraviolet radiation (UV) for men, increased use of indoor
tanning among young women, and improvements in early detection practices over time. 15
Differences by race and ethnicity in the number of new cases of cancer nationally are also present, as
the chart below shows.16
National estimates for the probability of developing skin cancer over one’s lifetime is 2.9 percent which
is the sixth highest behind uterine (3.1 percent), colorectum (4.1 percent), lung and bronchus (6
percent), prostate (12.6 percent), and breast (12.9 percent).17
The long term survival rate is high for those diagnosed with skin cancer after five years at 93.5 percent.
The more localized the cancer is when it is found, meaning the cancer has been confined to a primary
spot, the higher the survival rate is compared to a cancer that has spread to the regional lymph nodes
or metastasized to another region of the body.18
Skin Cancer in Florida
For Florida, the estimated new cases of skin cancer are 9,640 with projected deaths at 680
individuals.19 The state’s incidence rate was calculated at 25.70, indicating the number of diagnoses
14 American Cancer Society, Cancer Statistic Center, Prob ability of Developing or Dying of Cancer, b y Type (data run on January 13,
2024) available at Cancer Statistics Center - American Cancer Society (last viewed January 13, 2024).
15 American Cancer Society, Cancer Facts & Figures 2023, p. 25, available at Cancer Facts & Figures 2023, (last viewed January 12,
2024).
16 Id.
17 Id.
18 National Cancer Institute, Cancer Stat Facts: Melanoma of the Skin, Survival b y State, available at
https://seer.cancer.gov/statfacts/html/melan.html (last viewed January 12, 2024).
19 American Cancer Society, Cancer Statistics Center, Estimated New Cancer Cases and Deaths b y States (sexes com b ined, Florida)
(data run on January 13, 2024) available at Cancer Statistics Center - American Cancer Society (last viewed January 13, 2024).
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 per 100,000 individuals.20 In 2020, 4,477 new cases were reported for males and 2,770 cases for
women.21 Hospitalization rates and cost data for Florida are illustrated in the chart below.
Skin Cancer – Comparisons by Sex – Florida Only22
Total and Length Median Length
# of Total Charges
of Stay Per of Stay Per
Hospitalizations (in millions)
Hospitalization Hospitalization
All Cancers 72,456 441,678 4.0 $8,632.7
Melanoma
TOTAL: 136 594 2.0 $12.1
Female 41 184 4.0 $3.5
Male 95 410 2.0 $8.6
From a national perspective, Florida ranks 17th for the rate of melanoma per 100,000 people and 30th
when compared to other states for mortality rates.23 Increased exposure to UV radiation from the sun,
and indoor or outdoor tanning beds are major risks for skin cancer and Floridians may carry a higher
likelihood of such risks than individuals in other states. Other artificial sources of UV radiation include
mercury vaping lighting which is usually found in stadiums and school gyms, some halogen, florescent
and incandescent lights, and a few types of lasers. 24
A few Florida counties have significantly higher incident rates for skin cancer with rates that fall in the
32.7 to 45.6 per 100,000 per incident rate.25 Statistical models used by the National Cancer Institute
show that new cases are on the rise at the rate of 1.2 percent per year nationally from 2010 through
2019, but for the period of time of 2015 through 2020, Florida’s incident rate has remained stable.
20 American Cancer Society, Cancer Statistics Center, Incidence Rates b y State and By Type (data run on January 13, 2024) available
at Cancer Statistics Center - American Cancer Society (last viewed January 13, 2024).
21 Florida Cancer Data System, Tab le 1:Number of New Cancer Cases b y Sex and Race, available at
https://fcds.med.miami.edu/downloads/FloridaAnnualCancerReport/2020/Table_No_T1_(2020).pdf (last viewed January 11, 2024).
22 Florida Cancer Data System, Tab les 33 – 38: Numb er of Cancer Hospitalizations b y Sex, reports generated at
https://fcds.med.miami.edu/inc/statistics_data_vizf.shtml (last viewed January 12, 2024).
23American Cancer Society, Cancer Statistic Center, Cancer Statistic Center, available at Cancer Statistics Center - American Cancer
Society (last viewed January 14, 2024). .
24 Centers for Disease Control and Prevention, UV Radiation, availab le at https://www.cdc.gov/nceh/features/uv-radiation-
safety/index.html (last viewed January 10, 2024).
25 National Cancer Institute, Interactive Maps – Incident Rates for Florida b y County, Melanoma of the Skin, 2016 – 2020, All Races
(includes Hispanic), Both Sexes, All Ages, report can be re-generated at Interactive Maps (cancer.gov), (last viewed January 10, 2024).
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 A corresponding map showing the death rate by county reflects a different set of counties. The
grouping of counties in southwestern Florida are in one of the lowest death rate quartiles meaning
those counties have fewer residents who were diagnosed succumb to death because of that diagnosis.
Likewise, many of the southeastern Florida counties have also fallen into the lower death rates as
shown in the next figure.26
25Id.
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 Skin Cancer Screening
During a skin cancer screening test, a doctor or nurse checks a patient’s skin for moles, birthmarks, or
other pigmented areas that may be abnormal in color, size, shape, or texture. If an area looks
abnormal, a biopsy of the area may be done where the health care provider may remove as much of
the suspicious tissue as possible with a local excision. A pathologist reviews this tissue under a
microscope to check for cancer cells.27
The American Academy of Dermatologists (AAD) encourages everyone to perform skin self-exams for
signs of skin cancer and to get an exam from a doctor, especially if a new spot is found, or an existing
spot changes, bleeds, or itches.28 Individuals with a history of melanoma should have a full-body exam
by a board-certified dermatologist at least annually and perform regular self-exams to check for any
changes. A Body Mole Map is available on the AAD website which allows an individual to record a
response for each of the A, B, C, D, and E components discussed below and to record the location of
the spot on one sheet.29
The American Melanoma Foundation provides a “Record Your Spots” self-check body map on its
website to help individuals document any new or changing areas. The AAD also has an infographic to
assist individuals with self-checking through the ABCDEs of Melanoma. For each letter, the individual is
reminded to look for a warning sign:
 A stands for asymmetry; does one half of the spot look different than the other?
 B stands for border; does the spot have an irregular, scalloped, or poorly defined border?
 C stands for color; does the spot have varying colors from one area to the next?
 D stands for diameter; what is the size?
 E stands for evolving; does the spot look different from the rest or is it changing in size, shape,
or color?
The United States Preventive Services Task Force (USPSTF) is a volunteer board of national experts
in prevention and evidence-based medicine who make recommendations using letters grades (A, B, C,
D or I) after a review of the evidence and the balance of benefits and harms of a preventive service .30
In April 2023, the USPST issued its final recommendations on screening for skin cancer and
determined that there was not enough evidence to recommend for or against screening all individuals
without symptoms. As a result, the recommendation, received an “I” grade. 31 The Task Force noted that
evidence on screening is limited and Task Force members wanted the recommendation to draw
attention to more culturally diverse research and to be reflective of the nation’s population.32,33 Because
27 National Cancer Institute, Skin Cancer Screening (PDQ) – Patient Version, available at Skin Cancer Screening - NCI (last viewed
January 12, 2024).
28 American Academy of Dermatologists, Infographic: How to Spot Skin Cancer, Infogra https://www.aad.org/pub lic/diseases/skin-
cancer/how-to-spot-skin-cancer phic: How to SPOT Skin Cancer™ (aad.org), (last viewed January 12, 2024).
29
American Academy of Dermatology, Infographic: Skin Cancer Body Mole Map, available at https://www.aad.org/public/diseases/skin-
cancer/find/mole-map (last viewed January 12, 2024).
30 An “A” grade means the USPSTF recommends the service and there is a high certainty that the net benefit of the service is
substantial. A service with a “B” grade is also recommended, and there is a finding of a high certainty that the net benefit is moderate or
there is a moderate certainty that the net benefit is moderate to substantial. 30 A service or screening receiving a “C” grade is
recommended to be offered selectively or to be provided to patients based on professional judgment and patient preference s. There is
at least a moderate certainty that the net benefit is small. A “D” grade reflects the task force’s recommendation against the service
finding moderate or high certainty that the service has no net benefit or that the harms outweigh the risks. U .S. Preventive Services
Task Force, Grade Definitions after July 2012, available at https://www.uspreventiveservicestaskforce.org/apps/gradedef.jsp (last
viewed January 12, 2024).
31 An “I” grade by the USPSTF means the task force concluded that current evidence is inconclusive to assess the balance of bene fits
and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefit and harms can not be
determined. United States Prevention Services Task Force, U.S. Preventive Services Task Force Issues Final Recommendation on
Screening for Skin Cancer (April 18, 2023),