This bill requires a health benefit plan to provide, upon the recommendation of a physician, coverage for the early detection of prostate cancer for men 40-49 who are at a high risk of developing prostate cancer, men 50 and older, and other men, if a physician determines that early detection for prostate cancer is medically necessary.
This bill generally requires a health benefit plan that provides coverage for the early detection of prostate cancer to provide such coverage without imposing a cost sharing requirement on the enrollee. However, if compliance with this provision would result in a high deductible health benefit plan with a health savings account becoming ineligible under federal tax law, then this provision applies to such plans only after the plan enrollee has satisfied the minimum deductible required under federal tax law, except with respect to items or services that are deemed preventive care.
This bill applies to policies or contracts entered into, issued, amended, or renewed on or after July 1, 2024.
ON APRIL 15, 2024, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 2954, AS AMENDED.
AMENDMENT #1 revises the bill to, instead, require a health benefit plan to provide, upon the recommendation of a physician and when determined by the health benefit plan to be medically necessary, coverage for the early detection of prostate cancer for (i) men 40 to 49 who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer; (ii) men 50 and older; and (iii) other men, if early detection for prostate cancer is medically necessary.
ON APRIL 22, 2024, THE SENATE SUBSTITUTED HOUSE BILL 2954 FOR SENATE BILL 2883, ADOPTED AMENDMENT #2, AND PASSED HOUSE BILL 2954, AS AMENDED.
AMENDMENT #2 rewrites the bill to enact the "Prostate-Specific Antigen Screening for High-risk Insured Men Act" or the "PSA Screening for HIM Act" ("act") as follows:
(1) Requires a health benefit plan to provide, upon the recommendation of a physician, coverage for the early detection of prostate cancer for (i) men 40 to 49 who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer; (ii) men 50 and older; and (iii) other men, if a physician determines that early detection for prostate cancer is medically necessary;
(2) Requires a health benefit plan that provides coverage for the early detection of prostate cancer to provide such coverage without imposing a cost sharing requirement on the enrollee;
(3) If compliance with (2) above would result in a high deductible health benefit plan with a health savings account becoming ineligible under federal law, establishes that (2) above applies to such plans only after the plan enrollee has satisfied the minimum deductible required under federal law, except with respect to items or services that are deemed preventive care pursuant to federal law; and
(4) Requires a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program, or the CoverKids program or a successor program, to provide coverage when determined to be medically necessary pursuant to state law.

Statutes affected:
Introduced: 56-7-2354
Amended with HA0738 -- 04/15/2024: 56-7-2354
Amended with HA0738, SA1029 -- 04/22/2024: 56-7-2354