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H 4933

An Act relative to colon cancer screening

194th Legislature (2025-2026) Introduced by Jim Arciero and 5 co-sponsors

Expands no-cost colorectal cancer screening to all insured adults starting at age 30 across multiple plans, with no cost-sharing for screening or related services.

Reporting date extended to Thursday, December 31, 2026
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Bill Summary · H 4933

Overview

  • Bill: H 4933 (An Act relative to colon cancer screening)
  • Jurisdiction: Massachusetts
  • Session: 194th (2025-2026)
  • Objective: Expand and standardize coverage for colorectal cancer (CRC) screening for insured individuals and program participants, starting at age 30, with no cost-sharing for CRC screening services and associated procedures, across multiple public and private coverage contexts.

Purpose and intent

  • To ensure broad, no-cost access to medically necessary colorectal cancer screening for adults beginning at age 30.
  • To align coverage across several types of plans and insurers, including Commonwealth’s group insurance, Medicaid managed care, employer-provided plans, and health plans offered by insurers and HMOs.
  • To promote early detection and prevention of colorectal cancer by reducing financial barriers to screening.

Key provisions and changes

The bill adds new CRC screening requirements in several areas of Massachusetts law. The main elements are consistent across sections and can be summarized as follows:

  • Eligible population: Starting at age 30, coverage must be provided for colorectal cancer screening as determined medically necessary by the insured’s primary care physician.
  • Covered screening modalities (examples listed in the bill):
    • Flexible sigmoidoscopy every 5 years
    • Flexible sigmoidoscopy every 10 years plus FIT (fecal immunochemical test) every year
    • KRAS, BRAF, PIK3CA genetic array testing as frequently as medically necessary
    • FIT-DNA testing every year or every 3 years as medically necessary
    • FIT every year
    • HSgFOBT (high-sensitivity guaiac fecal occult blood test) every year
    • CT colonography every 5 years
    • Colonoscopy every 5 or 10 years
    • For clarity, “colonoscopy” includes removal of polyps or biopsy during the procedure
  • Cost-sharing prohibition:
    • CRC screening services provided under the new sections shall not be subject to co-payments, deductibles, coinsurance, or other cost-sharing.
    • Prohibits additional charges for services associated with CRC screening (e.g., tissue removal, lab services, physician services, facility use, anesthesia).
    • An exception exists if the plan is governed by the Federal Internal Revenue Code and the prohibition would cause loss of tax-exempt status.
  • Coverage context:
    • The provisions apply to multiple health coverage contexts, including:
    • Group insurance for active/retired Commonwealth employees
    • Medicaid managed care organizations and primary care plans
    • Blanket or general insurance policies (employer-provided, hospital service plans, etc.)
    • Hospital service plans and medical service agreements (Each context mirrors the same set of screening modalities and cost-sharing rules.)

Who is affected

  • Insured individuals in Massachusetts starting at age 30, across:
    • Commonwealth group insurance plans
    • Medicaid managed care plans and primary care plans
    • Employer-based health and welfare funds and other general insurance policies
    • Individual and group hospital service plans, medical service agreements, and health maintenance organization plans
  • Employers, insurers, and health care providers who administer or perform CRC screening tests and related services, due to new coverage obligations and cost-sharing prohibitions.

Procedural and timeline aspects

  • Effective provisions appear to apply upon enactment and operating under the various General Laws cited (Chapters 32A, 118E, 175, 176A, 176B, 176G).
  • The bill sets “starting at 30 years of age” as the threshold for coverage eligibility, potentially accelerating coverage previously focused on older adults.
  • If any plan is subject to the Federal Internal Revenue Code and would lose tax-exempt status due to these prohibitions, cost-sharing requirements may be adjusted accordingly (per the exceptions noted in each section).
  • The measure follows standard legislative process: referral from Financial Services, favorable report, and referral to Health Care Financing, as indicated in the bill’s action history.

Summary of potential impact

  • Increased access to preventive CRC screening for a broader adult population (starting at age 30).
  • Elimination of financial barriers to screening and related services, potentially improving early detection rates.
  • Uniformity of coverage across multiple types of health plans, reducing variability in cost-sharing obligations for CRC screening.
  • Possible compliance considerations for plans under the Federal Internal Revenue Code, due to tax-exempt status rules.

If you’d like, I can provide a side-by-side comparison with current Massachusetts CRC screening coverage to highlight exact changes, or create a simple outline of when each provision would take effect after passage.

Compiled from official sources — confirm details with the bill’s official record.

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