Mandated coverage for cancer-screening services - Whose guidelines do states follow?

Objectives: To determine the prevalence and nature of state coverage mandat es for cancer screening. Methods: We contacted insurance departments in 50 states, Washington, DC, a nd 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 Societ y (ACS) and U.S. Preventive Services Task Force (USPSTF) guidelines for lik ely 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 fre quently mandated (n = 44), followed by cervical (n = 22), prostate (n = 18) , and colorectal cancer screening (n = 1), Twenty-three states used ACS gui delines only, 18 states used ACS and non-ACS/non-USPSTF guidelines, and 3 s tates used only non-ACS/non-USPSTF guidelines in development of coverage ma ndates. No state screening coverage mandate reflected USPSTF-screening guid elines. Of 85 mandates in place, 57 have been passed since 1990. Conclusions: Although state mandates for insurer coverage of cancer screeni ng are common and increasing, we found noticeable inter- and intra-state va riation in coverage, selection, and use of screening guidelines.