Maine recently passed major colorectal cancer (CRC) policy at the state level. Join us to listen to their story and learn what worked well for CRC state advocacy!

2. Today’s webinar will be recorded and added to our
resource library for future reference by other states
looking to pass similar policy. This can be found at
https://fightcolorectalcancer.org/resource-library/
This is the first of many webinars to increase the capacity
and tools available to states as part of our Catalyst State-
by-State Advocacy Program.
This program aims to accelerate progress toward turning
aspirational CRC screening goals into a reality by
increasing access and reducing barriers to CRC
screening.
To learn more about the program, visit
https://fightcolorectalcancer.org/catalyst-state-by-
state-advocacy-program

3. TODAY’S SPEAKER
Hilary Schneider
Director, Maine Government
Relations, American Cancer Society
Cancer Action Network (ACS CAN)

5. Hilary Schneider
Maine Government Relations
Director, ACS CAN
Introductions

6. Timeline May 2018
ACS Releases
updated screening
guidelines
July 2018
State Medicaid
directors and
Insurance
Commissioners are
informed of change
Aug. 2018
ACS CAN and
coalition partners
notify USPSTF of
changes and ask for
review
Jan. 2019
ACS and ACS CAN
submit comments
on USPSTF CRC Draft
Plan
Feb. 2019
Maine legislature
introduces bill to
amend guidelines
May 2019
Maine Gov. Mills
signs into law LD
555, “An Act To
Reduce Colorectal
Cancer Incidence
and Mortality by
Updating Screening
Coverage.”

7. Legislation in
Maine
P.L. 2019, Chapter 86 (LD 555)
• Signed by Gov May 9, 2019
• Unanimous Insurance Committee
Support
• Passed by Senate and House “under
the hammer” (without a roll call vote)
• Effective for all private insurance
contracts issued or renewed on or after
January 1, 2020
Ø Applies to certificates issued in Maine through
group policies that are issued outside of Maine
Ø Self-insured, or ERISA, plans are not required to
include coverage for state mandated benefits

8. What was updated to
Maine’s law in 2019?
• Maine had existing mandated benefit law for
colorectal cancer screening
Ø Mandated coverage for average risk according to
published guidelines of a “national cancer
society,” but starting age of 50 included in law
and for “a colorectal cancer screening test”
• Removed starting age in statute,
• removed reference to national cancer society
guidelines for high-risk, and
• changed “a test” to “all colorectal cancer
examinations and laboratory tests”

9. Key
Stakeholders
Effort led by American Cancer Society Cancer Action Network
Goals:
• Increase colon cancer screening rates
• Update required coverage based on new medical evidence and
best practices
• Maintain and increase engagement of stakeholders in federal
effort to remove Medicare loophole re: polyp removal as part of
screening colonoscopy
• Maintain engagement/partnership with key Republican
lawmaker
Supporters:
• Maine Medical Association
• Maine Hospital Association
• Maine Primary Care Association
• Consumers for Affordable Health Care (statewide consumer
access to care advocacy organization)
• Individual health care providers

10. Biggest
Roadblocks
• “New Mandate”
• Fiscal impact – “health insurance costs are
already too high for many businesses”
• USPSTF – primary care physicians; wait for
guidelines to be updated

11. Compelling Data
+ Resources
• Screening saves lives
Ø Can’t afford to wait for USPSTF
to update guidelines
• Update to existing mandate; NOT
new mandate
• Rural state – best test is the test
that gets done
• Lifetime costs are not higher
Ø # colonoscopies same for
average risk if no additional
testing needed
Ø Early data showing system-wide
savings of promotion of FIT and
other stool-based tests
Ø Colon cancer treatment is costly
In my own practice, 16% of the patients I have treated for colorectal
cancer were 50 or younger at the time of diagnosis. Since colon cancer is
thought to require 10 years or more to develop from a pre-cancerous
polyp, any patient diagnosed at 55 or younger likely would have benefited
from a colonoscopy before the age of 50, and this cohort makes up 28% of
my colorectal cancer patients. Earlier screening of these individuals would
have led to earlier diagnosis of the cancer or even removal of the pre-
cancerous polyp that ultimately evolved into cancer, potentially sparing
the patient an operation, lowering the cost of care and, in some cases,
saving a life.
~Karin Cole, MD, surgical oncologist

12. Keys to
Success
• Groundwork had been laid with ACS 80 by 2018
initiatives
Ø Contributed to rapid engagement of provider
and patient testimony
• Relationships and strategic campaign tactics
matter
Ø Sponsor passionate and personally invested
Ø ACS CAN reputation and relationships with
lawmakers
Ø ACS CAN experience with strategic campaign
tactics – mobilizing available resources and
relationships at the right times
• Compelling patient stories kept focus on lives;
can’t afford to wait

13. Advocate
Involvement
[Text here]
“It is critical that screening guidelines
adapt as research and evidence warrant a
change in practice. The ability to screen for cancer
and find cancer in early stages is priceless in human life
and cost of care… Nine years ago, I delivered care and
chemotherapy to a woman in her forties who was diagnosed
with late stage CRC. She had no family history of CRC, so
screening of course was unable to pick up her cancer in the
early stages. Instead, a diagnostic colonoscopy found her
cancer in the late stages. Five years ago, she lost her battle
with CRC. Coincidently two years ago I met her
brother, who is now my husband. I am a witness to the pain
her loss has caused her family. Had she had a screening
colonoscopy at the age of 45, she very well could still be
here with us today. As evidence changes so should our
behavior.”
~Kerri Medeiros, RN, BSN OCN, ONN-CG (T),
Augusta, ME
Numerous patients,
caregiver/family members,
providers and partner orgs
testified in-person or in
writing.