Part 1: KRS304. 17A-257 (House Bill 421)

Revised Guidelines for  High-Risk CRC Screening Implementation

Effective Jan 1, 2026, KRS304. 17A-257 requires Kentucky health plans to cover CRC screening:
– Average risk (ACS): start at age 45. This remains unchanged under KRS304. 17A-257

– High risk (<45, MSTF): follow family-history rules below.

The law bans prior authorization and prohibits cost sharing (deductibles, copays, coinsurance), with a narrow HSA–HDHP exception until the IRS minimum deductible is met. Applies to commercial and Medicaid managed care plans issued/renewed on or after 1/1/26.

First-degree relative (FDR)	When to Start	Interval
CRC or advanced adenoma <60, OR ≥2 FDRs with CRC/adenoma at any age	40, or 10 years before the youngest age (whichever is earlier)	Colonoscopy every 5 years
Single FDR with CRC or  advanced adenoma ≥60	40	Start at age 40 with any screening modality, ie, stool-based testing. Colonoscopy preferred

Key point: MSTF includes advanced adenomas and advanced serrated lesions in family history, which are treated the same as CRC.

Who Needs to Act

•   • Primary care: document FDR CRC/adenomas; trigger 40/10 referrals.
•   • Endoscopists/centers: prepare for more high-risk colonoscopies, correct coding, and 5-year recalls when appropriate.
•   • Health systems: update EMR alerts/order sets for family history.
•   • Payers/coders: remove PA & cost sharing; code high-risk family history correctly.

References

1. Kentucky General Assembly. HB 421 (2025 Reg. Session), Acts Ch. 158. Enrolled Act text, eff. Jan 1, 2026. https://apps.legislature.ky.gov/record/25rs/hb421.html
2. Rex DK, Boland CR, Dominitz JA, et al. U.S. MSTF on Colorectal Cancer: Screening Recommendations. Gastroenterology. 2017;153:307-323.
3. Gupta S, Lieberman D, Anderson JC, et al. MSTF Consensus Update on Polypectomy/Follow-Up. Gastrointest Endosc. 2020;91:463-485.
4. Shaukat A, Kahi CJ, Burke CA, et al. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol. 2021;116:458-479.