Access to Breast Cancer Diagnosis Act of 2021
This bill prohibits private health insurance plans from imposing higher cost-sharing requirements on breast cancer diagnostic examinations than initial breast cancer screening examinations. Diagnostic examinations are generally required after an initial screening detects an abnormality and typically require additional mammogram images (e.g., x-rays).
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1067 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 1067
To amend title XXVII of the Public Health Service Act to prohibit group
health plans and health insurance issuers offering group or individual
health insurance coverage from imposing cost-sharing requirements or
treatment limitations with respect to diagnostic examinations for
breast cancer that are less favorable than such requirements with
respect to screening examinations for breast cancer.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 12, 2021
Mr. Blunt (for himself and Mrs. Shaheen) introduced the following bill;
which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act to prohibit group
health plans and health insurance issuers offering group or individual
health insurance coverage from imposing cost-sharing requirements or
treatment limitations with respect to diagnostic examinations for
breast cancer that are less favorable than such requirements with
respect to screening examinations for breast cancer.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Access to Breast Cancer Diagnosis
Act of 2021''.
SEC. 2. REQUIRING PARITY IN COST-SHARING AND TREATMENT LIMITATIONS WITH
RESPECT TO DIAGNOSTIC AND SCREENING EXAMINATIONS FOR
BREAST CANCER.
(a) In General.--Section 2719A of the Public Health Service Act (42
U.S.C. 300gg-19a) is amended by adding at the end the following new
subsection:
``(e) Diagnostic and Screening Examinations for Breast Cancer
Parity.--
``(1) In general.--In the case of a group health plan, or a
health insurance issuer offering group or individual health
insurance coverage, that provides benefits with respect to a
diagnostic examination for breast cancer furnished to an
individual enrolled under such plan or such coverage, such plan
or such coverage shall ensure that--
``(A) the cost-sharing requirements applicable to
such examination for such individual are no less
favorable than such requirements applicable to a
screening examination for breast cancer for such
individual; and
``(B) the treatment limitations applicable to such
diagnostic examination for breast cancer for such
individual are no less favorable than such limitations
applicable to a screening examinations for breast
cancer for such individual.
``(2) Restriction on certain changes.--A group health plan
or health insurance issuer may not, for the sole purpose of
complying with paragraph (1), increase cost-sharing
requirements with respect to screening examinations for breast
cancer.
``(3) Construction.--Nothing in this subsection shall be
construed--
``(A) to require the use of diagnostic examinations
for breast cancer as a replacement for screening
examinations for breast cancer;
``(B) to prohibit a group health plan or health
insurance issuers from requiring prior authorization or
imposing other appropriate utilization controls in
approving coverage for any screening or diagnostic
imaging; or
``(C) to supersede a State law that provides
greater protections with respect to the coverage of
diagnostic examinations for breast cancer than is
provided under this subsection.
``(4) Definitions.--In this subsection:
``(A) Cost-sharing requirement.--The term `cost-
sharing requirement' includes a deductible,
coinsurance, copayment, and any maximum limitation on
the application of such a deductible, coinsurance,
copayment, or similar out-of-pocket expense.
``(B) Diagnostic examination for breast cancer.--
The term `diagnostic examination for breast cancer'
means a medically necessary and appropriate (as
determined by the health care professional treating the
individual) examination for breast cancer to evaluate
an abnormality in the breast that is--
``(i) seen or suspected from a screening
examination for breast cancer;
``(ii) detected by another means of
examination; or
``(iii) suspected based on the medical
history or family medical history of the
individual.
``(C) Examination for breast cancer.--The term
`examination for breast cancer' includes such an
examination using breast ultrasound, breast magnetic
resonance imaging, or mammography.
``(D) Treatment limitation.--The term `treatment
limitation' includes limits on the frequency of
treatment, number of visits, days of coverage, or other
similar limits on the scope or duration of
treatment.''.
(b) Application to Grandfathered Health Plans.--Section
1251(a)(4)(A) of the Patient Protection and Affordable Care Act (42
U.S.C. 18011(a)(4)(A)) is amended--
(1) by striking ``title'' and inserting ``title, or as
added after the date of the enactment of this Act)''; and
(2) by adding at the end the following new clause:
``(v) Section 2719A(e) (relating to parity
for diagnostic and screening examinations for
breast cancer).''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2022.
<all>
Introduced in Senate
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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