Increasing Access to Lung Cancer Screening Act
This bill provides for coverage without prior authorization requirements of annual lung cancer screenings under Medicaid, Medicare, and private health insurance for individuals for whom screenings are recommended under U.S. Preventive Services Task Force guidelines. It also expands Medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use to all individuals, rather than only pregnant women.
The Department of Health and Human Services must conduct outreach on the importance of lung cancer screenings and who should be screened, and the Government Accountability Office must report on the demographics of those diagnosed with lung cancer and recommend ways the federal government can improve screenings.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4286 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 4286
To amend title XIX of the Social Security Act to require coverage under
State plans under the Medicaid program for annual lung cancer screening
with no cost sharing for individuals for whom screening is recommended
by U.S. Preventive Services Task Force guidelines, to expand coverage
under Medicaid of counseling and pharmacotherapy for cessation of
tobacco use, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 22, 2023
Mr. Higgins of New York (for himself, Mr. Fitzpatrick, and Ms. Castor
of Florida) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to require coverage under
State plans under the Medicaid program for annual lung cancer screening
with no cost sharing for individuals for whom screening is recommended
by U.S. Preventive Services Task Force guidelines, to expand coverage
under Medicaid of counseling and pharmacotherapy for cessation of
tobacco use, and for other purposes.
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 ``Increasing Access to Lung Cancer
Screening Act''.
SEC. 2. MEDICAID COVERAGE OF ANNUAL LUNG CANCER SCREENING WITH NO COST
SHARING FOR CERTAIN INDIVIDUALS.
(a) In General.--Section 1905(a)(4) of the Social Security Act (42
U.S.C. 1396d(a)(4)) is amended--
(1) by striking ``and'' before ``(F)''; and
(2) by inserting before the semicolon at the end the
following: ``; and (G) an annual lung cancer screening for
individuals who are eligible under the plan and for whom such
screening is recommended under guidelines published by the
United States Preventive Services Task Force, without regard to
prior authorization''.
(b) No Cost Sharing.--
(1) In general.--Subsections (a)(2) and (b)(2) of section
1916 of the Social Security Act (42 U.S.C. 1396o) are each
amended--
(A) in subparagraph (G), by adding at the end ``,
or''; and
(B) by adding at the end the following new
subparagraph:
``(H) lung cancer screening for which payment may
be made under the State plan pursuant section to
1905(a)(4)(G);''.
(2) Application to alternative cost sharing.--Section
1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o-
1(b)(3)(B)) is amended by adding at the end the following new
clause:
``(xiv) Lung cancer screening for which
payment may be made under the State plan
pursuant to section 1905(a)(4)(G).''.
(c) Application to Medicaid Managed Care Organizations.--Section
1932(b) of the Social Security Act (42 U.S.C. 1396u-2(b)) is amended by
adding at the end the following new paragraph:
``(9) Lung cancer screening.--Each contract with a medicaid
managed care organization under section 1903(m) shall require
the organization to provide coverage for lung cancer screening
for which payment may be made under the State plan pursuant to
section 1905(a)(4)(G) without regard to prior authorization.''.
(d) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply with respect to items and
services furnished on or after January 1, 2024.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet such additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
SEC. 3. EXPANDING COVERAGE UNDER MEDICAID OF COUNSELING AND
PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE TO ALL
MEDICAID INDIVIDUALS.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)(4)(D)--
(A) by striking ``by pregnant women''; and
(B) by inserting ``without regard to prior
authorization'' after ``(as defined in subsection
(bb))''; and
(2) in subsection (bb)--
(A) in paragraph (1)--
(i) by striking the first place it appears
``by pregnant women''; and
(ii) by striking ``by pregnant women who''
and inserting ``by individuals who'';
(B) in paragraph (2)(A), by striking ``with respect
to pregnant women''; and
(C) in paragraph (2)(B), by striking ``by pregnant
women''.
(b) Conforming Amendments.--
(1) Section 1927(d)(2)(F) of the Social Security Act (42
U.S.C. 1396r-8(d)(2)(F)) is amended by striking ``, in the case
of pregnant women''.
(2) Section 1916 of the Social Security Act (42 U.S.C.
1396o), as amended by section 1, is further amended--
(A) in each of subsections (a)(2) and (b)(2)--
(i) in subparagraph (B), by striking ``,
and counseling and pharmacotherapy for
cessation of tobacco use by pregnant women (as
defined in section 1905(bb)) and covered
outpatient drugs (as defined in subsection
(k)(2) of section 1927 and including
nonprescription drugs described in subsection
(d)(2) of such section) that are prescribed for
purposes of promoting, and when used to
promote, tobacco cessation by pregnant women in
accordance with the Guideline referred to in
section 1905(bb)(2)(A)'';
(ii) in subparagraph (H), at the end by
adding ``or''; and
(iii) by adding at the end the following
new subparagraph:
``(I) counseling and pharmacotherapy for cessation
of tobacco use (as defined in section 1905(bb)) and
covered outpatient drugs (as defined in subsection
(k)(2) of section 1927 and including nonprescription
drugs described in subsection (d)(2) of such section)
that are prescribed for purposes of promoting, and when
used to promote, tobacco cessation in accordance with
the Guideline referred to in section 1905(bb)(2)(A);
and''.
(3) Section 1916A(b)(3)(B) of such Act (42 U.S.C. 1396o-
1(b)(3)(B)), as amended by section 1, is further amended--
(A) in clause (iii), by striking ``, and counseling
and pharmacotherapy for cessation of tobacco use by
pregnant women (as defined in section 1905(bb))''; and
(B) by adding at the end the following new clause:
``(xv) Counseling and pharmacotherapy for
cessation of tobacco use (as defined in section
1905(bb)).''.
(c) Application to Medicaid Managed Care Organizations.--Section
1932(b) of the Social Security Act (42 U.S.C. 1396u-2(b)), as amended
by section 1, is further amended by adding at the end the following new
paragraph:
``(10) Cessation of tobacco use.--Each contract with a
medicaid managed care organization under section 1903(m) shall
require the organization to provide coverage for counseling and
pharmacotherapy for cessation of tobacco use without regard to
prior authorization.''.
(d) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply with respect to items and
services furnished on or after January 1, 2024.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet such additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
SEC. 4. COVERAGE UNDER MEDICARE AND PRIVATE HEALTH INSURANCE OF ANNUAL
LUNG CANCER SCREENING WITHOUT UTILIZATION MANAGEMENT
REQUIREMENTS.
(a) Medicare.--
(1) In general.--Section 1834 of the Social Security Act
(42 U.S.C. 1395m) is amended by adding at the end the following
new subsection:
``(z) Special Rule for Annual Lung Cancer Screening.--
Notwithstanding any other provision of this title, in the case of an
annual lung cancer screening for which benefits are provided under this
part for any individual for whom such screening is recommended in
accordance with guidelines issued by the Secretary, such benefits shall
be provided without application of any prior authorization.''.
(2) Application under medicare advantage.--Section
1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w-
22(a)(1)(B)) is amended by adding at the end the following new
clause:
``(vii) Prohibition of application of
certain requirements for annual lung cancer
screening.--In the case of an annual lung
cancer screening for which benefits are
provided under part B for any individual for
whom such screening is recommended in
accordance with guidelines issued by the
Secretary for purposes of section 1834(z), an
MA plan may not impose any prior authorization
with respect to the coverage of such screening
under such plan.''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to services furnished on or after
January 1, 2024.
(b) Individual and Group Health Insurance Markets.--
(1) In general.--Section 2713 of the Public Health Service
Act (42 U.S.C. 300gg-(3)) is amended by adding at the end the
following new subsection:
``(d) Prohibition of Application of Certain Requirements for Annual
Lung Cancer Screening.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage may not
impose any prior authorization with respect to the benefits under such
plan or coverage for an annual lung cancer screening for any individual
for whom such screening is recommended by the United States Preventive
Services Task Force.''.
(2) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
January 1, 2024.
SEC. 5. LUNG CANCER SCREENING EDUCATION AND OUTREACH.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary''), in consultation with
patient and lung cancer advocacy groups, shall conduct an education and
outreach campaign for purposes of informing individuals and health care
providers of--
(1) the importance of lung cancer screenings; and
(2) the categories of individuals who should receive such
screenings.
(b) Manner of Outreach.--The Secretary may carry out the campaign
described in subsection (a) directly, by contract, through the issuance
of grants, or otherwise. In carrying out such campaign, the Secretary
shall ensure that the campaign is targeted to reach individuals at high
risk of lung cancer.
(c) Funding.--There are authorized to be appropriated $10,000,000
for each of fiscal years 2023 through 2027 for purposes of carrying out
this section.
SEC. 6. REPORT.
Not later than 1 year after the date of the enactment of this Act,
the Comptroller General of the United States shall conduct a study and
submit to Congress a report on the demographics of individuals
diagnosed with lung cancer and individuals screened for such cancer.
Such report shall identify--
(1) any segments of the population diagnosed with lung
cancer but not captured in current screening eligibility
guidelines (such as firefighters, veterans, and women under 50
years of age); and
(2) actions the Federal Government could take to improve
screening for such cancer among such segments.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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