Access to Breast Cancer Diagnosis Act of 2025

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1500 Introduced in Senate (IS)]

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119th CONGRESS
  1st Session
                                S. 1500

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 with 
      respect to diagnostic and supplemental breast examinations.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 28, 2025

Mrs. Shaheen (for herself, Mrs. Britt, and Mrs. Capito) 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 with 
      respect to diagnostic and supplemental breast examinations.

    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 2025''.

SEC. 2. REQUIRING DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS TO BE 
              COVERED WITH NO COST-SHARING REQUIREMENTS.

    (a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at 
the end the following new section:

``SEC. 2730. DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS.

    ``(a) 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 diagnostic and 
supplemental breast examinations furnished to an individual enrolled 
under such plan or such coverage, such plan or coverage shall not 
impose any cost-sharing requirements for these benefits.
    ``(b) Construction.--Nothing in this section shall be construed--
            ``(1) to prohibit a group health plan or health insurance 
        issuer from requiring timely prior authorization or imposing 
        other appropriate utilization controls in approving coverage 
        for any diagnostic and supplemental breast examination; or
            ``(2) to supersede a State law that provides greater 
        protections with respect to the coverage of diagnostic and 
        supplemental breast examinations than is provided under this 
        section.
    ``(c) Definitions.--In this section:
            ``(1) Cost-sharing requirements.--The term `cost-sharing 
        requirements' means a deductible, coinsurance, copayment, and 
        any maximum limitation on the application of such a deductible, 
        coinsurance, copayment or similar out-of-pocket expense.
            ``(2) Diagnostic breast examination.--The term `diagnostic 
        breast examination' means a medically necessary and appropriate 
        (in accordance with National Comprehensive Cancer Network 
        Guidelines) examination of the breast (including, but not 
        limited to such an examination using diagnostic mammography, 
        breast magnetic resonance imaging, or breast ultrasound) that 
        is--
                    ``(A) used to evaluate an abnormality seen or 
                suspected from a screening examination for breast 
                cancer; or
                    ``(B) used to evaluate an abnormality detected by 
                another means of examination.
            ``(3) Supplemental breast examinations.--The term 
        `supplemental breast examination' means a medically necessary 
        and appropriate (in accordance with National Comprehensive 
        Cancer Network Guidelines) examination of the breast 
        (including, but not limited to such an examination using breast 
        magnetic resonance imaging or breast ultrasound) that is--
                    ``(A) used to screen for breast cancer when there 
                is no abnormality seen or suspected; and
                    ``(B) furnished based on personal or family medical 
                history or additional factors that may increase the 
                individual's risk of breast cancer.''.
    (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 2730 (relating to coverage 
                        for diagnostic and supplemental breast 
                        examinations).''.
    (c) Application to High Deductible Health Plans With Health Savings 
Account Eligibility.--Section 223(c)(2) of the Internal Revenue Code of 
1986 is amended by adding at the end the following:
                    ``(H) Safe harbor for absence of deductible for 
                diagnostic and supplemental breast examinations.--In 
                the case of plan years beginning on or after January 1, 
                2026, a plan shall not fail to be treated as a high 
                deductible health plan by reason of failing to have a 
                deductible for diagnostic and supplemental breast 
                examinations.''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2026.
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