Access to Breast Cancer Diagnosis Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 2428 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 HOUSE OF REPRESENTATIVES MAY 1, 2019 Mrs. DINGELL (for herself, Mr. KING of New York, Ms. WASSERMAN SCHULTZ, Mr. FITZPATRICK, Mr. ALLRED, and Mrs. RODGERS of Wash- ington) introduced the following bill; which was referred to the Committee on Energy and Commerce 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 cov- erage from imposing cost-sharing requirements or treat- ment limitations with respect to diagnostic examinations for breast cancer that are less favorable than such re- quirements with respect to screening examinations for breast cancer. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 01:38 May 04, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2428.IH H2428 kjohnson on DSK79L0C42 with BILLS 2 •HR 2428 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Access to Breast Can- 2 cer Diagnosis Act of 2019’’. 3 SEC. 2. REQUIRING PARITY IN COST-SHARING AND TREAT- 4 MENT LIMITATIONS WITH RESPECT TO DIAG- 5 NOSTIC AND SCREENING EXAMINATIONS FOR 6 BREAST CANCER. 7 (a) IN GENERAL.—Section 2719A of the Public 8 Health Service Act (42 U.S.C. 300gg–19a) is amended by 9 adding at the end the following new subsection: 10 ‘‘(e) DIAGNOSTIC AND SCREENING EXAMINATIONS 11 FOR BREAST CANCER PARITY.— 12 ‘‘(1) IN GENERAL.—In the case of a group 13 health plan, or a health insurance issuer offering 14 group or individual health insurance coverage, that 15 provides benefits with respect to a diagnostic exam- 16 ination for breast cancer furnished to an individual 17 enrolled under such plan or such coverage, such plan 18 or such coverage shall ensure that— 19 ‘‘(A) the cost-sharing requirements appli- 20 cable to such examination for such individual 21 are no less favorable than such requirements 22 applicable to a screening examination for breast 23 cancer for such individual; and 24 ‘‘(B) the treatment limitations applicable 25 to such diagnostic examination for breast can- 26 VerDate Sep 11 2014 01:38 May 04, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2428.IH H2428 kjohnson on DSK79L0C42 with BILLS 3 •HR 2428 IH cer for such individual are no less favorable 1 than such limitations applicable to a screening 2 examinations for breast cancer for such indi- 3 vidual. 4 ‘‘(2) RESTRICTION ON CERTAIN CHANGES.—A 5 group health plan or health insurance issuer may 6 not, for the sole purpose of complying with para- 7 graph (1), increase cost-sharing requirements with 8 respect to screening examinations for breast cancer. 9 ‘‘(3) CONSTRUCTION.—Nothing in this sub- 10 section shall be construed— 11 ‘‘(A) to require the use of diagnostic ex- 12 aminations for breast cancer as a replacement 13 for screening examinations for breast cancer; 14 ‘‘(B) to prohibit a group health plan or 15 health insurance issuers from requiring prior 16 authorization or imposing other appropriate uti- 17 lization controls in approving coverage for any 18 screening or diagnostic imaging; or 19 ‘‘(C) to supersede a State law that pro- 20 vides greater protections with respect to the 21 coverage of diagnostic examinations for breast 22 cancer than is provided under this subsection. 23 ‘‘(4) DEFINITIONS.—In this subsection: 24 VerDate Sep 11 2014 01:38 May 04, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2428.IH H2428 kjohnson on DSK79L0C42 with BILLS 4 •HR 2428 IH ‘‘(A) COST-SHARING REQUIREMENT.—The 1 term ‘cost-sharing requirement’ includes a de- 2 ductible, coinsurance, copayment, and any max- 3 imum limitation on the application of such a 4 deductible, coinsurance, copayment, or similar 5 out-of-pocket expense. 6 ‘‘(B) DIAGNOSTIC EXAMINATION FOR 7 BREAST CANCER.—The term ‘diagnostic exam- 8 ination for breast cancer’ means a medically 9 necessary and appropriate (as determined by 10 the health care professional treating the indi- 11 vidual) examination for breast cancer to evalu- 12 ate an abnormality in the breast that is— 13 ‘‘(i) seen or suspected from a screen- 14 ing examination for breast cancer; 15 ‘‘(ii) detected by another means of ex- 16 amination; or 17 ‘‘(iii) suspected based on the medical 18 history or family medical history of the in- 19 dividual. 20 ‘‘(C) EXAMINATION FOR BREAST CAN- 21 CER.—The term ‘examination for breast cancer’ 22 includes such an examination using breast 23 ultrasound, breast magnetic resonance imaging, 24 or mammography. 25 VerDate Sep 11 2014 01:38 May 04, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2428.IH H2428 kjohnson on DSK79L0C42 with BILLS 5 •HR 2428 IH ‘‘(D) TREATMENT LIMITATION.—The term 1 ‘treatment limitation’ includes limits on the fre- 2 quency of treatment, number of visits, days of 3 coverage, or other similar limits on the scope or 4 duration of treatment.’’. 5 (b) APPLICATION TO GRANDFATHERED HEALTH 6 PLANS.—Section 1251(a)(4)(A) of the Patient Protection 7 and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 8 amended— 9 (1) by striking ‘‘title’’ and inserting ‘‘title, or as 10 added after the date of the enactment of this Act)’’; 11 and 12 (2) by adding at the end the following new 13 clause: 14 ‘‘(v) Section 2719A(e) (relating to 15 parity for diagnostic and screening exami- 16 nations for breast cancer).’’. 17 (c) EFFECTIVE DATE.—The amendments made by 18 this section shall apply with respect to plan years begin- 19 ning on or after January 1, 2020. 20 Æ VerDate Sep 11 2014 01:38 May 04, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H2428.IH H2428 kjohnson on DSK79L0C42 with BILLS