Find It Early Act

I 118TH CONGRESS 1ST SESSION H. R. 3086 To provide for health coverage with no cost-sharing for additional breast screenings for certain individuals at greater risk for breast cancer. IN THE HOUSE OF REPRESENTATIVES MAY 5, 2023 Ms. DELAURO (for herself, Mr. FITZPATRICK, Mr. KELLY of Pennsylvania, Mrs. CHERFILUS-MCCORMICK, Mr. GARCI´A of Illinois, Mr. PAYNE, Ms. VELA´ZQUEZ, Ms. KAPTUR, Mr. MORELLE, Ms. PETTERSEN, Mrs. HAYES, Ms. STEVENS, Mr. LANDSMAN, Ms. BROWNLEY, Ms. SCHAKOWSKY, Ms. SEWELL, Ms. JACKSON LEE, and Mr. COURTNEY) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, Armed Services, and Veterans’ Affairs, for a period to be subsequently deter- mined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide for health coverage with no cost-sharing for addi- tional breast screenings for certain individuals at greater risk 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Find It Early Act’’. 4 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3086 IH SEC. 2. COVERAGE WITH NO COST-SHARING FOR ADDI- 1 TIONAL BREAST SCREENINGS FOR CERTAIN 2 INDIVIDUALS AT GREATER RISK FOR BREAST 3 CANCER. 4 (a) COVERAGE UNDER GROUP HEALTH PLANS AND 5 GROUP AND INDIVIDUAL HEALTH INSURANCE COV- 6 ERAGE.— 7 (1) IN GENERAL.—Section 2713(a) of the Pub- 8 lic Health Service Act (42 U.S.C. 300gg–13(a)) is 9 amended— 10 (A) in paragraph (2), by striking at the 11 end ‘‘and’’; 12 (B) in paragraph (3), by striking at the 13 end the period and inserting a semicolon; 14 (C) in paragraph (4), by striking at the 15 end the period and inserting ‘‘; and’’; 16 (D) by striking ‘‘(5) for the purposes of 17 this Act,’’ and inserting: 18 ‘‘For the purposes of this Act, subject to paragraph (5)’’; 19 and 20 (E) by inserting after paragraph (4) the 21 following: 22 ‘‘(5) for plan years beginning on or after Janu- 23 ary 1, 2024, in addition to any items or services oth- 24 erwise described in this subsection— 25 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3086 IH ‘‘(A) with respect to an individual who is 1 at increased risk of breast cancer (as deter- 2 mined in accordance with the most recent appli- 3 cable American College of Radiology Appro- 4 priateness Criteria or the most recent applicable 5 guidelines of the National Comprehensive Can- 6 cer Network) or with heterogeneously or ex- 7 tremely dense breast tissue (as defined by the 8 Breast Imaging Reporting and Data System es- 9 tablished by the American College of Radi- 10 ology), screening and diagnostic imaging (with 11 no limitation applied on frequency) for the de- 12 tection of breast cancer, including 2D or 3D 13 mammograms, breast ultrasounds, breast mag- 14 netic resonance imaging, or other technologies 15 (as determined in accordance with such applica- 16 ble criteria or guidelines); and 17 ‘‘(B) with respect to an individual who is 18 not described in subparagraph (A) and who is 19 determined by a health care provider (in ac- 20 cordance with such most recent applicable cri- 21 teria or guidelines) to require screening or diag- 22 nostic breast imaging by reason of factors, in- 23 cluding age, race, ethnicity, or personal or fam- 24 ily medical history, screening and diagnostic im- 25 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3086 IH aging (with no limitation applied on frequency) 1 for the detection of breast cancer, including 2D 2 or 3D mammograms, breast ultrasounds, breast 3 magnetic resonance imaging, or other tech- 4 nologies (as determined in accordance with such 5 applicable criteria or guidelines).’’. 6 (2) APPLICATION TO GRANDFATHERED 7 PLANS.—Notwithstanding section 1251 of the Pa- 8 tient Protection and Affordable Care Act, the provi- 9 sions of paragraph (5) of section 2713(a) of the 10 Public Health Service Act, as added by paragraph 11 (1)(E), shall apply to grandfathered health plans de- 12 scribed in such section 1251 for plan years begin- 13 ning on or after January 1, 2024. 14 (b) COVERAGE UNDER MEDICARE.— 15 (1) IN GENERAL.—Section 1861(ddd)(1)(B) of 16 the Social Security Act (42 U.S.C. 17 1395x(ddd)(1)(B)) is amended— 18 (A) by striking ‘‘(B) recommended’’ and 19 inserting ‘‘(B)(i) recommended’’; 20 (B) by striking ‘‘Task Force; and’’ and in- 21 serting ‘‘Task Force; or’’; and 22 (C) by adding at the end the following new 23 clause: 24 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3086 IH ‘‘(ii) beginning on January 1, 2024, in ad- 1 dition to any other items or services described 2 in this subsection— 3 ‘‘(I) with respect to an individual who 4 is at increased risk of breast cancer (as de- 5 termined in accordance with the most re- 6 cent applicable American College of Radi- 7 ology Appropriateness Criteria or the most 8 recent applicable guidelines of the National 9 Comprehensive Cancer Network) or with 10 heterogeneously or extremely dense breast 11 tissue (as defined by the Breast Imaging 12 Reporting and Data System established by 13 the American College of Radiology), 14 screening and diagnostic imaging (with no 15 limitation applied on frequency) for the de- 16 tection of breast cancer, including 2D or 17 3D mammograms, breast ultrasounds, 18 breast magnetic resonance imaging, or 19 other technologies (as determined in ac- 20 cordance with such applicable criteria or 21 guidelines); and 22 ‘‘(II) with respect to an individual 23 who is not described in subclause (I) and 24 who is determined by a health care pro- 25 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3086 IH vider (in accordance with such most recent 1 applicable criteria or guidelines) to require 2 screening or diagnostic breast imaging by 3 reason of factors, including age, race, eth- 4 nicity, or personal or family medical his- 5 tory, screening and diagnostic imaging 6 (with no limitation applied on frequency) 7 for the detection of breast cancer, includ- 8 ing 2D or 3D mammograms, breast 9 ultrasounds, breast magnetic resonance im- 10 aging, or other technologies (as determined 11 in accordance with such applicable criteria 12 or guidelines); and’’. 13 (2) APPLICATION OF NO COST-SHARING UNDER 14 MEDICARE ADVANTAGE PLANS.—Section 15 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 16 1395w–22(a)(1)(B)) is amended— 17 (A) in clause (iv)— 18 (i) by redesignating subclause (VIII) 19 as subclause (IX); and 20 (ii) inserting after subclause (VII) the 21 following: 22 ‘‘(VIII) Beginning on January 1, 23 2024, screening and diagnostic imag- 24 ing and other technologies described 25 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3086 IH in subclause (I) or (II) of section 1 1861(ddd)(1)(B)(ii) furnished to an 2 individual described in such subclause 3 (I) or (II), respectively.’’; and 4 (B) in clause (v), by striking ‘‘and (VI)’’ 5 and inserting ‘‘(VI), and (VIII)’’. 6 (c) COVERAGE UNDER MEDICAID.— 7 (1) IN GENERAL.—Section 1905(a) of the So- 8 cial Security Act (42 U.S.C. 1396d(a)) is amend- 9 ed— 10 (A) in paragraph (4)— 11 (i) by striking ‘‘; and (D)’’ and insert- 12 ing ‘‘; (D)’’; 13 (ii) by striking ‘‘; and (E)’’ and in- 14 serting ‘‘; (E)’’; 15 (iii) by striking ‘‘; and (F)’’ and in- 16 serting ‘‘; (F)’’; and 17 (iv) by inserting before the semicolon 18 at the end the following: ‘‘; and (G)(i) with 19 respect to an individual who is at increased 20 risk of breast cancer (as determined in ac- 21 cordance with the most recent applicable 22 American College of Radiology Appro- 23 priateness Criteria or the most recent ap- 24 plicable guidelines of the National Com- 25 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3086 IH prehensive Cancer Network) or with het- 1 erogeneously or extremely dense breast tis- 2 sue (as defined by the Breast Imaging Re- 3 porting and Data System established by 4 the American College of Radiology), in ad- 5 dition to any other item or service de- 6 scribed in this subsection, screening and 7 diagnostic imaging (with no limitation ap- 8 plied on frequency) for the detection of 9 breast cancer, including 2D or 3D mam- 10 mograms, breast ultrasounds, breast mag- 11 netic resonance imaging, or other tech- 12 nologies (as determined in accordance with 13 such applicable criteria or guidelines); and 14 (ii) with respect to an individual who is not 15 described in clause (i) and who is deter- 16 mined by a health care provider (in accord- 17 ance with such most recent applicable cri- 18 teria or guidelines) to require screening or 19 diagnostic breast imaging by reason of fac- 20 tors, including age, race, ethnicity, or per- 21 sonal or family medical history, screening 22 and diagnostic imaging (with no limitation 23 applied on frequency) for the detection of 24 breast cancer, including 2D or 3D mam- 25 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3086 IH mograms, breast ultrasounds, breast mag- 1 netic resonance imaging, or other tech- 2 nologies (as determined in accordance with 3 such applicable criteria or guidelines)’’; 4 and 5 (B) in paragraph (13), in the matter pre- 6 ceding subparagraph (A), by inserting ‘‘(other 7 than an item or service for which medical as- 8 sistance is provided pursuant to paragraph 9 (4)(G))’’ after ‘‘services’’. 10 (2) NO COST-SHARING FOR CERTAIN BREAST 11 CANCER SCREENING AND DIAGNOSTIC IMAGING.— 12 (A) IN GENERAL.—Subsections (a)(2) and 13 (b)(2) of section 1916 of the Social Security 14 Act (42 U.S.C. 1396o(a)(2)(D)) are each 15 amended— 16 (i) in the last subparagraph, by strik- 17 ing at the end ‘‘; and’’ and inserting ‘‘, 18 or’’; and 19 (ii) by adding at the end the following 20 subparagraph: 21 ‘‘(K) with respect to an individual de- 22 scribed in clause (i) or (ii) of section 23 1905(a)(4)(G), screening and diagnostic imag- 24 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3086 IH ing and other technologies described in such 1 clause (i) or (ii), respectively; and’’. 2 (B) APPLICATION TO ALTERNATIVE COST- 3 SHARING.—Section 1916A(b)(3)(B) of the So- 4 cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 5 is amended by adding at the end the following 6 new clause: 7 ‘‘(xv) With respect to an individual 8 described in clause (i) or (ii) of section 9 1905(a)(4)(G), screening and diagnostic 10 imaging and other technologies described 11 in such clause (i) or (ii), respectively.’’. 12 (3) INCLUSION IN BENCHMARK COVERAGE.— 13 Section 1937(b) of the Social Security Act (42 14 U.S.C. 1396u–7(b)) is amended by adding at the 15 end the following new paragraph: 16 ‘‘(9) COVERAGE OF CERTAIN BREAST CANCER 17 SCREENING AND DIAGNOSTIC IMAGING FOR CERTAIN 18 INDIVIDUALS.—Notwithstanding the previous provi- 19 sions of this section, a State may not provide for 20 medical assistance through enrollment of an indi- 21 vidual with benchmark coverage or benchmark-equiv- 22 alent coverage under this section unless such cov- 23 erage includes medical assistance, with respect to an 24 individual described in clause (i) or (ii) of section 25 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 3086 IH 1905(a)(4)(G), for screening and diagnostic imaging 1 and other technologies described in such clause (i) or 2 (ii), respectively.’’. 3 (4) EFFECTIVE DATE.— 4 (A) IN GENERAL.—Except as provided in 5 subparagraph (B), the amendments made by 6 this subsection shall take effect on January 1, 7 2024. 8 (B) DELAY PERMITTED IF STATE LEGISLA- 9 TION REQUIRED.—In the case of a State plan 10 approved under title XIX of the Social Security 11 Act which the Secretary of Health and Human 12 Services determines requires State legislation 13 (other than legislation appropriating funds) in 14 order for the plan to meet the additional re- 15 quirements imposed by this section, the State 16 plan shall not be regarded as failing to comply 17 with the requirements of such title solely on the 18 basis of the failure of the plan to meet such ad- 19 ditional requirements before the first day of the 20 first calendar quarter beginning after the close 21 of the first regular session of the State legisla- 22 ture that ends after the 1-year period beginning 23 with the date of the enactment of this section. 24 For purposes of the preceding sentence, in the 25 VerDate Sep 11 2014 21:17 May 17, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3086.IH H3086 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 3086 IH case of a State that has a 2-year legislative ses- 1 sion, each year of the session is deemed to be 2 a separate regular session of the State legisla- 3 ture. 4 (d) COVERAGE AND ELIMINATION OF COST-SHARING 5 UNDER TRICARE.— 6 (1) COVERAGE.—Title 10, United States Code, 7 is amended— 8 (A) in section 1074d(a), by adding at the 9 end the following new paragraph: 10 ‘‘(3) Any member or former member of the uniformed 11 services who is entitled to medical care under section 1074 12 or 1074a of this title and is an individual described in 13 subparagraph (B) of section 1079(a)(20) of this title shall 14 also be entitled to the items and services described in sub- 15 paragraph (A) of such section (subject to the same limita- 16 tions specified in such subparagraph), as part of such 17 medical care.’’; and 18 (B) in section 1079(a), by adding at the 19 end the following new paragraph: 20 ‘‘(20)(A) Screening and diagnostic imaging 21 (with no limitation applied on frequency) for the de- 22 tection of breast cancer, including 2D or 3D mam- 23 mograms, breast ultrasounds, breast magnetic reso- 24 nance imaging, or other technologies (as determined 25 VerDate S [Text truncated for display. 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