Access to Breast Cancer Diagnosis Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 3851 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 HOUSE OF REPRESENTATIVES JUNE 6, 2023 Mrs. DINGELL (for herself, Mr. FITZPATRICK, Ms. WASSERMAN SCHULTZ, and Mr. ALLRED) 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 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 with re- spect to diagnostic and supplemental breast examina- tions. 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 23:41 Jul 01, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3851.IH H3851 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3851 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Access to Breast Can- 2 cer Diagnosis Act of 2023’’. 3 SEC. 2. REQUIRING DIAGNOSTIC AND SUPPLEMENTAL 4 BREAST EXAMINATIONS TO BE COVERED 5 WITH NO COST-SHARING REQUIREMENTS. 6 (a) IN GENERAL.—Subpart II of part A of title 7 XXVII of the Public Health Service Act (42 U.S.C. 8 300gg–11 et seq.) is amended by adding at the end the 9 following new section: 10 ‘‘SEC. 2730. DIAGNOSTIC AND SUPPLEMENTAL BREAST EX- 11 AMINATIONS. 12 ‘‘(a) IN GENERAL.—In the case of a group health 13 plan, or a health insurance issuer offering group or indi- 14 vidual health insurance coverage, that provides benefits 15 with respect to diagnostic and supplemental breast exami- 16 nations furnished to an individual enrolled under such 17 plan or such coverage, such plan or coverage shall not im- 18 pose any cost-sharing requirements for these benefits. 19 ‘‘(b) CONSTRUCTION.—Nothing in this section shall 20 be construed— 21 ‘‘(1) to prohibit a group health plan or health 22 insurance issuer from requiring timely prior author- 23 ization or imposing other appropriate utilization con- 24 trols in approving coverage for any diagnostic and 25 supplemental breast examination; or 26 VerDate Sep 11 2014 23:41 Jul 01, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3851.IH H3851 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3851 IH ‘‘(2) to supersede a State law that provides 1 greater protections with respect to the coverage of 2 diagnostic and supplemental breast examinations 3 than is provided under this section. 4 ‘‘(c) DEFINITIONS.—In this section: 5 ‘‘(1) COST-SHARING REQUIREMENTS.—The 6 term ‘cost-sharing requirements’ means a deductible, 7 coinsurance, copayment, and any maximum limita- 8 tion on the application of such a deductible, coinsur- 9 ance, copayment or similar out-of-pocket expense. 10 ‘‘(2) DIAGNOSTIC BREAST EXAMINATION.—The 11 term ‘diagnostic breast examination’ means a medi- 12 cally necessary and appropriate (in accordance with 13 National Comprehensive Cancer Network Guide- 14 lines) examination of the breast (including such an 15 examination using diagnostic mammography, breast 16 magnetic resonance imaging, or breast ultrasound) 17 that is— 18 ‘‘(A) used to evaluate an abnormality seen 19 or suspected from a screening examination for 20 breast cancer; or 21 ‘‘(B) used to evaluate an abnormality de- 22 tected by another means of examination. 23 ‘‘(3) SUPPLEMENTAL BREAST EXAMINA- 24 TIONS.—The term ‘supplemental breast examination’ 25 VerDate Sep 11 2014 23:41 Jul 01, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3851.IH H3851 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3851 IH means a medically necessary and appropriate (in ac- 1 cordance with National Comprehensive Cancer Net- 2 work Guidelines) examination of the breast (includ- 3 ing such an examination using breast magnetic reso- 4 nance imaging or breast ultrasound) that is— 5 ‘‘(A) used to screen for breast cancer when 6 there is no abnormality seen or suspected; and 7 ‘‘(B) furnished based on personal or family 8 medical history or additional factors that may 9 increase the individual’s risk of breast cancer.’’. 10 (b) APPLICATION TO GRANDFATHERED HEALTH 11 PLANS.—Section 1251(a)(4)(A) of the Patient Protection 12 and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 13 amended— 14 (1) by striking ‘‘title’’ and inserting ‘‘title, or as 15 added after the date of the enactment of this Act’’; 16 and 17 (2) by adding at the end the following new 18 clause: 19 ‘‘(v) Section 2730 (relating to cov- 20 erage for diagnostic and supplemental 21 breast examinations).’’. 22 (c) APPLICATION TO HIGH DEDUCTIBLE HEALTH 23 PLANS WITH HEALTH SAVINGS ACCOUNT ELIGIBILITY.— 24 VerDate Sep 11 2014 23:41 Jul 01, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3851.IH H3851 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3851 IH Section 223(c)(2) of the Internal Revenue Code of 1986 1 is amended by adding at the end the following: 2 ‘‘(H) SAFE HARBOR FOR ABSENCE OF DE- 3 DUCTIBLE FOR DIAGNOSTIC AND SUPPLE- 4 MENTAL BREAST EXAMINATIONS.—In the case 5 of plan years beginning on or after January 1, 6 2024, a plan shall not fail to be treated as a 7 high deductible health plan by reason of failing 8 to have a deductible for diagnostic and supple- 9 mental breast examinations.’’. 10 (d) EFFECTIVE DATE.—The amendments made by 11 this section shall apply with respect to plan years begin- 12 ning on or after January 1, 2024. 13 Æ VerDate Sep 11 2014 23:41 Jul 01, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H3851.IH H3851 kjohnson on DSK79L0C42PROD with BILLS