108th CONGRESS
1st Session
H. R. 736
To amend the Public Health Service Act and Employee Retirement Income
Security Act of 1974 to require that group and individual health insurance
coverage and group health plans provide coverage for annual screening mammography
for women 40 years of age or older if the coverage or plans include coverage
for diagnostic mammography.
IN THE HOUSE OF REPRESENTATIVES
February 12, 2003
Mr. NADLER (for himself, Mr. WEINER, Ms. LEE, Mr. SERRANO, Mr. TOWNS, Ms.
WOOLSEY, Mr. MCINTYRE, Mr. LANGEVIN, Ms. NORTON, Mr. OBERSTAR, Mr. MCNULTY,
Mr. KILDEE, Mr. HOLDEN, Mr. FROST, Mr. TIERNEY, Mr. MEEHAN, Mr. GRIJALVA,
Mr. LAMPSON, Mr. SANDERS, Mr. WALSH, Mr. CASE, Mrs. JONES of Ohio, Ms. KAPTUR,
Ms. CARSON of Indiana, Mr. OLVER, Mr. BAIRD, Mr. RUSH, Mr. FRANK of Massachusetts,
Ms. ROS-LEHTINEN, Mr. LANTOS, Mr. DAVIS of Illinois, Ms. BORDALLO, Mr. HINCHEY,
Mr. RANGEL, Mr. HINOJOSA, Mr. MICHAUD, Mr. ROTHMAN, Mr. HASTINGS of Florida,
Mr. CUMMINGS, Mr. WEXLER, Mrs. CHRISTENSEN, Ms. EDDIE BERNICE JOHNSON of Texas,
Mr. VAN HOLLEN, Mr. WYNN, Mr. MCDERMOTT, Mr. BRADY of Pennsylvania, Mr. LYNCH,
Mr. GUTIERREZ, Mr. KUCINICH, Mr. ACKERMAN, Mr. PAYNE, Mr. OWENS, and Mr. RYAN
of Ohio) introduced the following bill; which was referred to the Committee
on Energy and Commerce, and in addition to the Committee on Education and
the Workforce, 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 the Public Health Service Act and Employee Retirement Income
Security Act of 1974 to require that group and individual health insurance
coverage and group health plans provide coverage for annual screening mammography
for women 40 years of age or older if the coverage or plans include coverage
for diagnostic mammography.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) SHORT TITLE- This Act may be cited as the `Mammogram Availability Act
of 2003'.
(b) FINDINGS- Congress finds the following:
(1) Breast cancer is the single leading cause of death for women between
the ages of 40 and 49 in the United States.
(2) An expert panel convened by the National Institutes of Health recommended
on January 23, 1997, that all women between the ages of 40 and 49 should
choose for themselves, following consultation with their health care provider,
whether to undergo screening mammography.
(3) The same panel unanimously recommended that for women between the ages
of 40 and 49 who choose to have a screening mammogram, costs of the mammograms
should be reimbursed by third-party payers or covered by health maintenance
organizations.
SEC. 2. COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY UNDER GROUP HEALTH PLANS.
(a) PUBLIC HEALTH SERVICE ACT AMENDMENTS-
(1) Subpart 2 of part A of title XXVII of the Public Health Service Act
is amended by adding at the end the following new section:
`SEC. 2707. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.
`(a) REQUIREMENTS FOR COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY-
`(1) IN GENERAL- A group health plan, and a health insurance issuer offering
group health insurance coverage, that provides coverage for diagnostic mammography
for any woman who is 40 years of age or older shall provide coverage for
annual screening mammography for such a woman under terms and conditions
that are not less favorable than the terms and conditions for coverage of
diagnostic mammography.
`(2) DIAGNOSTIC AND SCREENING MAMMOGRAPHY DEFINED- For purposes of this
section--
`(A) The term `diagnostic mammography' means a radiologic procedure that
is medically necessary for the purpose of diagnosing breast cancer and
includes a physician's interpretation of the results of the procedure.
`(B) The term `screening mammography' means a radiologic procedure provided
to a woman for the purpose of early detection of breast cancer and includes
a physician's interpretation of the results of the procedure.
`(b) PROHIBITIONS- A group health plan, and a health insurance issuer offering
group health insurance coverage in connection with a group health plan, may
not--
`(1) deny coverage for annual screening mammography on the basis that the
coverage is not medically necessary or on the basis that the screening mammography
is not pursuant to a referral, consent, or recommendation by any health
care provider;
`(2) deny to a woman eligibility, or continued eligibility, to enroll or
to renew coverage under the terms of the plan, solely for the purpose of
avoiding the requirements of this section;
`(3) provide monetary payments or rebates to women to encourage such women
to accept less than the minimum protections available under this section;
`(4) penalize or otherwise reduce or limit the reimbursement of an attending
provider because such provider provided care to an individual participant
or beneficiary in accordance with this section; or
`(5) provide incentives (monetary or otherwise) to an attending provider
to induce such provider to provide care to an individual participant or
beneficiary in a manner inconsistent with this section.
`(c) RULES OF CONSTRUCTION-
`(1) Nothing in this section shall be construed to require a woman who is
a participant or beneficiary to undergo annual screening mammography.
`(2) This section shall not apply with respect to any group health plan,
or any group health insurance coverage offered by a health insurance issuer,
which does not provide benefits for diagnostic mammography.
`(3) Nothing in this section shall be construed as preventing a group health
plan or issuer from imposing deductibles, coinsurance, or other cost-sharing
in relation to benefits for screening mammography under the plan (or under
health insurance coverage offered in connection with a group health plan),
except that such coinsurance or other cost-sharing for any portion may not
be greater than such coinsurance or cost-sharing that is otherwise applicable
with respect to benefits for diagnostic mammography.
`(4) Women between the ages of 40 and 49 should (but are not required to)
consult with appropriate health care practitioners before undergoing
screening mammography, but nothing in this section shall be construed as
requiring the approval of such a practitioner before undergoing an annual
screening mammography.
`(d) NOTICE- A group health plan under this part shall comply with the notice
requirement under section 714(d) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements of this section as if such section
applied to such plan.
`(e) LEVEL AND TYPE OF REIMBURSEMENTS- Nothing in this section shall be construed
to prevent a group health plan or a health insurance issuer offering group
health insurance coverage from negotiating the level and type of reimbursement
with a provider for care provided in accordance with this section.
`(f) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN CERTAIN STATES-
`(1) IN GENERAL- The requirements of this section shall not apply with respect
to health insurance coverage if there is a State law (as defined in section
2723(d)(1)) for a State that regulates such coverage, that requires coverage
to be provided for annual screening mammography for women who are 40 years
of age or older and that provides at least the protections described in
subsection (b).
`(2) CONSTRUCTION- Section 2723(a)(1) shall not be construed as superseding
a State law described in paragraph (1).'.
(2) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is amended by striking
`section 2704' and inserting `sections 2704 and 2707'.
(1) Subpart B of part 7 of subtitle B of title I of the Employee Retirement
Income Security Act of 1974 is amended by adding at the end the following
new section:
`SEC. 714. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.
`(a) REQUIREMENTS FOR COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY-
`(1) IN GENERAL- A group health plan, and a health insurance issuer offering
group health insurance coverage, that provides coverage for diagnostic mammography
for any woman who is 40 years of age or older shall provide coverage for
annual screening mammography for such a woman under terms and conditions
that are not less favorable than the terms and conditions for coverage of
diagnostic mammography.
`(2) DIAGNOSTIC AND SCREENING MAMMOGRAPHY DEFINED- For purposes of this
section--
`(A) The term `diagnostic mammography' means a radiologic procedure that
is medically necessary for the purpose of diagnosing breast cancer and
includes a physician's interpretation of the results of the procedure.
`(B) The term `screening mammography' means a radiologic procedure provided
to a woman for the purpose of early detection of breast cancer and includes
a physician's interpretation of the results of the procedure.
`(b) PROHIBITIONS- A group health plan, and a health insurance issuer offering
group health insurance coverage in connection with a group health plan, may
not--
`(1) deny coverage described in subsection (a)(1) on the basis that the
coverage is not medically necessary or on the basis that the screening mammography
is not pursuant to a referral, consent, or recommendation by any health
care provider;
`(2) deny to a woman eligibility, or continued eligibility, to enroll or
to renew coverage under the terms of the plan, solely for the purpose of
avoiding the requirements of this section;
`(3) provide monetary payments or rebates to women to encourage such women
to accept less than the minimum protections available under this section;
`(4) penalize or otherwise reduce or limit the reimbursement of an attending
provider because such provider provided care to an individual participant
or beneficiary in accordance with this section; or
`(5) provide incentives (monetary or otherwise) to an attending provider
to induce such provider to provide care to an individual participant or
beneficiary in a manner inconsistent with this section.
`(c) RULES OF CONSTRUCTION-
`(1) Nothing in this section shall be construed to require a woman who is
a participant or beneficiary to undergo annual screening mammography.
`(2) This section shall not apply with respect to any group health plan,
or any group health insurance coverage offered by a health insurance issuer,
which does not provide benefits for diagnostic mammography.
`(3) Nothing in this section shall be construed as preventing a group health
plan or issuer from imposing deductibles, coinsurance, or other cost-sharing
in relation to benefits for screening mammography under the plan (or under
health insurance coverage offered in connection with a group health plan),
except that such coinsurance or other cost-sharing for any portion may not
be greater than such coinsurance or cost-sharing that is otherwise applicable
with respect to benefits for diagnostic mammography.
`(4) Women between the ages of 40 and 49 should (but are not required to)
consult with appropriate health care practitioners before undergoing screening
mammography, but nothing in this section shall be construed as requiring
the approval of such a practitioner before undergoing an annual screening
mammography.
`(d) NOTICE UNDER GROUP HEALTH PLAN- The imposition of the requirements of
this section shall be treated as a material modification in the terms of the
plan described in section 102(a)(1), for purposes of assuring notice of such
requirements under the plan; except that the summary description required
to be provided under the last sentence of section 104(b)(1) with respect to
such modification shall be provided by not later than 60 days after the first
day of the first plan year in which such requirements apply.
`(e) LEVEL AND TYPE OF REIMBURSEMENTS- Nothing in this section shall be construed
to prevent a group health plan or a health insurance issuer offering group
health insurance coverage from negotiating the level and type of reimbursement
with a provider for care provided in accordance with this section.
`(f) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN CERTAIN STATES-
`(1) IN GENERAL- The requirements of this section shall not apply with respect
to health insurance coverage if there is a State law (as defined in section
731(d)(1)) for a State that regulates such coverage, that requires coverage
to be provided for annual screening mammography for women who are 40 years
of age or older, and that provides at least the protections described in
subsection (b).
`(2) CONSTRUCTION- Section 731(a)(1) shall not be construed as superseding
a State law described in paragraph (1).'.
(2) Section 731(c) of such Act (29 U.S.C. 1191(c)) is amended by striking
`section 711' and inserting `sections 711 and 714'.
(3) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is amended by striking
`section 711' and inserting `sections 711 and 714'.
(4) The table of contents in section 1 of such Act is amended by inserting
after the item relating to section 713 the following new item:
`Sec. 714. Standards relating to benefits for screening mammography.'.
(c) EFFECTIVE DATES- (1) Subject to paragraph (2), the amendments made by
this section shall apply with respect to group health plans (and health insurance
coverage offered in connection with group health plans) for plan years beginning
on or after 1 year after the date of the enactment of this Act.
(2) In the case of a group health plan maintained pursuant to 1 or more collective
bargaining agreements between employee representatives and 1 or more employers
ratified before the date of enactment of this Act, the amendments made by
this section shall not apply to plan years beginning before the later of--
(A) the date on which the last collective bargaining agreements relating
to the plan terminates (determined without regard to any extension thereof
agreed to after the date of enactment of this Act), or
(B) 1 year after the date of the enactment of this Act.
For purposes of subparagraph (A), any plan amendment made pursuant to a collective
bargaining agreement relating to the plan which amends the plan solely to
conform to any requirement added by this section shall not be treated as a
termination of such collective bargaining agreement.
SEC. 3. COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY UNDER INDIVIDUAL HEALTH
COVERAGE.
(a) IN GENERAL- Part B of title XXVII of the Public Health Service Act is
amended by inserting after section 2751 the following new section:
`SEC. 2753. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.
`(a) IN GENERAL- The provisions of section 2706 (other than subsections (d)
and (f)) shall apply to health insurance coverage offered by a health insurance
issuer in the individual market in the same manner as it applies to health
insurance coverage offered by a health insurance issuer in connection with
a group health plan in the small or large group market.
`(b) NOTICE- A health insurance issuer under this part shall comply with the
notice requirement under section 714(d) of the Employee Retirement Income
Security Act of 1974 with respect to the requirements referred to in subsection
(a) as if such section applied to such issuer and such issuer were a group
health plan.
`(c) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN CERTAIN STATES-
`(1) IN GENERAL- The requirements of this section shall not apply with respect
to health insurance coverage if there is a State law (as defined in section
2723(d)(1)) for a State that regulates such coverage, that requires coverage
in the individual health insurance market to be provided for annual screening
mammography for women who are 40 years of age or older and that provides
at least the protections described in section 2706(b) (as applied under
subsection (a)).
`(2) CONSTRUCTION- Section 2762(a) shall not be construed as superseding
a State law described in paragraph (1).'.
(b) CONFORMING AMENDMENT- Section 2763(b)(2) of such Act (42 U.S.C. 300gg-63(b)(2))
is amended by striking `section 2751' and inserting `sections 2751 and 2753'.
(c) EFFECTIVE DATE- The amendments made by this section shall apply with respect
to health insurance coverage offered, sold, issued, or renewed in the individual
market on or after the date that is 1 year after the date of the enactment
of this Act.
END
