[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5769 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 5769
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.
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IN THE HOUSE OF REPRESENTATIVES
October 28, 2021
Mrs. Dingell (for herself, Ms. Wasserman Schultz, Mr. Fitzpatrick, Mr.
Cole, and Mr. Allred) introduced the following bill; which was referred
to the Committee on Energy and Commerce
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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 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.
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 2021''.
SEC. 2. REQUIRING PARITY IN COST-SHARING AND TREATMENT LIMITATIONS WITH
RESPECT TO DIAGNOSTIC AND SCREENING EXAMINATIONS FOR
BREAST CANCER.
(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 SCREENING EXAMINATIONS FOR BREAST CANCER
PARITY.
``(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 a diagnostic
examination for breast cancer furnished to an individual enrolled under
such plan or such coverage, such plan or such coverage shall ensure
that--
``(1) the cost-sharing requirements applicable to such
examination for such individual are no less favorable than such
requirements applicable to a screening examination for breast
cancer for such individual; and
``(2) the treatment limitations applicable to such
diagnostic examination for breast cancer for such individual
are no less favorable than such limitations applicable to a
screening examinations for breast cancer for such individual.
``(b) Restriction on Certain Changes.--A group health plan or
health insurance issuer may not, for the sole purpose of complying with
subsection (a), increase cost-sharing requirements with respect to
screening examinations for breast cancer.
``(c) Construction.--Nothing in this section shall be construed--
``(1) to require the use of diagnostic examinations for
breast cancer as a replacement for screening examinations for
breast cancer;
``(2) to prohibit a group health plan or health insurance
issuers from requiring prior authorization or imposing other
appropriate utilization controls in approving coverage for any
screening or diagnostic imaging; or
``(3) to supersede a State law that provides greater
protections with respect to the coverage of diagnostic
examinations for breast cancer than is provided under this
subsection.
``(d) Definitions.--In this section:
``(1) Cost-sharing requirement.--The term `cost-sharing
requirement' includes 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 examination for breast cancer.--The term
`diagnostic examination for breast cancer' means a medically
necessary and appropriate (as determined by the health care
professional treating the individual) examination for breast
cancer to evaluate an abnormality in the breast that is--
``(A) seen or suspected from a screening
examination for breast cancer;
``(B) detected by another means of examination; or
``(C) suspected based on the medical history or
family medical history of the individual.
``(3) Examination for breast cancer.--The term `examination
for breast cancer' includes such an examination using breast
ultrasound, breast magnetic resonance imaging, or mammography.
``(4) Treatment limitation.--The term `treatment
limitation' includes limits on the frequency of treatment,
number of visits, days of coverage, or other similar limits on
the scope or duration of treatment.''.
(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 parity for
diagnostic and screening examinations for
breast cancer).''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2022.
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