[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9505 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. R. 9505
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
December 13, 2022
Ms. DeLauro (for herself, Mr. Fitzpatrick, Ms. Kaptur, Mr. Courtney,
Mr. Bishop of Georgia, Ms. Schakowsky, Mr. Trone, Ms. Jackson Lee, and
Mr. Kahele) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, Armed Services, and Veterans' Affairs, 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 provide for health coverage with no cost-sharing for additional
breast screenings for certain individuals at greater risk 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 ``Find It Early Act''.
SEC. 2. COVERAGE WITH NO COST-SHARING FOR ADDITIONAL BREAST SCREENINGS
FOR CERTAIN INDIVIDUALS AT GREATER RISK FOR BREAST
CANCER.
(a) Coverage Under Group Health Plans and Group and Individual
Health Insurance Coverage.--
(1) In general.--Section 2713(a) of the Public Health
Service Act (42 U.S.C. 300gg-13(a)) is amended--
(A) in paragraph (2), by striking at the end
``and'';
(B) in paragraph (3), by striking at the end the
period and inserting a semicolon;
(C) in paragraph (4), by striking at the end the
period and inserting ``; and'';
(D) by striking ``(5) for the purposes of this
Act,'' and inserting:
``For the purposes of this Act, subject to paragraph (5)''; and
(E) by inserting after paragraph (4) the following:
``(5) for plan years beginning on or after January 1, 2023,
in addition to any items or services otherwise described in
this subsection--
``(A) with respect to an individual who is at
increased risk of breast cancer (as determined in
accordance with the most recent applicable American
College of Radiology Appropriateness Criteria or the
most recent applicable guidelines of the National
Comprehensive Cancer Network) or with heterogeneously
or extremely dense breast tissue (as defined by the
Breast Imaging Reporting and Data System established by
the American College of Radiology), screening and
diagnostic imaging (with no limitation applied on
frequency) for the detection of breast cancer,
including 2D or 3D mammograms, breast ultrasounds,
breast magnetic resonance imaging, or other
technologies (as determined in accordance with such
applicable criteria or guidelines); and
``(B) with respect to an individual who is not
described in subparagraph (A) and who is determined by
a health care provider (in accordance with such most
recent applicable criteria or guidelines) to require
screening or diagnostic breast imaging by reason of
factors, including age, race, ethnicity, or personal or
family medical history, screening and diagnostic
imaging (with no limitation applied on frequency) for
the detection of breast cancer, including 2D or 3D
mammograms, breast ultrasounds, breast magnetic
resonance imaging, or other technologies (as determined
in accordance with such applicable criteria or
guidelines).''.
(2) Application to grandfathered plans.--Notwithstanding
section 1251 of the Patient Protection and Affordable Care Act,
the provisions of paragraph (5) of section 2713(a) of the
Public Health Service Act, as added by paragraph (1)(E), shall
apply to grandfathered health plans described in such section
1251 for plan years beginning on or after January 1, 2023.
(b) Coverage Under Medicare.--
(1) In general.--Section 1861(ddd)(1)(B) of the Social
Security Act (42 U.S.C. 1395x(ddd)(1)(B)) is amended--
(A) by striking ``(B) recommended'' and inserting
``(B)(i) recommended'';
(B) by striking ``Task Force; and'' and inserting
``Task Force; or''; and
(C) by adding at the end the following new clause:
``(ii) beginning on January 1, 2023, in addition to
any other items or services described in this
subsection--
``(I) with respect to an individual who is
at increased risk of breast cancer (as
determined in accordance with the most recent
applicable American College of Radiology
Appropriateness Criteria or the most recent
applicable guidelines of the National
Comprehensive Cancer Network) or with
heterogeneously or extremely dense breast
tissue (as defined by the Breast Imaging
Reporting and Data System established by the
American College of Radiology), screening and
diagnostic imaging (with no limitation applied
on frequency) for the detection of breast
cancer, including 2D or 3D mammograms, breast
ultrasounds, breast magnetic resonance imaging,
or other technologies (as determined in
accordance with such applicable criteria or
guidelines); and
``(II) with respect to an individual who is
not described in subclause (I) and who is
determined by a health care provider (in
accordance with such most recent applicable
criteria or guidelines) to require screening or
diagnostic breast imaging by reason of factors,
including age, race, ethnicity, or personal or
family medical history, screening and
diagnostic imaging (with no limitation applied
on frequency) for the detection of breast
cancer, including 2D or 3D mammograms, breast
ultrasounds, breast magnetic resonance imaging,
or other technologies (as determined in
accordance with such applicable criteria or
guidelines); and''.
(2) Application of no cost-sharing under medicare advantage
plans.--Section 1852(a)(1)(B) of the Social Security Act (42
U.S.C. 1395w-22(a)(1)(B)) is amended--
(A) in clause (iv)--
(i) by redesignating subclause (VIII) as
subclause (IX); and
(ii) inserting after subclause (VII) the
following:
``(VIII) Beginning on January 1,
2023, screening and diagnostic imaging
and other technologies described in
subclause (I) or (II) of section
1861(ddd)(1)(B)(ii) furnished to an
individual described in such subclause
(I) or (II), respectively.''; and
(B) in clause (v), by striking ``and (VI)'' and
inserting ``(VI), and (VIII)''.
(c) Coverage Under Medicaid.--
(1) In general.--Section 1905(a) of the Social Security Act
(42 U.S.C. 1396d(a)) is amended--
(A) in paragraph (4)--
(i) by striking ``; and (D)'' and inserting
``; (D)'';
(ii) by striking ``; and (E)'' and
inserting ``; (E)'';
(iii) by striking ``; and (F)'' and
inserting ``; (F)''; and
(iv) by inserting before the semicolon at
the end the following: ``; and (G)(i) with
respect to an individual who is at increased
risk of breast cancer (as determined in
accordance with the most recent applicable
American College of Radiology Appropriateness
Criteria or the most recent applicable
guidelines of the National Comprehensive Cancer
Network) or with heterogeneously or extremely
dense breast tissue (as defined by the Breast
Imaging Reporting and Data System established
by the American College of Radiology), in
addition to any other item or service described
in this subsection, screening and diagnostic
imaging (with no limitation applied on
frequency) for the detection of breast cancer,
including 2D or 3D mammograms, breast
ultrasounds, breast magnetic resonance imaging,
or other technologies (as determined in
accordance with such applicable criteria or
guidelines); and (ii) with respect to an
individual who is not described in clause (i)
and who is determined by a health care provider
(in accordance with such most recent applicable
criteria or guidelines) to require screening or
diagnostic breast imaging by reason of factors,
including age, race, ethnicity, or personal or
family medical history, screening and
diagnostic imaging (with no limitation applied
on frequency) for the detection of breast
cancer, including 2D or 3D mammograms, breast
ultrasounds, breast magnetic resonance imaging,
or other technologies (as determined in
accordance with such applicable criteria or
guidelines)''; and
(B) in paragraph (13), in the matter preceding
subparagraph (A), by inserting ``(other than an item or
service for which medical assistance is provided
pursuant to paragraph (4)(G))'' after ``services''.
(2) No cost-sharing for certain breast cancer screening and
diagnostic imaging.--
(A) In general.--Subsections (a)(2) and (b)(2) of
section 1916 of the Social Security Act (42 U.S.C.
1396o(a)(2)(D)) are each amended--
(i) in the last subparagraph, by striking
at the end ``; and'' and inserting ``, or'';
and
(ii) by adding at the end the following
subparagraph:
``(K) with respect to an individual described in
clause (i) or (ii) of section 1905(a)(4)(G), screening
and diagnostic imaging and other technologies described
in such clause (i) or (ii), respectively; and''.
(B) Application to alternative cost-sharing.--
Section 1916A(b)(3)(B) of the Social Security Act (42
U.S.C. 1396o-1(b)(3)(B)) is amended by adding at the
end the following new clause:
``(xv) With respect to an individual
described in clause (i) or (ii) of section
1905(a)(4)(G), screening and diagnostic imaging
and other technologies described in such clause
(i) or (ii), respectively.''.
(3) Inclusion in benchmark coverage.--Section 1937(b) of
the Social Security Act (42 U.S.C. 1396u-7(b)) is amended by
adding at the end the following new paragraph:
``(9) Coverage of certain breast cancer screening and
diagnostic imaging for certain individuals.--Notwithstanding
the previous provisions of this section, a State may not
provide for medical assistance through enrollment of an
individual with benchmark coverage or benchmark-equivalent
coverage under this section unless such coverage includes
medical assistance, with respect to an individual described in
clause (i) or (ii) of section 1905(a)(4)(G), for screening and
diagnostic imaging and other technologies described in such
clause (i) or (ii), respectively.''.
(4) Effective date.--
(A) In general.--Except as provided in subparagraph
(B), the amendments made by this subsection shall take
effect on January 1, 2023.
(B) Delay permitted if state legislation
required.--In the case of a State plan approved under
title XIX of the Social Security Act which the
Secretary of Health and Human Services determines
requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirements imposed by this section, the
State plan shall not be regarded as failing to comply
with the requirements of such title solely on the basis
of the failure of the plan to meet such additional
requirements before the first day of the first calendar
quarter beginning after the close of the first regular
session of the State legislature that ends after the 1-
year period beginning with the date of the enactment of
this section. For purposes of the preceding sentence,
in the case of a State that has a 2-year legislative
session, each year of the session is deemed to be a
separate regular session of the State legislature.
(d) Coverage and Elimination of Cost-Sharing Under TRICARE.--
(1) Coverage.--Title 10, United States Code, is amended--
(A) in section 1074d(a), by adding at the end the
following new paragraph:
``(3) Any member or former member of the uniformed services who is
entitled to medical care under section 1074 or 1074a of this title and
is an individual described in subparagraph (B) of section 1079(a)(20)
of this title shall also be entitled to the items and services
described in subparagraph (A) of such section (subject to the same
limitations specified in such subparagraph), as part of such medical
care.''; and
(B) in section 1079(a), by adding at the end the
following new paragraph:
``(20)(A) Screening and diagnostic imaging (with no
limitation applied on frequency) for the detection of breast
cancer, including 2D or 3D mammograms, breast ultrasounds,
breast magnetic resonance imaging, or other technologies (as
determined in accordance with the most recent applicable
criteria or guidelines described in subparagraph (B)), shall be
provided if the patient is an individual described in
subparagraph (B).
``(B) An individual described in this subparagraph is--
``(i) an individual who is at increased risk of
breast cancer (as determined in accordance with the
most recent applicable American College of Radiology
Appropriateness Criteria or the most recent applicable
guidelines of the National Comprehensive Cancer
Network) or with heterogeneously or extremely dense
breast tissue (as defined by the Breast Imaging
Reporting and Data System established by the American
College of Radiology); or
``(ii) an individual who is not described in clause
(i) and who is determined by a health care provider (in
accordance with such most recent applicable criteria or
guidelines) to require screening or diagnostic breast
imaging by reason of factors including age, race,
ethnicity, or personal or family medical history.''.
(2) Elimination of cost-sharing.--Such title is further
amended--
(A) in section 1075a, by adding at the end the
following new subsection:
``(d) Elimination of Cost-Sharing for Certain Breast Cancer-Related
Items and Services.--Notwithstanding any other provision under this
section, cost-sharing may not be imposed or collected with respect to
any beneficiary enrolled in TRICARE Prime for any item or service
described in subparagraph (A) of section 1079(a)(20) of this title
provided under TRICARE Prime, in accordance with the limitations
specified in such subparagraph, if the beneficiary is an individual
described in subparagraph (B) of such section.'';
(B) in section 1075(c), by adding at the end the
following new paragraph:
``(4) Notwithstanding any other provision under this
section, cost-sharing may not be imposed or collected with
respect to any beneficiary enrolled in TRICARE Select for any
item or service described in subparagraph (A) of section
1079(a)(20) of this title provided under TRICARE Select, in
accordance with the limitations specified in such subparagraph,
if the beneficiary is an individual described in subparagraph
(B) of such section.''; and
(C) in section 1086(d)(3)--
(i) by redesignating subparagraph (C) as
subparagraph (D); and
(ii) by inserting after subparagraph (B)
the following new subparagraph:
``(C) Notwithstanding any other provision under this section, cost-
sharing may not be imposed or collected under subsection (a) with
respect to any individual described in subparagraph (B) of section
1079(a)(20) of this title for an item or service described in
subparagraph (A) of such section and provided in accordance with the
limitations specified in such subparagraph.''.
(3) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2023.
(e) Coverage and Elimination of Cost-Sharing With Respect to
Veterans.--
(1) Coverage and elimination of cost-sharing.--Chapter 17
of title 38, United States Code, is amended by inserting after
section 1720J the following new section (and conforming the
table of sections at the beginning of such chapter
accordingly):
``Sec. 1720K. Breast screenings for certain individuals at increased
risk for breast cancer
``(a) Coverage of Items and Services.--
``(1) Coverage.--The Secretary shall furnish to a veteran
described in paragraph (2) screening and diagnostic imaging
(with no limitation applied on frequency) for the detection of
breast cancer, including 2D or 3D mammograms, breast
ultrasounds, breast magnetic resonance imaging, or other
technologies (as determined in accordance with the most recent
applicable criteria or guidelines described in such paragraph)
pursuant to this section.
``(2) Eligibility.--A veteran described in this
subparagraph is--
``(A) a veteran who is at increased risk of breast
cancer (as determined in accordance with the most
recent applicable American College of Radiology
Appropriateness Criteria or the most recent applicable
guidelines of the National Comprehensive Cancer
Network) or with heterogeneously or extremely dense
breast tissue (as defined by the Breast Imaging
Reporting and Data System established by the American
College of Radiology), without regard to whether the
veteran is enrolled in the system of annual patient
enrollment established under section 1705(a) of this
title; or
``(B) a veteran who is not described in
subparagraph (A) and who is determined by a health care
provider (in accordance with such most recent
applicable criteria or guidelines) to require screening
or diagnostic breast imaging by reason of factors
including age, race, ethnicity, or personal or family
medical history, without regard to whether the veteran
is enrolled in the system of annual patient enrollment
established under section 1705(a) of this title.
``(b) Prohibition on Cost-Sharing.--Notwithstanding subsections (f)
and (g) of section 1710 and section 1722A of this title, the Secretary
may not require any veteran described in paragraph (2) of subsection
(a) to make any copayment for, or charge the veteran for any other cost
of, the receipt of any item or service furnished pursuant to paragraph
(1) of such subsection.''.
(2) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2023.
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