[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3037 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 3037
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.
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IN THE HOUSE OF REPRESENTATIVES
April 28, 2025
Mrs. Dingell (for herself, Mr. Fitzpatrick, and Ms. Wasserman Schultz)
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
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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 with
respect to diagnostic and supplemental breast examinations.
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 2025''.
SEC. 2. REQUIRING DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS TO BE
COVERED WITH NO COST-SHARING REQUIREMENTS.
(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 SUPPLEMENTAL BREAST EXAMINATIONS.
``(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 diagnostic and
supplemental breast examinations furnished to an individual enrolled
under such plan or such coverage, such plan or coverage shall not
impose any cost-sharing requirements for these benefits.
``(b) Construction.--Nothing in this section shall be construed--
``(1) to prohibit a group health plan or health insurance
issuer from requiring timely prior authorization or imposing
other appropriate utilization controls in approving coverage
for any diagnostic and supplemental breast examination; or
``(2) to supersede a State law that provides greater
protections with respect to the coverage of diagnostic and
supplemental breast examinations than is provided under this
section.
``(c) Definitions.--In this section:
``(1) Cost-sharing requirements.--The term `cost-sharing
requirements' means 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 breast examination.--The term `diagnostic
breast examination' means a medically necessary and appropriate
(in accordance with National Comprehensive Cancer Network
Guidelines) examination of the breast (including, but not
limited to such an examination using diagnostic mammography,
breast magnetic resonance imaging, or breast ultrasound) that
is--
``(A) used to evaluate an abnormality seen or
suspected from a screening examination for breast
cancer; or
``(B) used to evaluate an abnormality detected by
another means of examination.
``(3) Supplemental breast examinations.--The term
`supplemental breast examination' means a medically necessary
and appropriate (in accordance with National Comprehensive
Cancer Network Guidelines) examination of the breast
(including, but not limited to such an examination using breast
magnetic resonance imaging or breast ultrasound) that is--
``(A) used to screen for breast cancer when there
is no abnormality seen or suspected; and
``(B) furnished based on personal or family medical
history or additional factors that may increase the
individual's risk of breast cancer.''.
(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 coverage
for diagnostic and supplemental breast
examinations).''.
(c) Application to High Deductible Health Plans With Health Savings
Account Eligibility.--Section 223(c)(2) of the Internal Revenue Code of
1986 is amended by adding at the end the following:
``(H) Safe harbor for absence of deductible for
diagnostic and supplemental breast examinations.--In
the case of plan years beginning on or after January 1,
2026, a plan shall not fail to be treated as a high
deductible health plan by reason of failing to have a
deductible for diagnostic and supplemental breast
examinations.''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2026.
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