118 HR 9417 IH: Early Access to Screening Act U.S. House of Representatives 2024-08-27 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I118th CONGRESS2d SessionH. R. 9417IN THE HOUSE OF REPRESENTATIVESAugust 27, 2024Mr. Lawler (for himself and Mr. Williams of New York) 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 concernedA BILLTo amend titles XVIII and XIX of the Social Security Act and title XXVII of the Public Health Service Act to provide no-cost coverage for annual screening mammography beginning at 30 years of age.

1.

Short title

This Act may be cited as the Early Access to Screening Act.

2.

No-cost coverage of annual screening mammography beginning at 30 years of age

(a)

Coverage under Medicare

(1)

In general

Section 1834(c) of the Social Security Act (42 U.S.C. 1395m(c)) is amended—(A)in paragraph (1)(A), by inserting or (3) after paragraph (2);(B)in paragraph (2)—(i)by striking the paragraph heading and inserting Frequency covered before January 1, 2025; and(ii)in subparagraph (A), by striking Subject and inserting With respect to screening mammography performed before January 1, 2025, subject; and(C)by adding at the end the following new paragraph:(3)

Frequency covered on or after January 1, 2025

With respect to screening mammography performed on or after January 1, 2025—(A)no payment may be made under this part for screening mammography performed on a woman under 30 years of age; and(B)in the case of a woman over 29 years of age, payment may not be made under this part for screening mammography performed within 11 months following the month in which a previous screening mammography was performed..(2)

Prohibition of cost sharing

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—(A)in subparagraph (Y), by inserting after “in the case of such services described in subparagraph (A)” the following: “(other than screening mammography (as defined in section 1861(jj)) performed on or after January 1, 2025)”;(B)in subparagraph (GG), by striking and at the end; and(C)by inserting before the semicolon at the end the following: , and (II) with respect to screening mammography (as defined in section 1861(jj)) performed on or after January 1, 2025, the amounts paid shall be shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the fee schedule that applies to such services under this part.(3)

Conforming amendment

Section 1862(a)(1)(F) is amended by striking section 1834(c)(2) and inserting section 1834(c).(b)

Coverage under Medicaid

(1)

Mandatory coverage

(A)

In general

Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by inserting (13)(D), before (17),.(B)

Medically needy

Section 1902(a)(10)(C)(iv) of the Social Security Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by inserting (13)(D), before and (17).(C)

Alternative benefit plans

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)

Annual screening mammography

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, beginning on January 1, 2025, for any individual over age 29, such coverage includes (and does not impose any deduction, cost sharing, or similar charge for) annual screening mammography described in section 1905(a)(13)(D).. (2)

Inclusion under diagnostic, screening, preventive, and rehabilitative services

Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended—(A)in subparagraph (B), by striking and at the end;(B)in subparagraph (C), by adding and at the end; and(C)by adding at the end the following new subparagraph:(D)beginning January 1, 2025, for individuals over age 29, annual screening mammography;.(3)

Prohibition of cost sharing

(A)

In general

Section 1916 of the Social Security Act (42 U.S.C. 1396o) is amended—(i)in subsection (a)(2)—(I)in subparagraph (I), by striking or at the end;(II)in subparagraph (J), by striking ; and at the end and inserting , or; and(III)by adding at the end the following new subparagraph:(K)beginning January 1, 2025, annual screening mammography described in section 1905(a)(13)(D); and; and(ii)in subsection (b)(2)—(I)in subparagraph (I), by striking or at the end;(II)in subparagraph (J), by striking ; and at the end and inserting , or; and(III)by adding at the end the following new subparagraph:(K)beginning January 1, 2025, annual screening mammography described in section 1905(a)(13)(D); 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)Beginning January 1, 2025, annual screening mammography described in section 1905(a)(13)(D)..(c)

Coverage under group health plans and group and individual health insurance

(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 ; and; and(C)in paragraph (4)—(i)by striking at the end the period and inserting ; and;(ii)by striking women, such and inserting women—(A)such; and(iii)by adding at the end the following new subparagraph:(B)in the case of a woman over 29 years of age, annual mammography screening..(2)

Effective date

The amendments made by this subsection shall apply to plan years beginning on or after January 1, 2025.