[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 425 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 425

To amend title XIX of the Social Security Act to require State medicaid 
          plans to provide coverage of screening mammography.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 5, 1993

 Mrs. Vucanovich introduced the following bill; which was referred to 
                  the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 


    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 ``Medicaid Mammography Coverage Act of 
1993''.

SEC. 2. COVERAGE OF SCREENING MAMMOGRAPHY UNDER MEDICAID.

    (a) In General.--Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)), as amended by the Omnibus Budget Reconciliation Act 
of 1990, is amended--
            (1) by striking ``and'' at the end of paragraph (21);
            (2) in paragraph (24), by striking the comma at the end and 
        inserting a semicolon;
            (3) by redesignating paragraphs (22), (23), and (24) as 
        paragraphs (21), (22), and (23), respectively, and by 
        transferring and inserting paragraph (25) after paragraph (23), 
        as so redesignated; and
            (4) by inserting after paragraph (23) the following new 
        paragraph:
            ``(24) screening mammography (as defined in subsection 
        (t)(1)) that meets the quality standards established under 
        section 1834(c)(3), to the extent consistent with the frequency 
        permitted under subsection (t)(2); and''.
    (b) Frequency of Coverage.--Section 1905 of the Social Security Act 
(42 U.S.C. 1396d) is amended by adding at the end the following new 
subsection:
    ``(t) Coverage of Screening Mammography.--
            ``(1) Definition.--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.
            ``(2) Frequency covered.--
                    ``(A) In general.--Subject to revision by the 
                Secretary under subparagraph (B)--
                            ``(i) Medical assistance is not required to 
                        be made under this title for screening 
                        mammography performed on a woman under 35 years 
                        of age.
                            ``(ii) Medical assistance is available 
                        under this title for only 1 screening 
                        mammography performed on a woman over 34 years 
                        of age, but under 40 years of age.
                            ``(iii) In the case of a woman over 39 
                        years of age, but under 50 years of age, who--
                                    ``(I) is at a high risk of 
                                developing breast cancer (as determined 
                                pursuant to factors identified by the 
                                Secretary), medical assistance is not 
                                required to be made available under 
                                this title for a screening mammography 
                                performed within 11 months of a 
                                previous screening mammography, or
                                    ``(II) is not at a high risk of 
                                developing breast cancer, medical 
                                assistance is not required to be made 
                                available under this title for a 
                                screening mammography performed within 
                                23 months of a previous screening 
                                mammography.
                            ``(iv) In the case of a woman over 49 years 
                        of age, medical assistance is not required to 
                        be made available under this title for 
                        screening mammography performed within 11 
                        months of a previous screening mammography.
                    ``(B) Revision of frequency.--
                            ``(i) Review.--The Secretary, in 
                        consultation with the Director of the National 
                        Cancer Institute, shall review periodically 
                        appropriate frequency for performing screening 
                        mammography, based on age and such other 
                        factors as the Secretary believes to be 
                        pertinent.
                            ``(ii) Revision of frequency.--The 
                        Secretary, taking into consideration the review 
                        made under clause (i), may revise from time to 
                        time the frequency with which medical 
                        assistance is required to be made available 
                        under this title, but no such revision shall 
                        apply to screening mammography performed before 
                        January 1, 1993.''.
    (c) Conforming Amendments.--(1) Section 1902(a)(10(A) of such Act 
(42 U.S.C. 1396a(a)(10)(A)) is amended by striking ``(17) and (21)'' 
and inserting ``(17), (21) and (24)''.
    (2) Section 1902(a)(10)(C)(iv) (42 U.S.C. 1396a(a)(10)(C)(iv)) is 
amended--
            (A) by striking ``(5) and (17)'' and inserting ``(5), (17), 
        and (24)''; and
            (B) by striking ``through (21)'' and inserting ``through 
        (24)''.
    (3) Section 1902(j) (42 U.S.C. 1396a(j)) is amended by striking 
``through (22)'' and inserting ``through (24)''.
    (4) Sections 1916(a)(2)(D) and 1916(b)(2)(D) (42 U.S.C. 
1396o(a)(2)(D), 1396o(b)(2)(D)) are each amended by inserting 
``services described in section 1905(a)(24)'' before ``family planning 
services''.
    (d) Effective Date.--(1) Except as provided in paragraph (2), the 
amendments made by subsections (a), (b), and (c) shall apply to 
screening mammography performed on or after January 1, 1994, without 
regard to whether or not final regulations to carry out such amendments 
have been promulgated by such date.
    (2) In the case of a State plan for medical assistance 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 
requirement imposed by the amendments made 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 its failure to meet this 
additional requirement before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the case of a State that 
has a 2-year legislative session, each year of such session shall be 
deemed to be a separate regular session of the State legislature.

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