[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3630 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3630

   To require coverage of screening mammography and pap smears under 
                             health plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 12, 1996

  Mr. Fox of Pennsylvania (for himself, Mr. Gene Green of Texas, Mr. 
   Lipinski, Mrs. Roukema, Mr. Davis, and Mr. Forbes) introduced the 
following bill; which was referred to the Committee on Commerce, and in 
 addition to the Committee on Economic and Educational Opportunities, 
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 require coverage of screening mammography and pap smears under 
                             health plans.

    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 ``Women's Preventive Health Care Act 
of 1996''.

SEC. 2. REQUIRING COVERAGE OF SCREENING MAMMOGRAPHY AND PAP SMEARS 
              UNDER HEALTH PLANS.

    (a) In General.--Every policy or contract that provides health 
insurance coverage (as defined in subsection (h)(1)) and every group 
health plan (as defined in subsection (h)(2)) shall include (consistent 
with this section)--
            (1) coverage for screening pap smears, and
            (2) coverage for low-dose screening mammography.
    (b) Definitions Relating to Coverage.--In this section:
            (1) Low-dose screening mammography.--The term ``low-dose 
        screening mammography'' means a radiologic procedure for the 
        early detection of breast cancer provided to an asymptomatic 
        women using equipment dedicated specifically for mammography 
        and at a facility which meets mammography accreditation 
        standards established by the Secretary for coverage of 
        screening mammography under the medicare program under title 
        XVIII of the Social Security Act. Such term also includes a 
        physician's interpretation of the results of the procedure.
            (2) Screening pap smear.--The term ``screening pap smear'' 
        means a diagnostic laboratory test consisting of a routine 
        exfoliative cytology test (Papanicolaou test) provided to a 
        woman for the purpose of early detection of cervical cancer and 
        includes the examination, the laboratory test itself, and a 
        physician's interpretation of the results of the test. If the 
        Secretary establishes qualify standards for facilities 
        furnishing screening pap smears, such term shall only include a 
        test if the test is performed in a facility that has been 
        determined to meet such standards.
    (c) Restrictions on Cost-Sharing.--The coverage under this section 
shall not provide for the application of deductibles, coinsurance, or 
other limitations for low-dose screening mammography or screening pap 
smears that are greater than the deductibles, coinsurance, and 
limitations that are applied to similar services under the health 
insurance coverage or group health plan.
    (d) Frequency of Coverage of Screening Mammography.--
            (1) In general.--Coverage of low-dose screening mammography 
        is consistent with this section only if it is provided 
        consistent with the following periodicity schedule:
                    (A) Coverage is made available for one baseline 
                low-dose screening mammography for any woman between 35 
                and 40 years of age.
                    (B) Coverage is made available for such mammography 
                on an annual basis to any woman who is 50 years or age 
                or older or who is determined by a physician to be at-
                risk of breast cancer (as defined in paragraph (2)).
                    (C) Coverage is made available for such mammography 
                for a woman at least once every other year.
            (2) At-risk of breast cancer.--For purposes of paragraph 
        (1)(B), a woman is considered to be ``at-risk of breast 
        cancer'' if any of the following is true:
                    (A) The woman has a personal history of breast 
                cancer.
                    (B) The woman has a personal history of biopsy-
                proven benign breast disease.
                    (C) The woman's mother, sister, or daughter has or 
                has had breast cancer.
                    (D) The woman has not given birth prior to the age 
                of 30.
    (e) Frequency of Coverage of Screening Pap Smears.--Coverage of 
screening pap smears is consistent with this section only if it is 
provided not more often than once every year (or more frequently if 
recommended by a physician).
    (f) Enforcement.--
            (1) Regulated insurers.--It is the responsibility of State 
        regulators what regulate insurers that offer health insurance 
        coverage in a State to apply the requirements of this section 
        to such insurers and coverage. If the Secretary determines that 
        such regulators do not have the intent or means of enforcing 
        such requirements with respect to such insurers in a State, the 
        Secretary may provide such remedies (which may include civil 
        money penalties) as may be necessary to assure compliance with 
        the requirements of this section in such State.
            (2) Group health plans.--The requirements of this section 
        are deemed, in relation to group health plans offered as 
        employee welfare benefit plans under title I of Employee 
        Retirement Income Security Act of 1974, to be provisions of 
        such title, for purposes of applying the enforcement related 
        provisions of such title.
            (3) Other plans.--In the case of health coverage not 
        described in paragraph (1) or (2), the Secretary shall develop 
        such non-criminal enforcement mechanisms as may be necessary 
        and appropriate to carry out this section in relation to 
        entities offering such coverage.
    (g) Relation to State Law.--The provisions of this section do not 
preempt State law to the extent such State law provides greater 
protection to women in relation to the benefits provided under this 
section.
    (h) Definitions.--In this section:
            (1) Health insurance coverage.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the term ``health insurance coverage'' means 
                benefits consisting of medical care (provided directly, 
                through insurance or reimbursement, or otherwise) under 
                any hospital or medical service policy or certificate, 
                hospital or medical service plan contract, or health 
                maintenance organization group contract offered by an 
                insurer or a health maintenance organization.
                    (B) Exception.--Such term does not include coverage 
                under any separate policy, certificate, or contract 
                only for one or more of any of the following:
                            (i) Coverage for accident, credit-only, 
                        vision, disability income, long-term care, 
                        nursing home care, community-based care dental, 
                        on-site medical clinics, or employee assistance 
                        programs, or any combination thereof.
                            (ii) Medicare supplemental health insurance 
                        (within the meaning of section 1882(g)(1) of 
                        the Social Security Act (42 U.S.C. 
                        1395ss(g)(1))) and similar supplemental 
                        coverage provided under a group health plan.
                            (iii) Coverage issued as a supplement to 
                        liability insurance.
                            (iv) Liability insurance, including general 
                        liability insurance and automobile liability 
                        insurance.
                            (v) Workers' compensation or similar 
                        insurance.
                            (vi) Automobile medical-payment insurance.
                            (vii) Coverage for a specified disease or 
                        illness.
                            (viii) Hospital or fixed indemnity 
                        insurance.
                            (ix) Short-term limited duration insurance.
                            (x) Such other coverage, comparable to that 
                        described in previous clauses, as may be 
                        specified in regulations prescribed by the 
                        Secretary.
            (2) Group health plan.--
                    (A) In general.--Subject to subparagraph (B), the 
                term ``group health plan'' means an employee welfare 
                benefit plan (as defined in section 3 of the Employee 
                Retirement Income Security Act of 1974) to the extent 
                that the plan provides medical care (as defined in 
                paragraph (5)) to employees or their dependents (as 
                defined under the terms of the plan) directly or 
                through insurance, reimbursement, or otherwise, and 
                includes a group health plan (within the meaning of 
                section 5000(b)(1) of the Internal Revenue Code of 
                1986).
                    (B) Exclusion of plans with limited coverage.--An 
                employee welfare benefit plan shall be treated as a 
                group health plan under this section only with respect 
                to medical care which is provided under the plan and 
                which does not consist of coverage excluded from the 
                definition of health insurance coverage under paragraph 
                (1)(B).
            (3) Health maintenance organization.--The term ``health 
        maintenance organization'' means--
                    (A) a Federally qualified health maintenance 
                organization (as defined in section 1301(a) of the 
                Public Health Service Act (42 U.S.C. 300e(a))),
                    (B) an organization recognized under State law as a 
                health maintenance organization, or
                    (C) a similar organization regulated under State 
                law for solvency in the same manner and to the same 
                extent as such a health maintenance organization,
        if it is subject to State law which regulates insurance (within 
        the meaning of section 514(b)(2) of the Employee Retirement 
        Income Security Act of 1974).
            (4) Insurer.--The term ``insurer'' means an insurance 
        company, insurance service, or insurance organization which is 
        licensed to engage in the business of insurance in a State and 
        which is subject to State law which regulates insurance (within 
        the meaning of section 514(b)(2)(A) of the Employee Retirement 
        Income Security Act of 1974).
            (5) Medical care.--The term ``medical care'' means--
                    (A) amounts paid for, or items or services in the 
                form of, the diagnosis, cure, mitigation, treatment, or 
                prevention of disease, or amounts paid for, or items or 
                services provided for, the purpose of affecting any 
                structure or function of the body,
                    (B) amounts paid for, or services in the form of, 
                transportation primarily for and essential to medical 
                care referred to in subparagraph (A), and
                    (C) amounts paid for insurance covering medical 
                care referred to in subparagraphs (A) and (B).
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (7) State.--The term ``State'' includes the District of 
        Columbia, Puerto Rico, the Virgin Islands, the Northern Mariana 
        Islands, Guam, and American Samoa.
    (i) Effective Date.--This section shall apply to health insurance 
coverage that is issued, renewed, or amended on or after January 1, 
1997, and to group health plans for plan years beginning on or after 
such date.
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