[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 777 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 777

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

                            February 1, 1995

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

_______________________________________________________________________

                                 A BILL


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

    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 
1995''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Breast cancer is the second leading cause of death by 
        cancer in women.
            (2) An estimated 182,000 new invasive cases of breast 
        cancer in the United States are expected during 1995.
            (3) An estimated 46,240 individuals are expected to die of 
        breast cancer during 1995, of whom 46,000 will be women.
            (4) There is no cure for breast cancer.
            (5) Early detection is the key to survival of this 
        devastating disease.
            (6) Mammography is recognized as a valuable diagnostic 
        technique for the detection of breast cancer.
            (7) The American Cancer Society recommends that 
        asymptomatic women have a screening mammogram by age 40 and a 
        screening mammogram every 1 to 2 years between the ages of 40 
        and 49.
            (8) The American Cancer Society and the National Cancer 
        Institute recommend an annual mammogram for women over age 50.
            (9) Lower-income women are often unable to afford 
        recommended cancer screening.
            (10) Many lower-income women receive health care benefits 
        under the medicaid program.

SEC. 3. COVERAGE OF SCREENING MAMMOGRAPHY UNDER MEDICAID.

    (a) In General.--Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) is amended--
            (1) by striking ``and'' at the end of paragraph (24);
            (2) by redesignating paragraph (25) as paragraph (26); and
            (3) by inserting after paragraph (24) the following new 
        paragraph:
            ``(25) screening mammography (as defined in subsection 
        (t)(1)) that is conducted by a facility that has a certificate 
        (or provisional certificate) issued under section 354 of the 
        Public Health Service Act, to the extent consistent with the 
        frequency permitted under subsection (t)(2); and''.
    (b) Frequency of Coverage.--Section 1905 of such 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, 1997.''.
    (c) Making Coverage Mandatory.--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 (25)''.
    (d) Prohibiting Imposition of Charges Against Beneficiaries.--
Sections 1916(a)(2)(D) and 1916(b)(2)(D) of such Act (42 U.S.C. 
1396o(a)(2)(D), 1396o(b)(2)(D)) are each amended by inserting 
``services described in section 1905(a)(25),'' after 
``1905(a)(4)(C),''.
    (e) 100 Percent Federal Match.--Section 1905(b) of such Act (42 
U.S.C. 1396d(b)) is amended by adding at the end the following: 
``Notwithstanding the first sentence of this subsection, the Federal 
medical assistance percentage shall be 100 percent with respect to 
amounts expended for medical assistance consisting of screening 
mammography under subsection (a)(25).''.
    (f) Conforming Amendments.--(1) Section 1902(a)(10)(C)(iv) of such 
Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended--
            (A) by striking ``(5) and (17)'' and inserting ``(5), (17), 
        and (25)''; and
            (B) by striking ``through (21)'' and inserting ``through 
        (25)''.
    (2) Section 1902(j) (42 U.S.C. 1396a(j)) of such Act is amended by 
striking ``through (22)'' and inserting ``through (26)''.
    (g) Effective Date.--(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to screening mammography 
performed on or after January 1, 1996, 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.
                                 <all>