[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2152 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 2152

 To amend the Public Health Service Act and Employee Retirement Income 
   Security Act of 1974 to require that group and individual health 
 insurance coverage and group health plans provide coverage for annual 
   screening mammography for any class of covered individuals if the 
coverage or plans include coverage for diagnostic mammography for such 
class, and to amend titles XVIII and XIX of the Social Security Act to 
         provide for coverage of annual screening mammography.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 11, 1997

 Mr. Andrews introduced the following bill; which was referred to the 
 Committee on Commerce, and in addition to the Committees on Ways and 
Means and Education and the Workforce, 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 amend the Public Health Service Act and Employee Retirement Income 
   Security Act of 1974 to require that group and individual health 
 insurance coverage and group health plans provide coverage for annual 
   screening mammography for any class of covered individuals if the 
coverage or plans include coverage for diagnostic mammography for such 
class, and to amend titles XVIII and XIX of the Social Security Act to 
         provide for coverage of annual 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 ``Screening Mammography Act of 1997''.

SEC. 2. COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY UNDER GROUP HEALTH 
              PLANS.

    (a) Public Health Service Act Amendments.--
            (1) Subpart 2 of part A of title XXVII of the Public Health 
        Service Act, as amended by section 703(a) of Public Law 104-
        204, is amended by adding at the end the following new section:

``SEC. 2706. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.

    ``(a) Requirements for Coverage of Annual Screening Mammography.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, that 
        provides coverage for diagnostic mammography for any class of 
        participants or beneficiaries shall provide coverage for annual 
        screening mammography for such class under terms and conditions 
        that are not less favorable than the terms and conditions for 
        coverage of diagnostic mammography.
            ``(2) Diagnostic and annual screening mammography 
        defined.--For purposes of this section--
                    ``(A) The term `diagnostic mammography' means a 
                radiologic procedure that is medically necessary for 
                the purpose of diagnosing breast cancer and includes a 
                physician's interpretation of the results of the 
                procedure.
                    ``(B) The term `annual screening mammography' means 
                a radiologic procedure provided to an individual, not 
                more frequently than on an annual basis, for the 
                purpose of early detection of breast cancer and 
                includes a physician's interpretation of the results of 
                the procedure.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny coverage for annual screening mammography on the 
        basis that the coverage is not medically necessary or on the 
        basis that the screening mammography is not pursuant to a 
        referral, consent, or recommendation by any health care 
        provider;
            ``(2) deny to a participant or beneficiary eligibility, or 
        continued eligibility, to enroll or to renew coverage under the 
        terms of the plan, solely for the purpose of avoiding the 
        requirements of this section;
            ``(3) provide monetary payments or rebates to participants 
        or beneficiaries to encourage them to accept less than the 
        minimum protections available under this section;
            ``(4) penalize or otherwise reduce or limit the 
        reimbursement of an attending provider because such provider 
        provided care to an individual participant or beneficiary in 
        accordance with this section; or
            ``(5) provide incentives (monetary or otherwise) to an 
        attending provider to induce such provider to provide care to 
        an individual participant or beneficiary in a manner 
        inconsistent with this section.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to require 
        a participant or beneficiary to undergo annual screening 
        mammography.
            ``(2) This section shall not apply with respect to any 
        group health plan, or any group health insurance coverage 
        offered by a health insurance issuer, which does not provide 
        benefits for diagnostic mammography.
            ``(3) Nothing in this section shall be construed as 
        preventing a group health plan or a health insurance issuer 
        offering group health plan coverage from imposing deductibles, 
        coinsurance, or other cost-sharing in relation to benefits for 
        annual screening mammography under the plan (or under health 
        insurance coverage offered in connection with a group health 
        plan), except that such coinsurance or other cost-sharing for 
        any portion may not be greater than such coinsurance or cost-
        sharing that is otherwise applicable with respect to benefits 
        for diagnostic mammography.
            ``(4) Nothing in this section shall be construed as 
        preventing a group health plan or a health insurance issuer 
        offering group health insurance coverage from requiring that a 
        participant or beneficiary, before undergoing an annual 
        screening mammography more frequently than on an annual basis, 
        consult with an appropriate health care practitioner or obtain 
        a written authorization from such a practitioner for submission 
        to the plan or issuer, but nothing in this section shall be 
        construed as requiring prior authorization before undergoing an 
        annual screening mammography.
    ``(d) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 713(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
of this section as if such section applied to such plan.
    ``(e) Level and Type of Reimbursements.--Nothing in this section 
shall be construed as preventing a group health plan or a health 
insurance issuer offering group health insurance coverage from 
negotiating the level and type of reimbursement with a provider for 
care provided in accordance with this section.
    ``(f) Preemption; Exception for Health Insurance Coverage in 
Certain States.--
            ``(1) In general.--The requirements of this section shall 
        not apply with respect to health insurance coverage for any 
        class of participants or beneficiaries if there is a State law 
        (as defined in section 2723(d)(1)) for a State that regulates 
        such coverage, that requires coverage to be provided for annual 
        screening mammography for such class, and that provides at 
        least the protections described in subsection (b).
            ``(2) Construction.--Section 2723(a)(1) shall not be 
        construed as superseding a State law described in paragraph 
        (1).''.
            (2) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)), as 
        amended by section 604(b)(2) of Public Law 104-204, is amended 
        by striking ``section 2704'' and inserting ``sections 2704 and 
        2706''.
    (b) ERISA Amendments.--
            (1) Subpart B of part 7 of subtitle B of title I of the 
        Employee Retirement Income Security Act of 1974, as amended by 
        section 702(a) of Public Law 104-204, is amended by adding at 
        the end the following new section:

``SEC. 713. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.

    ``(a) Requirements for Coverage of Annual Screening Mammography.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, that 
        provides coverage for diagnostic mammography for any class of 
        participants or beneficiaries shall provide coverage for annual 
        screening mammography for such class under terms and conditions 
        that are not less favorable than the terms and conditions for 
        coverage of diagnostic mammography.
            ``(2) Diagnostic and annual screening mammography 
        defined.--For purposes of this section--
                    ``(A) The term `diagnostic mammography' means a 
                radiologic procedure that is medically necessary for 
                the purpose of diagnosing breast cancer and includes a 
                physician's interpretation of the results of the 
                procedure.
                    ``(B) The term `annual screening mammography' means 
                a radiologic procedure provided to an individual, not 
                more frequently than on an annual basis, for the 
                purpose of early detection of breast cancer and 
                includes a physician's interpretation of the results of 
                the procedure.
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny coverage described in subsection (a)(1) on the 
        basis that the coverage is not medically necessary or on the 
        basis that the annual screening mammography is not pursuant to 
        a referral, consent, or recommendation by any health care 
        provider;
            ``(2) deny to a participant or beneficiary eligibility, or 
        continued eligibility, to enroll or to renew coverage under the 
        terms of the plan, solely for the purpose of avoiding the 
        requirements of this section;
            ``(3) provide monetary payments or rebates to participants 
        or beneficiaries to encourage them to accept less than the 
        minimum protections available under this section;
            ``(4) penalize or otherwise reduce or limit the 
        reimbursement of an attending provider because such provider 
        provided care to an individual participant or beneficiary in 
        accordance with this section; or
            ``(5) provide incentives (monetary or otherwise) to an 
        attending provider to induce such provider to provide care to 
        an individual participant or beneficiary in a manner 
        inconsistent with this section.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to require 
        a participant or beneficiary to undergo annual screening 
        mammography.
            ``(2) This section shall not apply with respect to any 
        group health plan, or any group health insurance coverage 
        offered by a health insurance issuer, which does not provide 
        benefits for diagnostic mammography.
            ``(3) Nothing in this section shall be construed as 
        preventing a group health plan or a health insurance issuer 
        offering group health insurance coverage from imposing 
        deductibles, coinsurance, or other cost-sharing in relation to 
        benefits for annual screening mammography under the plan (or 
        under health insurance coverage offered in connection with a 
        group health plan), except that such coinsurance or other cost-
        sharing for any portion may not be greater than such 
        coinsurance or cost-sharing that is otherwise applicable with 
        respect to benefits for diagnostic mammography.
            ``(4) Nothing in this section shall be construed as 
        preventing a group health plan or a health insurance issuer 
        offering group health insurance coverage from requiring that a 
        participant or beneficiary, before undergoing an annual 
        screening mammography more frequently than on an annual basis, 
        consult with an appropriate health care practitioner or obtain 
        a written authorization from such a practitioner for submission 
        to the plan or issuer, but nothing in this section shall be 
        construed as requiring prior authorization before undergoing an 
        annual screening mammography.
    ``(d) Notice Under Group Health Plan.--The imposition of the 
requirements of this section shall be treated as a material 
modification in the terms of the plan described in section 102(a)(1), 
for purposes of assuring notice of such requirements under the plan; 
except that the summary description required to be provided under the 
last sentence of section 104(b)(1) with respect to such modification 
shall be provided by not later than 60 days after the first day of the 
first plan year in which such requirements apply.
    ``(e) Level and Type of Reimbursements.--Nothing in this section 
shall be construed as preventing a group health plan or a health 
insurance issuer offering group health insurance coverage from 
negotiating the level and type of reimbursement with a provider for 
care provided in accordance with this section.
    ``(f) Preemption; Exception for Health Insurance Coverage in 
Certain States.--
            ``(1) In general.--The requirements of this section shall 
        not apply with respect to health insurance coverage for any 
        class of participants or beneficiaries if there is a State law 
        (as defined in section 731(d)(1)) for a State that regulates 
        such coverage, that requires coverage to be provided for annual 
        screening mammography for such class, and that provides at 
        least the protections described in subsection (b).
            ``(2) Construction.--Section 731(a)(1) shall not be 
        construed as superseding a State law described in paragraph 
        (1).''.
            (2) Section 731(c) of such Act (29 U.S.C. 1191(c)), as 
        amended by section 603(b)(1) of Public Law 104-204, is amended 
        by striking ``section 711'' and inserting ``sections 711 and 
        713''.
            (3) Section 732(a) of such Act (29 U.S.C. 1191a(a)), as 
        amended by section 603(b)(2) of Public Law 104-204, is amended 
        by striking ``section 711'' and inserting ``sections 711 and 
        713''.
            (4) The table of contents in section 1 of such Act is 
        amended by inserting after the item relating to section 712 the 
        following new item:

``Sec. 713. Standards relating to benefits for screening 
                            mammography.''.
    (c) Effective Dates.--(1) Subject to paragraph (2), the amendments 
made by this section shall apply with respect to group health plans 
(and health insurance coverage offered in connection with group health 
plans) for plan years beginning on or after January 1, 1998.
    (2) In the case of a group health plan maintained pursuant to 1 or 
more collective bargaining agreements between employee representatives 
and 1 or more employers ratified before the date of enactment of this 
Act, the amendments made by this section shall not apply to plan years 
beginning before the later of--
            (A) the date on which the last collective bargaining 
        agreements relating to the plan terminates (determined without 
        regard to any extension thereof agreed to after the date of 
        enactment of this Act), or
            (B) January 1, 1998.
For purposes of subparagraph (A), any plan amendment made pursuant to a 
collective bargaining agreement relating to the plan which amends the 
plan solely to conform to any requirement added by this section shall 
not be treated as a termination of such collective bargaining 
agreement.

SEC. 3. COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY UNDER INDIVIDUAL 
              HEALTH COVERAGE.

    (a) In General.--Part B of title XXVII of the Public Health Service 
Act, as amended by section 605(a) of Public Law 104-204, is amended by 
inserting after section 2751 the following new section:

``SEC. 2752. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.

    ``(a) In General.--The provisions of section 2706 (other than 
subsections (d) and (f)) shall apply to health insurance coverage 
offered by a health insurance issuer in the individual market in the 
same manner as it applies to health insurance coverage offered by a 
health insurance issuer in connection with a group health plan in the 
small or large group market.
    ``(b) Notice.--A health insurance issuer under this part shall 
comply with the notice requirement under section 713(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
referred to in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan.
    ``(c) Preemption; Exception for Health Insurance Coverage in 
Certain States.--
            ``(1) In general.--The requirements of this section shall 
        not apply with respect to health insurance coverage for any 
        class of individuals if there is a State law (as defined in 
        section 2723(d)(1)) for a State that regulates such coverage, 
        that requires coverage in the individual health insurance 
        market to be provided for annual screening mammography for such 
        class and that provides at least the protections described in 
        section 2706(b) (as applied under subsection (a)).
            ``(2) Construction.--Section 2762(a) shall not be construed 
        as superseding a State law described in paragraph (1).''.
    (b) Conforming Amendment.--Section 2763(b)(2) of such Act (42 
U.S.C. 300gg-63(b)(2)), as added by section 605(b)(3)(B) of Public Law 
104-204, is amended by striking ``section 2751'' and inserting 
``sections 2751 and 2752''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to health insurance coverage offered, sold, issued, 
or renewed in the individual market on or after such January 1, 1998.

SEC. 4. ANNUAL SCREENING MAMMOGRAPHY UNDER MEDICARE PROGRAM.

    (a) Providing Annual Screening Mammography for Women of All Ages.--
Paragraph (2) of section 1834(c) of the Social Security Act (42 U.S.C. 
1395m(c)) is amended to read as follows:
            ``(2) Covered on an annual basis.--Payment may not be made 
        under this part for a screening mammography performed within 
        the 11 months following the month in which a previous screening 
        mammography was performed.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to screening mammography performed on or after January 1, 1998.

SEC. 5. COVERAGE OF ANNUAL 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) annual screening mammography (as defined in 
        subsection (t)) that is conducted by a facility that has a 
        certificate (or provisional certificate) issued under section 
        354 of the Public Health Service Act; and''.
    (b) Annual Screening Mammography Defined.--Section 1905 of such Act 
(42 U.S.C. 1396d) is amended by adding at the end the following new 
subsection:
    ``(t) The term `annual screening mammography' means a radiologic 
procedure provided to a woman, not more frequently than on an annual 
basis, for the purpose of early detection of breast cancer and includes 
a physician's interpretation of the results of the procedure.''.
    (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) Conforming Amendments.--Section 1902 of such Act (42 U.S.C. 
1396a) is amended--
            (1) in subsection (a)(10)(C)(iv)--
                    (A) by striking ``and (17)'' and inserting ``, 
                (17), and (25)'', and
                    (B) by striking ``through (24)'' and inserting 
                ``through (25)''; and
            (2) in subsection (j), by striking ``through (25)'' and 
        inserting ``through (26)''.
    (e) 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, 1998, 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>