[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4333 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4333

To amend the Public Health Service Act, the Employee Retirement Income 
Security Act of 1974, and the Internal Revenue Code of 1986 to require 
 that group and individual health insurance coverage and group health 
plans provide coverage of annual mammograms and annual prostate cancer 
  screening tests following the model established under the Medicare 
                                Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 24, 1998

   Mrs. Maloney of New York introduced the following bill; which was 
     referred to the Committee on Commerce, and in addition to the 
 Committees on Education and the Workforce, and 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 concerned

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act, the Employee Retirement Income 
Security Act of 1974, and the Internal Revenue Code of 1986 to require 
 that group and individual health insurance coverage and group health 
plans provide coverage of annual mammograms and annual prostate cancer 
  screening tests following the model established under the Medicare 
                                Program.

    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 ``Annual Mammogram and Prostate Cancer 
Screening Coverage Act of 1998''.

SEC. 2. COVERAGE OF ANNUAL MAMMOGRAMS AND ANNUAL PROSTATE CANCER 
              SCREENING TESTS

    (a) Group Health Plans.--
            (1) Public health service act amendments.--(A) Subpart 2 of 
        part A of title XXVII of the Public Health Service Act is 
        amended by adding at the end the following new section:

``SEC. 2706. STANDARDS RELATING TO BENEFITS FOR ANNUAL MAMMOGRAMS AND 
              ANNUAL PROSTATE CANCER SCREENING TESTS.

    ``(a) Requirement.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, 
        shall provide coverage for--
                    ``(A) annual screening mammograms for female 
                participants and beneficiaries who are 40 years of age 
                or older; and
                    ``(B) annual prostate cancer screening testing for 
                male participants and beneficiaries who are 50 years of 
                age or older.
            ``(2) Regulations.--The Secretary shall promulgate 
        regulations to carry out this section. In promulgating such 
        regulations, the Secretary shall provide that the coverage 
        required under paragraph (1) shall be comparable to the 
        coverage of similar benefits under the medicare program under 
        part B of title XVIII of the Social Security Act.
    ``(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 to an individual 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;
            ``(2) provide monetary payments or rebates to individuals 
        to encourage such individuals to accept less than the minimum 
        protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        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 
        an individual who is a participant or beneficiary to undergo a 
        screening mammogram or prostate cancer screening test.
            ``(2) Nothing in this section shall be construed as 
        preventing a group health plan or issuer from imposing 
        deductibles, coinsurance, or other cost-sharing in relation to 
        benefits described in subsection (a) consistent with such 
        subsection, except that such coinsurance or other cost-sharing 
        shall not discriminate on any basis related to the coverage 
        required under this section.
    ``(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 to prevent 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.''.
            (B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is 
        amended by striking ``section 2704'' and inserting ``sections 
        2704 and 2706''.
            (2) ERISA amendments.--(A) Subpart B of part 7 of subtitle 
        B of title I of the Employee Retirement Income Security Act of 
        1974 is amended by adding at the end the following new section:

``SEC. 713. STANDARDS RELATING TO BENEFITS FOR ANNUAL MAMMOGRAMS AND 
              ANNUAL PROSTATE CANCER SCREENING TESTS.

    ``(a) Requirement.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, 
        shall provide coverage for--
                    ``(A) annual screening mammograms for participants 
                and beneficiaries who are 40 years of age or older; and
                    ``(B) annual prostate cancer screening testing for 
                male participants and beneficiaries who are 50 years of 
                age or older.
            ``(2) Regulations.--The Secretary shall promulgate 
        regulations to carry out this section. In promulgating such 
        regulations, the Secretary shall provide that the coverage 
        required under paragraph (1) shall be comparable to the 
        coverage of similar benefits under the medicare program under 
        part B of title XVIII of the Social Security Act.
    ``(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 to an individual 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;
            ``(2) provide monetary payments or rebates to individuals 
        to encourage such individuals to accept less than the minimum 
        protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section; or
            ``(4) provide incentives (monetary or otherwise) to a 
        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 
        an individual who is a participant or beneficiary to undergo a 
        screening mammogram or prostate cancer screening test.
            ``(2) Nothing in this section shall be construed as 
        preventing a group health plan or issuer from imposing 
        deductibles, coinsurance, or other cost-sharing in relation to 
        benefits described in subsection (a) consistent with such 
        subsection, except that such coinsurance or other cost-sharing 
        shall not discriminate on any basis related to the coverage 
        required under this section.
    ``(d) Notice Under Group Health Plan.--The imposition of the 
requirement 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 requirement apply.
    ``(e) Level and Type of Reimbursements.--Nothing in this section 
shall be construed to prevent 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.''.
            (B) Section 731(c) of such Act (29 U.S.C. 1191(c)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 713''.
            (C) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 713''.
            (D) 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 annual mammograms and 
                            annual prostate cancer screening tests.''.
            (3) Internal revenue code amendments.--Subchapter B of 
        chapter 100 of the Internal Revenue Code of 1986 (as amended by 
        section 1531(a) of the Taxpayer Relief Act of 1997) is 
        amended--
            (A) in the table of sections, by inserting after the item 
        relating to section 9812 the following new item:

                              ``Sec. 9813. Standards relating to 
                                        benefits for annual mammograms 
                                        and annual prostate cancer 
                                        screening tests.''; and
            (B) by inserting after section 9812 the following:

``SEC. 9813. STANDARDS RELATING TO BENEFITS FOR ANNUAL MAMMOGRAMS AND 
              ANNUAL PROSTATE CANCER SCREENING TESTS.

    ``A group health plan shall comply with the requirements of section 
713(a) of the Employee Retirement Income Security Act of 1974.''
    (b) Individual Health Insurance.--(1) Part B of title XXVII of the 
Public Health Service Act is amended by inserting after section 2751 
the following new section:

``SEC. 2752. STANDARDS RELATING TO BENEFITS FOR ANNUAL MAMMOGRAMS AND 
              ANNUAL PROSTATE CANCER SCREENING TESTS.

    ``(a) In General.--The provisions of section 2706 (other than 
subsection (d)) 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) Effective Dates.--(1) Subject to paragraph (3), the amendments 
made by subsection (a) shall apply with respect to group health plans 
for plan years beginning on or after January 1, 1999.
    (2) The amendment made by subsection (b) shall apply with respect 
to health insurance coverage offered, sold, issued, renewed, in effect, 
or operated in the individual market on or after such date.
    (3) 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 subsection (a) 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, 1999.
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 subsection (a) shall 
not be treated as a termination of such collective bargaining 
agreement.
    (d) Coordinated Regulations.--Section 104(1) of Health Insurance 
Portability and Accountability Act of 1996 is amended by striking 
``this subtitle (and the amendments made by this subtitle and section 
401)'' and inserting ``the provisions of part 7 of subtitle B of title 
I of the Employee Retirement Income Security Act of 1974, the 
provisions of parts A and C of title XXVII of the Public Health Service 
Act, and chapter 100 of the Internal Revenue Code of 1986''.
                                 <all>