[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1132 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1132

 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 women 40 years of age or older if the 
     coverage or plans include coverage for diagnostic mammography.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 16, 1999

  Mr. Nadler introduced the following bill; which was referred to the 
 Committee on Commerce, and in addition to the Committee on 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 women 40 years of age or older if the 
     coverage or plans include coverage for diagnostic mammography.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Mammogram 
Availability Act of 1999''.
    (b) Findings.--Congress finds the following:
            (1) Breast cancer is the single leading cause of death for 
        women between the ages of 40 and 49 in the United States
            (2) An expert panel convened by the National Institutes of 
        Health recommended on January 23, 1997, that all women between 
        the ages of 40 and 49 should choose for themselves, following 
        consultation with their health care provider, whether to 
        undergo screening mammography.
            (3) The same panel unanimously recommended that for women 
        between the ages of 40 and 49 who choose to have a screening 
        mammogram, costs of the mammograms should be reimbursed by 
        third-party payers or covered by health maintenance 
        organizations.

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 is amended by adding at the end the following new 
        section:

``SEC. 2707. 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 woman who 
        is 40 years of age or older shall provide coverage for annual 
        screening mammography for such a woman under terms and 
        conditions that are not less favorable than the terms and 
        conditions for coverage of diagnostic mammography.
            ``(2) Diagnostic and 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 `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.
    ``(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 woman 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 women to 
        encourage such women 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 woman who is 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 issuer from imposing 
        deductibles, coinsurance, or other cost-sharing in relation to 
        benefits for 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) Women between the ages of 40 and 49 should (but are 
        not required to) consult with appropriate health care 
        practitioners before undergoing screening mammography, but 
        nothing in this section shall be construed as requiring the 
        approval of such a practitioner before undergoing an annual 
        screening mammography.
    ``(d) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 714(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.
    ``(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 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 women who are 40 years of 
        age or older 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)) is 
        amended by striking ``section 2704'' and inserting ``sections 
        2704 and 2707''.
    (b) ERISA Amendments.--
            (1) 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. 714. 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 woman who 
        is 40 years of age or older shall provide coverage for annual 
        screening mammography for such a woman under terms and 
        conditions that are not less favorable than the terms and 
        conditions for coverage of diagnostic mammography.
            ``(2) Diagnostic and 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 `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.
    ``(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 screening mammography is not pursuant to a 
        referral, consent, or recommendation by any health care 
        provider;
            ``(2) deny to a woman 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 women to 
        encourage such women 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 woman who is 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 issuer from imposing 
        deductibles, coinsurance, or other cost-sharing in relation to 
        benefits for 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) Women between the ages of 40 and 49 should (but are 
        not required to) consult with appropriate health care 
        practitioners before undergoing screening mammography, but 
        nothing in this section shall be construed as requiring the 
        approval of such a practitioner 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 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.
    ``(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 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 women who are 40 years of 
        age or older, 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)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 714''.
            (3) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 714''.
            (4) The table of contents in section 1 of such Act is 
        amended by inserting after the item relating to section 713 the 
        following new item:

``Sec. 714. 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, 1999.
    (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, 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 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 is amended by inserting after section 2751 the following new 
section:

``SEC. 2753. 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 714(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 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 women who are 40 years of age or 
        older 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)) is amended by striking ``section 2751'' and 
inserting ``sections 2751 and 2753''.
    (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, 1999.
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