[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4540 Introduced in House (IH)]







109th CONGRESS
  1st Session
                                H. R. 4540

 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

                           December 14, 2005

   Mr. Nadler (for himself, Mr. Wynn, Mr. Owens, Mr. Van Hollen, Mr. 
Rangel, Mr. Hinojosa, Mr. Holden, Ms. Jackson-Lee of Texas, Ms. Kaptur, 
  Ms. Millender-McDonald, Mr. Hinchey, Mr. Sherman, Mr. Michaud, Ms. 
   Herseth, Ms. Carson, Mr. Pallone, Mr. Grijalva, Mr. McIntyre, Mr. 
  McDermott, Mr. Kucinich, Ms. Solis, Ms. Norton, Mr. Gutierrez, Mr. 
       Boucher, Mr. Ackerman, Mr. Scott of Georgia, Mr. Frank of 
 Massachusetts, Mr. Payne, Mr. Cleaver, Mrs. Christensen, Mr. Conyers, 
Mr. Crowley, Mr. Honda, Mr. Ryan of Ohio, Ms. Ros-Lehtinen, Mr. Stark, 
Ms. Matsui, Mr. Towns, Mr. Lynch, Mr. McNulty, Mr. Lantos, Mr. Weiner, 
 Mr. Kildee, Ms. Woolsey, Mr. Langevin, and Mr. Meehan) introduced the 
   following bill; which was referred to the Committee on Energy and 
    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 2005''.
    (b) Findings.--Congress finds the following:
            (1) An estimated 211,000 women will have been diagnosed 
        with breast cancer and an estimated 40,000 women will have died 
        from breast cancer during 2005.
            (2) Breast cancer is the second leading cause of death for 
        women in the United States and is the leading cause of death 
        for women between the ages of 40 and 49 in the United States.
            (3) Breast cancer death rates were reduced by 24 percent 
        from 1990 to 2000.
            (4) A study sponsored by the National Cancer Institute and 
        published on October 27, 2005, concluded that up to 65 percent 
        of the reduction in the number of breast cancer deaths was 
        directly attributable to screening mammography.
            (5) An expert panel convened by the National Institutes of 
        Health's National Cancer Institute recommended on February 21, 
        2002, that women between the ages of 40 and 49 should be 
        screened every one to two years with mammography.
            (6) The American Cancer Society recommends that women over 
        the age of 40 receive an annual mammogram.

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) Protections.--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 a health care practitioner before a woman undergoes 
        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) Protections.--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 a health care practitioner before a woman undergoes 
        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 summary plan described in section 
102(a), 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 1 year after the date of 
the enactment of this Act.
    (2)(A) 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 the 
enactment of this Act, the amendments made by this section shall not 
apply to plan years beginning before the later of--
                    (i) 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 the enactment of this Act); 
                or
                    (ii) 1 year after the date of the enactment of this 
                Act.
    (B) For purposes of subparagraph (A)(i), 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 2752 the following new 
section:

``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.

    ``(a) In General.--The provisions of section 2707 (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 2707(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 2762(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 the date that is 1 year 
after the date of the enactment of this Act.
                                 <all>