[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 995 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 995

 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 and for such 
screening and annual magnetic resonance imaging for women at high risk 
    for breast cancer if the coverage or plans include coverage for 
       diagnostic mammography for women 40 years of age or older.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 11, 2009

   Mr. Nadler of New York (for himself, Mr. Ackerman, Mr. Bishop of 
    Georgia, Mr. Bishop of New York, Ms. Bordallo, Mrs. Capps, Mrs. 
Christensen, Mr. Cleaver, Mr. Cohen, Ms. Edwards of Maryland, Mr. Frank 
 of Massachusetts, Mr. Grijalva, Mr. Honda, Ms. Kaptur, Mr. Kucinich, 
Ms. Lee of California, Mrs. Maloney, Mr. Michaud, Mrs. Napolitano, Ms. 
  Norton, Ms. Schakowsky, Mr. Serrano, Mr. Sires, Ms. Sutton, Ms. Ros-
Lehtinen, Ms. Wasserman Schultz, and Mr. Scott of Virginia) introduced 
 the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committee on Education and Labor, 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 and for such 
screening and annual magnetic resonance imaging for women at high risk 
    for breast cancer if the coverage or plans include coverage for 
       diagnostic mammography for women 40 years of age or older.

    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 and MRI 
Availability Act of 2009''.
    (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.
            (7) The American Cancer Society, after reviewing research 
        since 2002, urges that women at high risk for breast cancer 
        receive annual magnetic resonance imaging in addition to a 
        mammogram because such imaging may detect small tumors not 
        found by a 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. 2708. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY 
              AND MAGNETIC RESONANCE IMAGING.

    ``(a) Requirements for Coverage of Annual Screening Mammography and 
Annual Magnetic Resonance Imaging.--
            ``(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 and diagnostic 
        mammography, annual screening mammography, and annual magnetic 
        resonance imaging for any high risk woman under terms and 
        conditions that are not less favorable than the terms and 
        conditions for coverage of diagnostic mammography for a woman 
        who is 40 years of age or older.
            ``(2) Definitions.--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 `high risk woman' means a woman 
                who--
                            ``(i) has a known BRCA1 or BRCA2 gene 
                        mutation;
                            ``(ii) has a mother, father, brother, 
                        sister, or child with such a gene mutation and 
                        has not had genetic testing to determine the 
                        existence of such a gene mutation;
                            ``(iii) has a lifetime risk of breast 
                        cancer of 20 percent or greater, according to 
                        risk assessment tools that are based mainly on 
                        family history;
                            ``(iv) had radiation therapy to the chest 
                        when the woman was between the ages of 10 and 
                        30 years of age;
                            ``(v) has Li-Fraumeni syndrome, Cowden 
                        syndrome, or Bannayan-Riley-Ruvalcaba syndrome, 
                        or has a relative described in clause (ii) who 
                        has one of such syndromes; or
                            ``(vi) has another predisposing condition, 
                        as determined by a physician, that 
                        significantly increases the risk of the woman 
                        contracting breast cancer.
                    ``(C) 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 or 
        annual magnetic resonance imaging on the basis that the 
        coverage is not medically necessary or on the basis that the 
        screening mammography or magnetic resonance imaging, 
        respectively, 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 or annual magnetic resonance imaging.
            ``(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 or magnetic resonance 
        imaging 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 of such 
        benefits may not be greater than such coinsurance or cost-
        sharing that is otherwise applicable with respect to benefits 
        for diagnostic mammography.
            ``(4) Women should (but are not required to) consult with 
        appropriate health care practitioners before undergoing 
        screening mammography or magnetic resonance imaging, 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 or annual magnetic resonance 
        imaging.
    ``(d) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 715(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) Screening mammography.--The requirements of this 
        section, with respect to annual screening mammography, shall 
        not apply with respect to health insurance coverage for women 
        who are 40 years of age or older or who are high risk women 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 or who are high risk women (as defined 
        in subsection (a)(2)(B)), respectively, and that provides at 
        least the protections described in subsection (b).
            ``(2) Magnetic resonance imaging.--The requirements of this 
        section, with respect to annual magnetic resonance imaging, 
        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 magnetic resonance imaging for high risk 
        women (as defined in subsection (a)(2)(B)), and that provides 
        at least the protections described in subsection (b).
            ``(3) Construction.--Section 2723(a)(1) shall not be 
        construed as superseding a State law described in paragraph (1) 
        or (2).''.
            (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 2708''.
    (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. 715. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY 
              AND MAGNETIC RESONANCE IMAGING.

    ``(a) Requirements for Coverage of Annual Screening Mammography and 
Annual Magnetic Resonance Imaging.--
            ``(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 and diagnostic 
        mammography, annual screening mammography, and annual magnetic 
        resonance imaging for any high risk woman under terms and 
        conditions that are not less favorable than the terms and 
        conditions for coverage of diagnostic mammography for a woman 
        who is 40 years of age or older.
            ``(2) Definitions.--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 `high risk woman' means a woman 
                who--
                            ``(i) has a known BRCA1 or BRCA2 gene 
                        mutation;
                            ``(ii) has a mother, father, brother, 
                        sister, or child with such a gene mutation and 
                        has not had genetic testing to determine the 
                        existence of such a gene mutation;
                            ``(iii) has a lifetime risk of breast 
                        cancer of 20 percent or greater, according to 
                        risk assessment tools that are based mainly on 
                        family history;
                            ``(iv) had radiation therapy to the chest 
                        when the woman was between the ages of 10 and 
                        30 years of age;
                            ``(v) has Li-Fraumeni syndrome, Cowden 
                        syndrome, or Bannayan-Riley-Ruvalcaba syndrome, 
                        or has a relative described in clause (ii) who 
                        has one of such syndromes; or
                            ``(vi) has another predisposing condition, 
                        as determined by a physician, that 
                        significantly increases the risk of the woman 
                        contracting breast cancer.
                    ``(C) 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 or magnetic resonance 
        imaging 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 or annual magnetic resonance imaging.
            ``(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 or magnetic resonance 
        imaging 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 of such 
        benefits may not be greater than such coinsurance or cost-
        sharing that is otherwise applicable with respect to benefits 
        for diagnostic mammography.
            ``(4) Women should (but are not required to) consult with 
        appropriate health care practitioners before undergoing 
        screening mammography or magnetic resonance imaging, 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 or annual magnetic resonance 
        imaging.
    ``(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) Screening mammography.--The requirements of this 
        section, with respect to annual screening mammography for women 
        who are 40 years of age or older or for high risk women, 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 or for high risk women (as defined in subsection 
        (a)(2)(B)), respectively, and that provides at least the 
        protections described in subsection (b).
            ``(2) Magnetic resonance imaging.--The requirements of this 
        section, with respect to annual magnetic resonance imaging, 
        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 magnetic resonance imaging for high risk 
        women (as defined in subsection (a)(2)(B)), and that provides 
        at least the protections described in subsection (b).
            ``(3) Construction.--Section 731(a)(1) shall not be 
        construed as superseding a State law described in paragraph (1) 
        or (2).''.
            (2) Section 731(c) of such Act (29 U.S.C. 1191(c)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 715''.
            (3) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 715''.
            (4) The table of contents in section 1 of such Act is 
        amended by inserting after the item relating to section 714 the 
        following new item:

``Sec. 715. Standards relating to benefits for screening mammography 
                            and magnetic resonance imaging.''.
    (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 AND ANNUAL MAGNETIC 
              RESONANCE IMAGING UNDER INDIVIDUAL HEALTH COVERAGE.

    (a) In General.--Part B of title XXVII of the Public Health Service 
Act is amended by inserting after section 2753 the following new 
section:

``SEC. 2754. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY 
              AND MAGNETIC RESONANCE IMAGING.

    ``(a) In General.--The provisions of section 2708 (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 715(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) Annual screening mammography.--The requirements of 
        this section, with respect to annual screening mammography for 
        women who are 40 years of age or older or for high risk women, 
        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 or for high risk women, respectively, and that 
        provides at least the protections described in section 2708(b) 
        (as applied under subsection (a)).
            ``(2) Magnetic resonance imaging.--The requirements of this 
        section, with respect to annual magnetic resonance imaging, 
        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 magnetic resonance imaging for high risk women, and that 
        provides at least the protections described in section 2708(b) 
        (as applied under subsection (a)).
            ``(3) Construction.--Section 2762(a) shall not be construed 
        as superseding a State law described in paragraph (1) or 
        (2).''.
    (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 2754''.
    (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>