[Congressional Record Volume 172, Number 85 (Tuesday, May 19, 2026)]
[Senate]
[Pages S2377-S2379]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. DURBIN (for himself and Ms. Hirono):
S. 4566. A bill to amend title XIX of the Social Security Act to
require coverage under State plans under the Medicaid program for
annual lung cancer screening with no cost sharing for individuals for
whom screening is recommended by U.S. Preventive Services Task Force
guidelines, to expand coverage under Medicaid of counseling and
pharmacotherapy for cessation of tobacco use, and for other purposes;
to the Committee on Finance.
Mr. DURBIN. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
[[Page S2378]]
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 4566
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 ``Increasing Access to Lung
Cancer Screening Act''.
SEC. 2. MEDICAID COVERAGE OF ANNUAL LUNG CANCER SCREENING
WITH NO COST SHARING FOR CERTAIN INDIVIDUALS.
(a) In General.--Section 1905(a)(4) of the Social Security
Act (42 U.S.C. 1396d(a)(4)) is amended--
(1) by striking ``and'' before ``(D)'';
(2) by striking ``and'' before ``(E)'';
(3) by striking ``and'' before ``(F)''; and
(4) by inserting before the semicolon at the end the
following: ``; and (G) an annual lung cancer screening for
individuals who are eligible under the State plan or under a
waiver of such plan and for whom such screening is
recommended under guidelines published by the United States
Preventive Services Task Force (provided that such guidelines
do not decrease the recommended frequency of lung cancer
screenings for such individuals or narrow the population
recommended for lung cancer screening published by the United
States Preventive Services Task Force on March 9, 2021),
without regard to prior authorization''.
(b) No Cost Sharing.--
(1) In general.--Subsections (a)(2) and (b)(2) of section
1916 of the Social Security Act (42 U.S.C. 1396o) are each
amended--
(A) in subparagraph (I), by striking ``or'' at the end;
(B) in subparagraph (J), by striking ``; and'' and
inserting ``, or'' at the end; and
(C) by adding at the end the following new subparagraph:
``(K) lung cancer screening for which payment may be made
under the State plan or under a waiver of such plan pursuant
section to 1905(a)(4)(G); and''.
(2) Application to alternative cost sharing.--Section
1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o-
1(b)(3)(B)) is amended by adding at the end the following new
clause:
``(xv) Lung cancer screening for which payment may be made
under the State plan or under a waiver of such plan pursuant
to section 1905(a)(4)(G).''.
(c) Application to Medicaid Managed Care Organizations.--
Section 1932(b) of the Social Security Act (42 U.S.C. 1396u-
2(b)) is amended by adding at the end the following new
paragraph:
``(9) Lung cancer screening.--Each contract with a medicaid
managed care organization under section 1903(m) shall require
the organization to provide coverage for lung cancer
screening for which payment may be made under the State plan
or under a waiver of such plan pursuant to section
1905(a)(4)(G) without regard to prior authorization.''.
(d) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply with respect to items and
services furnished on or after January 1, 2028.
(2) Exception if state legislation required.--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 requirements 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 such additional
requirements 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.
SEC. 3. EXPANDING COVERAGE UNDER MEDICAID OF COUNSELING AND
PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE TO
ALL MEDICAID INDIVIDUALS.
(a) In General.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d) is amended--
(1) in subsection (a)(4)(D)--
(A) by striking ``by pregnant women''; and
(B) by inserting ``without regard to prior authorization''
after ``(as defined in subsection (bb))''; and
(2) in subsection (bb)--
(A) by striking ``by pregnant women'' each place it
appears;
(B) in paragraph (1), by striking ``tobacco use who'' and
inserting ``tobacco use (including the use of e-cigarettes or
vape pens) by individuals who''; and
(C) in paragraph (2)(A), by striking ``with respect to
pregnant women''.
(b) Conforming Amendments.--
(1) Section 1927(d)(2)(F) of the Social Security Act (42
U.S.C. 1396r-8(d)(2)(F)) is amended by striking ``, in the
case of pregnant women''.
(2) Section 1916 of the Social Security Act (42 U.S.C.
1396o), as amended by section 2(b)(1), is further amended in
each of subsections (a)(2) and (b)(2)--
(A) in subparagraph (B), by striking ``, and counseling and
pharmacotherapy for cessation of tobacco use by pregnant
women (as defined in section 1905(bb)) and covered outpatient
drugs (as defined in subsection (k)(2) of section 1927 and
including nonprescription drugs described in subsection
(d)(2) of such section) that are prescribed for purposes of
promoting, and when used to promote, tobacco cessation by
pregnant women in accordance with the Guideline referred to
in section 1905(bb)(2)(A)'';
(B) in subparagraph (J), by striking ``or'' at the end;
(C) in subparagraph (K), by striking ``; and'' at the end
and inserting ``, or''; and
(D) by adding at the end the following new subparagraph:
``(L) counseling and pharmacotherapy for cessation of
tobacco use (as defined in section 1905(bb)) and covered
outpatient drugs (as defined in subsection (k)(2) of section
1927 and including nonprescription drugs described in
subsection (d)(2) of such section) that are prescribed for
purposes of promoting, and when used to promote, tobacco
cessation in accordance with the Guideline referred to in
section 1905(bb)(2)(A); and''.
(3) Section 1916A(b)(3)(B) of such Act (42 U.S.C. 1396o-
1(b)(3)(B)), as amended by section 2(b)(2), is further
amended--
(A) in clause (iii), by striking ``, and counseling and
pharmacotherapy for cessation of tobacco use by pregnant
women (as defined in section 1905(bb))''; and
(B) by adding at the end the following new clause:
``(xvi) Counseling and pharmacotherapy for cessation of
tobacco use (as defined in section 1905(bb)).''.
(c) Application to Medicaid Managed Care Organizations.--
Section 1932(b) of the Social Security Act (42 U.S.C. 1396u-
2(b)), as amended by section 2(c), is further amended by
adding at the end the following new paragraph:
``(10) Cessation of tobacco use.--Each contract with a
medicaid managed care organization under section 1903(m)
shall require the organization to provide coverage for
counseling and pharmacotherapy for cessation of tobacco use
without regard to prior authorization.''.
(d) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply with respect to items and
services furnished on or after January 1, 2028.
(2) Exception if state legislation required.--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 requirements 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 such additional
requirements 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.
SEC. 4. COVERAGE UNDER MEDICARE AND PRIVATE HEALTH INSURANCE
OF ANNUAL LUNG CANCER SCREENING WITHOUT
UTILIZATION MANAGEMENT REQUIREMENTS.
(a) Medicare.--
(1) In general.--Section 1834 of the Social Security Act
(42 U.S.C. 1395m) is amended by adding at the end the
following new subsection:
``(bb) Special Rule for Annual Lung Cancer Screening.--
Notwithstanding any other provision of this title, in the
case of an annual lung cancer screening for which benefits
are provided under this part for any individual for whom such
screening is recommended in accordance with guidelines issued
by the Secretary, such benefits shall be provided without
application of any prior authorization.''.
(2) Application under medicare advantage.--Section
1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w-
22(a)(1)(B)) is amended by adding at the end the following
new clause:
``(vii) Prohibition of application of certain requirements
for annual lung cancer screening.--In the case of an annual
lung cancer screening for which benefits are provided under
part B for any individual for whom such screening is
recommended in accordance with guidelines issued by the
Secretary for purposes of section 1834(bb), an MA plan may
not impose any prior authorization with respect to the
coverage of such screening under such plan.''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to services furnished on or after
January 1, 2028.
(b) Individual and Group Health Insurance Markets.--
(1) In general.--Section 2713 of the Public Health Service
Act (42 U.S.C. 300gg-13) is amended by adding at the end the
following new subsection:
``(d) Prohibition of Application of Certain Requirements
for Annual Lung Cancer Screening.--A group health plan and a
health insurance issuer offering group or individual health
insurance coverage may not require any prior authorization
with respect to the benefits under such plan or coverage for
an annual lung cancer screening for any individual for whom
such screening is recommended by the United States Preventive
Services Task Force.''.
[[Page S2379]]
(2) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
January 1, 2028.
SEC. 5. LUNG CANCER SCREENING EDUCATION AND OUTREACH.
(a) In General.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary''), in
consultation with patient and lung cancer advocacy groups,
shall conduct an education and outreach campaign for purposes
of informing individuals and health care providers of--
(1) the importance of lung cancer screenings; and
(2) the categories of individuals who should receive such
screenings.
(b) Manner of Outreach.--The Secretary may carry out the
campaign described in subsection (a) directly, by contract,
through the issuance of grants, or otherwise. In carrying out
such campaign, the Secretary shall ensure that the campaign
is targeted to reach individuals at high risk of lung cancer.
(c) Funding.--There are authorized to be appropriated
$10,000,000 for each of fiscal years 2028 through 2032 for
purposes of carrying out this section.
SEC. 6. REPORT.
Not later than 1 year after the date of the enactment of
this Act, the Comptroller General of the United States shall
conduct a study and submit to Congress a report on the
demographics of individuals diagnosed with lung cancer and
individuals screened for such cancer. Such report shall
identify--
(1) any segments of the population diagnosed with lung
cancer but not captured in current screening eligibility
guidelines (such as firefighters, veterans, and women under
50 years of age); and
(2) recommendations for how the Federal Government can
improve screening for such cancer among such segments.
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