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108th CONGRESS
1st Session
H. R. 736
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
February 12, 2003
Mr. Nadler (for himself, Mr. Weiner, Ms. Lee, Mr. Serrano, Mr. Towns,
Ms. Woolsey, Mr. McIntyre, Mr. Langevin, Ms. Norton, Mr. Oberstar, Mr.
McNulty, Mr. Kildee, Mr. Holden, Mr. Frost, Mr. Tierney, Mr. Meehan,
Mr. Grijalva, Mr. Lampson, Mr. Sanders, Mr. Walsh, Mr. Case, Mrs. Jones
of Ohio, Ms. Kaptur, Ms. Carson of Indiana, Mr. Olver, Mr. Baird, Mr.
Rush, Mr. Frank of Massachusetts, Ms. Ros-Lehtinen, Mr. Lantos, Mr.
Davis of Illinois, Ms. Bordallo, Mr. Hinchey, Mr. Rangel, Mr. Hinojosa,
Mr. Michaud, Mr. Rothman, Mr. Hastings of Florida, Mr. Cummings, Mr.
Wexler, Mrs. Christensen, Ms. Eddie Bernice Johnson of Texas, Mr. Van
Hollen, Mr. Wynn, Mr. McDermott, Mr. Brady of Pennsylvania, Mr. Lynch,
Mr. Gutierrez, Mr. Kucinich, Mr. Ackerman, Mr. Payne, Mr. Owens, and
Mr. Ryan of Ohio) 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 2003''.
(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 1 year after the date of
the enactment of this Act.
(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) 1 year after the date of the enactment of this Act.
For purposes of subparagraph (A), any plan amendment made pursuant to a
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