Women's Preventive Health Care Act of 1997

Summary: Women's Preventive Health Care Act of 1997 - Amends the Public Health Service Act and the Employee Retirement Income Security Act of 1974 to require a group health plan, and a health insurance issuer offering group coverage, to include coverage for screening pap smears and low-dose screening mammography.  Prohibits cost sharing or other limitations higher than those applied to similar services. Regulates coverage frequency.  Prohibits related enrollment or coverage discrimination, monetary incentives to women, and penalties against or incentives to providers.  Allows State laws providing greater protection to women.  Amends the Public Health Service Act to apply these requirements to health insurance issuers in the individual market.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Women's Preventive Health Care Act 
of 1997''.

SEC. 2. REQUIRING COVERAGE OF SCREENING MAMMOGRAPHY AND PAP SMEARS 
              UNDER HEALTH PLANS.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--(A) Subpart 2 of 
        part A of title XXVII of the Public Health Service Act, as 
        amended by section 703(a) of Public Law 104-204, is amended by 
        adding at the end the following new section:

``SEC. 2706. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY 
              AND PAP SMEARS.

    ``(a) Requirements for Coverage of Screening Mammography and Pap 
Smears.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, 
        shall include (consistent with this section)--
                    ``(A) coverage for screening pap smears, and
                    ``(B) coverage for low-dose screening mammography.
    ``(b) Definitions Relating to Coverage.--In this section:
            ``(1) Low-dose screening mammography.--The term `low-dose 
        screening mammography' means a radiologic procedure for the 
        early detection of breast cancer provided to an asymptomatic 
        women using equipment dedicated specifically for mammography 
        and at a facility which meets mammography accreditation 
        standards established by the Secretary of Health and Human 
        Services for coverage of screening mammography under the 
        medicare program under title XVIII of the Social Security Act. 
        Such term also includes a physician's interpretation of the 
        results of the procedure.
            ``(2) Screening pap smear.--The term `screening pap smear' 
        means a diagnostic laboratory test consisting of a routine 
        exfoliative cytology test (Papanicolaou test) provided to a 
        woman for the purpose of early detection of cervical cancer and 
        includes the examination, the laboratory test itself, and a 
        physician's interpretation of the results of the test. If the 
        Secretary of Health and Human Services establishes qualify 
        standards for facilities furnishing screening pap smears, such 
        term shall only include a test if the test is performed in a 
        facility that has been determined to meet such standards.
    ``(c) Restrictions on Cost-Sharing.--The coverage under this 
section shall not provide for the application of deductibles, 
coinsurance, or other limitations for low-dose screening mammography or 
screening pap smears that are greater than the deductibles, 
coinsurance, and limitations that are applied to similar services under 
the health insurance coverage or group health plan.
    ``(d) Frequency of Coverage of Screening Mammography.--
            ``(1) In general.--Coverage of low-dose screening 
        mammography is consistent with this section only if it is 
        provided consistent with the following periodicity schedule:
                    ``(A) Coverage is made available for one baseline 
                low-dose screening mammography for any woman between 35 
                and 40 years of age.
                    ``(B) Coverage is made available for such 
                mammography on an annual basis to any woman who is 50 
                years of age or older or who is determined by a 
                physician to be at-risk of breast cancer (as defined in 
                paragraph (2)).
                    ``(C) Coverage is made available for such 
                mammography for a woman at least once every other year.
            ``(2) At-risk of breast cancer.--For purposes of paragraph 
        (1)(B), a woman is considered to be `at-risk of breast cancer' 
        if any of the following is true:
                    ``(A) The woman has a personal history of breast 
                cancer.
                    ``(B) The woman has a personal history of biopsy-
                proven benign breast disease.
                    ``(C) The woman's mother, sister, or daughter has 
                or has had breast cancer.
                    ``(D) The woman has not given birth prior to the 
                age of 30.
    ``(e) Frequency of Coverage of Screening Pap Smears.--Coverage of 
screening pap smears is consistent with this section only if it is 
provided not more often than once every year (or more frequently if 
recommended by a physician).
    ``(f) 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 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;
            ``(2) provide monetary payments or rebates to women to 
        encourage such women to accept less than the minimum 
        protections available under this section;
            ``(3) 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
            ``(4) 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.
    ``(g) Rule of Construction.--Nothing in this section shall be 
construed to require a woman who is a participant or beneficiary to 
undergo a screening mammograph or screening pap smear.
    ``(h) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 713(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.
    ``(i) 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.
    ``(j) Preemption.--
            ``(1) In general.--The provisions of this section do not 
        preempt State law relating to health insurance coverage to the 
        extent such State law provides greater protection to women in 
        relation to the benefits provided under this section.
            ``(2) Construction.--Section 2723(a)(1) shall not be 
        construed as superseding a State law described in paragraph 
        (1).''.
            (B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)), as 
        amended by section 604(b)(2) of Public Law 104-204, is amended 
        by striking ``section 2704'' and inserting ``sections 2704 and 
        2706''.
            (2) ERISA amendments.--(A) Subpart B of part 7 of subtitle 
        B of title I of the Employee Retirement Income Security Act of 
        1974, as amended by section 702(a) of Public Law 104-204, is 
        amended by adding at the end the following new section:

``SEC. 713. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY 
              AND PAP SMEARS.

    ``(a) Requirements for Coverage of Screening Mammography and Pap 
Smears.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, 
        shall include (consistent with this section)--
                    ``(A) coverage for screening pap smears, and
                    ``(B) coverage for low-dose screening mammography.
    ``(b) Definitions Relating to Coverage.--In this section:
            ``(1) Low-dose screening mammography.--The term `low-dose 
        screening mammography' means a radiologic procedure for the 
        early detection of breast cancer provided to an asymptomatic 
        women using equipment dedicated specifically for mammography 
        and at a facility which meets mammography accreditation 
        standards established by the Secretary of Health and Human 
        Services for coverage of screening mammography under the 
        medicare program under title XVIII of the Social Security Act. 
        Such term also includes a physician's interpretation of the 
        results of the procedure.
            ``(2) Screening pap smear.--The term `screening pap smear' 
        means a diagnostic laboratory test consisting of a routine 
        exfoliative cytology test (Papanicolaou test) provided to a 
        woman for the purpose of early detection of cervical cancer 
and includes the examination, the laboratory test itself, and a 
physician's interpretation of the results of the test. If the Secretary 
of Health and Human Services establishes qualify standards for 
facilities furnishing screening pap smears, such term shall only 
include a test if the test is performed in a facility that has been 
determined to meet such standards.
    ``(c) Restrictions on Cost-Sharing.--The coverage under this 
section shall not provide for the application of deductibles, 
coinsurance, or other limitations for low-dose screening mammography or 
screening pap smears that are greater than the deductibles, 
coinsurance, and limitations that are applied to similar services under 
the health insurance coverage or group health plan.
    ``(d) Frequency of Coverage of Screening Mammography.--
            ``(1) In general.--Coverage of low-dose screening 
        mammography is consistent with this section only if it is 
        provided consistent with the following periodicity schedule:
                    ``(A) Coverage is made available for one baseline 
                low-dose screening mammography for any woman between 35 
                and 40 years of age.
                    ``(B) Coverage is made available for such 
                mammography on an annual basis to any woman who is 50 
                years of age or older or who is determined by a 
                physician to be at-risk of breast cancer (as defined in 
                paragraph (2)).
                    ``(C) Coverage is made available for such 
                mammography for a woman at least once every other year.
            ``(2) At-risk of breast cancer.--For purposes of paragraph 
        (1)(B), a woman is considered to be `at-risk of breast cancer' 
        if any of the following is true:
                    ``(A) The woman has a personal history of breast 
                cancer.
                    ``(B) The woman has a personal history of biopsy-
                proven benign breast disease.
                    ``(C) The woman's mother, sister, or daughter has 
                or has had breast cancer.
                    ``(D) The woman has not given birth prior to the 
                age of 30.
    ``(e) Frequency of Coverage of Screening Pap Smears.--Coverage of 
screening pap smears is consistent with this section only if it is 
provided not more often than once every year (or more frequently if 
recommended by a physician).
    ``(f) 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 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;
            ``(2) provide monetary payments or rebates to women to 
        encourage such women to accept less than the minimum 
        protections available under this section;
            ``(3) 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
            ``(4) 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.
    ``(g) Rule of Construction.--Nothing in this section shall be 
construed to require a woman who is a participant or beneficiary to 
undergo a screening mammograph or screening pap smear.
    ``(h) 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.
    ``(i) 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.
    ``(j) Preemption.--
            ``(1) In general.--The provisions of this section do not 
        preempt State law relating to health insurance coverage to the 
        extent such State law provides greater protection to women in 
        relation to the benefits provided under this section.
            ``(2) Construction.--Section 731(a)(1) shall not be 
        construed as superseding a State law described in paragraph 
        (1).''.
            (B) Section 731(c) of such Act (29 U.S.C. 1191(c)), as 
        amended by section 603(b)(1) of Public Law 104-204, is amended 
        by striking ``section 711'' and inserting ``sections 711 and 
        713''.
            (C) Section 732(a) of such Act (29 U.S.C. 1191a(a)), as 
        amended by section 603(b)(2) of Public Law 104-204, is amended 
        by striking ``section 711'' and inserting ``sections 711 and 
        713''.
            (D) The table of contents in section 1 of such Act is 
        amended by inserting after the item relating to section 712 the 
        following new item:

``Sec. 713. Standards relating to benefits for screening mammography 
                            and pap smears.
    (b) Individual Health Insurance.--(1) Part B of title XXVII of the 
Public Health Service Act, as amended by section 605(a) of Public Law 
104-204, is amended by inserting after section 2751 the following new 
section:

``SEC. 2752. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY 
              AND PAP SMEARS.

    ``(a) In General.--The provisions of section 2706 (other than 
subsection (h)) 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 713(h) 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.--
            ``(1) In general.--The provisions of this section do not 
        preempt State law relating to health insurance coverage to the 
        extent such State law provides greater protection to women in 
        relation to the benefits provided under this section.
            ``(2) Construction.--Section 2762(a) shall not be construed 
        as superseding a State law described in paragraph (1).''.
    (2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)), as 
added by section 605(b)(3)(B) of Public Law 104-204, is amended by 
striking ``section 2751'' and inserting ``sections 2751 and 2752''.
    (c) Effective Dates.--(1) The amendments made by subsection (a) 
shall apply with respect to group health plans for plan years beginning 
on or after January 1, 1998.
    (2) The amendment made by subsection (b) shall apply with respect 
to health insurance coverage offered, sold, issued, renewed, in effect, 
or operated in the individual market on or after such date.