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103D CONGRESS

1ST SESSION H. R. 425

To amend title XIX of the Social Security Act to require State medicaid

plans to provide coverage of screening mammography.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 5, 1993

Mrs. VUCANOVICH introduced the following bill; which was referred to the

Committee on Energy and Commerce

A BILL

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Medicaid Mammog5 raphy Coverage Act of 1993’’.

6 SEC. 2. COVERAGE OF SCREENING MAMMOGRAPHY UNDER

7 MEDICAID.

8 (a) IN GENERAL.—Section 1905(a) of the Social Se9 curity Act (42 U.S.C. 1396d(a)), as amended by the Om10 nibus Budget Reconciliation Act of 1990, is amended—
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1 (1) by striking ‘‘and’’ at the end of paragraph

2 (21);

3 (2) in paragraph (24), by striking the comma

4 at the end and inserting a semicolon;

5 (3) by redesignating paragraphs (22), (23), and

6 (24) as paragraphs (21), (22), and (23), respec7 tively, and by transferring and inserting paragraph

8 (25) after paragraph (23), as so redesignated; and

9 (4) by inserting after paragraph (23) the fol10 lowing new paragraph:

11 ‘‘(24) screening mammography (as defined in

12 subsection (t)(1)) that meets the quality standards

13 established under section 1834(c)(3), to the extent

14 consistent with the frequency permitted under sub15 section (t)(2); and’’.

16 (b) FREQUENCY OF COVERAGE.—Section 1905 of the

17 Social Security Act (42 U.S.C. 1396d) is amended by add18 ing at the end the following new subsection:

19 ‘‘(t) COVERAGE OF SCREENING MAMMOGRAPHY.—

20 ‘‘(1) DEFINITION.—The term ‘screening mam21 mography’ means a radiologic procedure provided to

22 a woman for the purpose of early detection of breast

23 cancer and includes a physician’s interpretation of

24 the results of the procedure.

25 ‘‘(2) FREQUENCY COVERED.—
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1 ‘‘(A) IN GENERAL.—Subject to revision by

2 the Secretary under subparagraph (B)—

3 ‘‘(i) Medical assistance is not required

4 to be made under this title for screening

5 mammography performed on a woman

6 under 35 years of age.

7 ‘‘(ii) Medical assistance is available

8 under this title for only 1 screening mam9 mography performed on a woman over 34

10 years of age, but under 40 years of age.

11 ‘‘(iii) In the case of a woman over 39

12 years of age, but under 50 years of age,

13 who—

14 ‘‘(I) is at a high risk of develop15 ing breast cancer (as determined pur16 suant to factors identified by the Sec17 retary), medical assistance is not re18 quired to be made available under this

19 title for a screening mammography

20 performed within 11 months of a pre21 vious screening mammography, or

22 ‘‘(II) is not at a high risk of de23 veloping breast cancer, medical assist24 ance is not required to be made avail25 able under this title for a screening
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1 mammography performed within 23

2 months of a previous screening mam3 mography.

4 ‘‘(iv) In the case of a woman over 49

5 years of age, medical assistance is not re6 quired to be made available under this title

7 for screening mammography performed

8 within 11 months of a previous screening

9 mammography.

10 ‘‘(B) REVISION OF FREQUENCY.—

11 ‘‘(i) REVIEW.—The Secretary, in con12 sultation with the Director of the National

13 Cancer Institute, shall review periodically

14 appropriate frequency for performing

15 screening mammography, based on age

16 and such other factors as the Secretary be17 lieves to be pertinent.

18 ‘‘(ii) REVISION OF FREQUENCY.—The

19 Secretary, taking into consideration the re20 view made under clause (i), may revise

21 from time to time the frequency with

22 which medical assistance is required to be

23 made available under this title, but no such

24 revision shall apply to screening mammog25 raphy performed before January 1, 1993.’’.
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1 (c) CONFORMING AMENDMENTS.—(1) Section

2 1902(a)(10(A) of such Act (42 U.S.C. 1396a(a)(10)(A))

3 is amended by striking ‘‘(17) and (21)’’ and inserting

4 ‘‘(17), (21) and (24)’’.

5 (2) Section 1902(a)(10)(C)(iv) (42 U.S.C.

6 1396a(a)(10)(C)(iv)) is amended—

7 (A) by striking ‘‘(5) and (17)’’ and inserting

8 ‘‘(5), (17), and (24)’’; and

9 (B) by striking ‘‘through (21)’’ and inserting

10 ‘‘through (24)’’.

11 (3) Section 1902(j) (42 U.S.C. 1396a(j)) is amended

12 by striking ‘‘through (22)’’ and inserting ‘‘through (24)’’.

13 (4) Sections 1916(a)(2)(D) and 1916(b)(2)(D) (42

14 U.S.C. 1396o(a)(2)(D), 1396o(b)(2)(D)) are each amend15 ed by inserting ‘‘services described in section

16 1905(a)(24)’’ before ‘‘family planning services’’.

17 (d) EFFECTIVE DATE.—(1) Except as provided in

18 paragraph (2), the amendments made by subsections (a),

19 (b), and (c) shall apply to screening mammography per20 formed on or after January 1, 1994, without regard to

21 whether or not final regulations to carry out such amend22 ments have been promulgated by such date.

23 (2) In the case of a State plan for medical assistance

24 under title XIX of the Social Security Act which the Sec25 retary of Health and Human Services determines requires
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1 State legislation (other than legislation appropriating

2 funds) in order for the plan to meet the additional require3 ment imposed by the amendments made by this section,

4 the State plan shall not be regarded as failing to comply

5 with the requirements of such title solely on the basis of

6 its failure to meet this additional requirement before the

7 first day of the first calendar quarter beginning after the

8 close of the first regular session of the State legislature

9 that begins after the date of the enactment of this Act.

10 For purposes of the previous sentence, in the case of a

11 State that has a 2-year legislative session, each year of

12 such session shall be deemed to be a separate regular ses13 sion of the State legislature.

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