I 

112TH CONGRESS 

1ST SESSION H. R. 1784 

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 

MAY 5, 2011 

Mr. NADLER 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 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. 


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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; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Mammogram and MRI Availability Act of 2011’’. 

6 (b) FINDINGS.—Congress finds the following: 

7 (1) An estimated 207,000 women were diag8 nosed with invasive breast cancer and an estimated 

9 40,000 women died from breast cancer during 2010. 

10 (2) Breast Cancer is the second leading cause 

11 of cancer death for women in the United States and 

12 is the leading cause of death for women between the 

13 ages of 40 and 49 in the United States. 

14 (3) Due to earlier detection through screening, 

15 increased awareness, and improved treatment proto16 cols, breast cancer death rates were reduced by 24 

17 percent from 1990 to 2000 and continue to de18 crease. 

19 (4) A study sponsored by the National Cancer 

20 Institute and published on October 27, 2005, con21 cluded that up to 65 percent of the reduction in the 

22 number of breast cancer deaths was directly attrib23 utable to screening mammography. 

24 (5) An expert panel convened by the National 

25 Institutes of Health’s National Cancer Institute recVerDate Mar 15 2010 02:32 May 11, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1784.IH H1784

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1 ommended on February 21, 2002, that women be2 tween the ages of 40 and 49 should be screened 

3 every one to two years with mammography. 

4 (6) The American Cancer Society recommends 

5 that women over the age of 40 receive an annual 

6 mammogram. 

7 (7) The American Cancer Society urges that 

8 women at high risk for breast cancer receive annual 

9 magnetic resonance imaging in addition to a mam10 mogram because such imaging may detect small tu11 mors not found by a mammogram. 

12 SEC. 2. COVERAGE OF ANNUAL SCREENING MAMMOG13 RAPHY UNDER GROUP HEALTH PLANS. 

14 (a) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 

15 (1) Title XXVII of the Public Health Service 

16 Act is amended by inserting after section 2728 of 

17 such Act (42 U.S.C. 300gg–28), as redesignated by 

18 section 1001(2) of the Patient Protection and Af19 fordable Care Act (Public Law 111–148), the fol20 lowing new section: 


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1 ‘‘SEC. 2729. STANDARDS RELATING TO BENEFITS FOR 

2 SCREENING MAMMOGRAPHY AND MAGNETIC 

3 RESONANCE IMAGING. 

4 ‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL

5 SCREENING MAMMOGRAPHY AND ANNUAL MAGNETIC

6 RESONANCE IMAGING.— 

7 ‘‘(1) IN GENERAL.—A group health plan, and a 

8 health insurance issuer offering group or individual 

9 health insurance coverage, that provides coverage for 

10 diagnostic mammography for any woman who is 40 

11 years of age or older shall provide coverage for an12 nual screening mammography for such a woman and 

13 diagnostic mammography, annual screening mam14 mography, and annual magnetic resonance imaging 

15 for any high risk woman under terms and conditions 

16 that are not less favorable than the terms and condi17 tions for coverage of diagnostic mammography for a 

18 woman who is 40 years of age or older. 

19 ‘‘(2) DEFINITIONS.—For purposes of this sec20 tion— 

21 ‘‘(A) The term ‘diagnostic mammography’ 

22 means a radiologic procedure that is medically 

23 necessary for the purpose of diagnosing breast 

24 cancer and includes a physician’s interpretation 

25 of the results of the procedure. 


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1 ‘‘(B) The term ‘high risk woman’ means a 

2 woman who— 

3 ‘‘(i) has a known BRCA1 or BRCA2 

4 gene mutation; 

5 ‘‘(ii) has a mother, father, brother, 

6 sister, or child with such a gene mutation 

7 and has not had genetic testing to deter8 mine the existence of such a gene muta9 tion; 

10 ‘‘(iii) has a lifetime risk of breast can11 cer of 20 percent or greater, according to 

12 risk assessment tools that are based main13 ly on family history; 

14 ‘‘(iv) had radiation therapy to the 

15 chest when the woman was between the 

16 ages of 10 and 30 years of age; 

17 ‘‘(v) has Li-Fraumeni syndrome, 

18 Cowden syndrome, or Bannayan-Riley19 Ruvalcaba syndrome, or has a relative de20 scribed in clause (ii) who has one of such 

21 syndromes; or 

22 ‘‘(vi) has another predisposing condi23 tion, as determined by a physician, that 

24 significantly increases the risk of the 

25 woman contracting breast cancer. 


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1 ‘‘(C) The term ‘screening mammography’ 

2 means a radiologic procedure provided to a 

3 woman for the purpose of early detection of 

4 breast cancer and includes a physician’s inter5 pretation of the results of the procedure. 

6 ‘‘(b) PROTECTIONS.—A group health plan, and a 

7 health insurance issuer offering group or individual health 

8 insurance coverage, may not— 

9 ‘‘(1) deny coverage for annual screening mam10 mography or annual magnetic resonance imaging on 

11 the basis that the coverage is not medically nec12 essary or on the basis that the screening mammog13 raphy or magnetic resonance imaging, respectively, 

14 is not pursuant to a referral, consent, or rec15 ommendation by any health care provider; 

16 ‘‘(2) deny to a woman eligibility, or continued 

17 eligibility, to enroll or to renew coverage under the 

18 terms of the plan, solely for the purpose of avoiding 

19 the requirements of this section; 

20 ‘‘(3) provide monetary payments or rebates to 

21 women to encourage such women to accept less than 

22 the minimum protections available under this sec23 tion; 

24 ‘‘(4) penalize or otherwise reduce or limit the 

25 reimbursement of an attending provider because 


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1 such provider provided care to an individual partici2 pant or beneficiary in accordance with this section; 

3 or 

4 ‘‘(5) provide incentives (monetary or otherwise) 

5 to an attending provider to induce such provider to 

6 provide care to an individual participant or bene7 ficiary in a manner inconsistent with this section. 

8 ‘‘(c) RULES OF CONSTRUCTION.— 

9 ‘‘(1) Nothing in this section shall be construed 

10 to require a woman who is a participant or bene11 ficiary to undergo annual screening mammography 

12 or annual magnetic resonance imaging. 

13 ‘‘(2) This section shall not apply with respect to 

14 any group health plan, or any group or individual 

15 health insurance coverage offered by a health insur16 ance issuer, which does not provide benefits for diag17 nostic mammography. 

18 ‘‘(3) Nothing in this section shall be construed 

19 as preventing a group health plan or issuer from im20 posing deductibles, coinsurance, or other cost-shar21 ing in relation to benefits for screening mammog22 raphy or magnetic resonance imaging under the plan 

23 (or under health insurance coverage offered in con24 nection with a group health plan), except that such 

25 coinsurance or other cost-sharing for any portion of 


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1 such benefits may not be greater than such coinsur2 ance or cost-sharing that is otherwise applicable with 

3 respect to benefits for diagnostic mammography. 

4 ‘‘(4) Women should (but are not required to) 

5 consult with appropriate health care practitioners 

6 before undergoing screening mammography or mag7 netic resonance imaging, but nothing in this section 

8 shall be construed as requiring the approval of a 

9 health care practitioner before a woman undergoes 

10 an annual screening mammography or annual mag11 netic resonance imaging. 

12 ‘‘(d) NOTICE.—A group health plan under this part 

13 shall comply with the notice requirement under section 

14 716(d) of the Employee Retirement Income Security Act 

15 of 1974 with respect to the requirements of this section 

16 as if such section applied to such plan. A health insurance 

17 issuer shall comply with the notice requirement under such 

18 section with respect to the requirements of this section as 

19 if such section 716(d) applied to such issuer and such 

20 issuer were a group health plan. 

21 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.— 

22 Nothing in this section shall be construed to prevent a 

23 group health plan or a health insurance issuer offering 

24 group or individual health insurance coverage from negotiVerDate Mar 15 2010 02:32 May 11, 2011 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1784.IH H1784

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1 ating the level and type of reimbursement with a provider 

2 for care provided in accordance with this section. 

3 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR4 ANCE COVERAGE IN CERTAIN STATES.— 

5 ‘‘(1) SCREENING MAMMOGRAPHY.—The re6 quirements of this section, with respect to annual 

7 screening mammography, shall not apply with re8 spect to health insurance coverage for women who 

9 are 40 years of age or older or who are high risk 

10 women if there is a State law (as defined in section 

11 2723(d)(1)) for a State that regulates such cov12 erage, that requires coverage to be provided for an13 nual screening mammography for women who are 40 

14 years of age or older or who are high risk women 

15 (as defined in subsection (a)(2)(B)), respectively, 

16 and that provides at least the protections described 

17 in subsection (b). 

18 ‘‘(2) MAGNETIC RESONANCE IMAGING.—The re19 quirements of this section, with respect to annual 

20 magnetic resonance imaging, shall not apply with re21 spect to health insurance coverage if there is a State 

22 law (as defined in section 2723(d)(1)) for a State 

23 that regulates such coverage, that requires coverage 

24 to be provided for annual magnetic resonance imag25 ing for high risk women (as defined in subsection 


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1 (a)(2)(B)), and that provides at least the protections 

2 described in subsection (b). 

3 ‘‘(3) CONSTRUCTION.—Section 2723(a)(1) shall 

4 not be construed as superseding a State law de5 scribed in paragraph (1) or (2). 

6 ‘‘(g) EFFECTIVE DATE.—Notwithstanding any other 

7 provision of law and subject to section 2(c)(2) of the Mam8 mogram and MRI Availability Act of 2011, this section 

9 shall apply with respect to plan years beginning on or after 

10 the date that is one year after the date of such Act and 

11 with respect to health insurance coverage issued on or 

12 after such date.’’. 

13 (2) Section 2723(c) of such Act (42 U.S.C. 

14 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

15 and inserting ‘‘sections 2704 and 2729’’. 

16 (3) For purposes of applying section 2729 of 

17 the Public Health Service Act, as inserted by para18 graph (1), to individual health insurance coverage 

19 before 2014, the provisions of such section shall be 

20 treated as also included under part B of title XXVII 

21 of the Public Health Service Act. 

22 (b) ERISA AMENDMENTS.— 

23 (1) Subpart B of part 7 of subtitle B of title 

24 I of the Employee Retirement Income Security Act 


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1 of 1974 (29 U.S.C. 1185 et seq.) is amended by 

2 adding at the end the following new section: 

3 ‘‘SEC. 716. STANDARDS RELATING TO BENEFITS FOR 

4 SCREENING MAMMOGRAPHY AND MAGNETIC 

5 RESONANCE IMAGING. 

6 ‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL

7 SCREENING MAMMOGRAPHY AND ANNUAL MAGNETIC

8 RESONANCE IMAGING.— 

9 ‘‘(1) IN GENERAL.—A group health plan, and a 

10 health insurance issuer offering group health insur11 ance coverage, that provides coverage for diagnostic 

12 mammography for any woman who is 40 years of 

13 age or older shall provide coverage for annual 

14 screening mammography for such a woman and di15 agnostic mammography, annual screening mammog16 raphy, and annual magnetic resonance imaging for 

17 any high risk woman under terms and conditions 

18 that are not less favorable than the terms and condi19 tions for coverage of diagnostic mammography for a 

20 woman who is 40 years of age or older. 

21 ‘‘(2) DEFINITIONS.—For purposes of this sec22 tion: 

23 ‘‘(A) The term ‘diagnostic mammography’ 

24 means a radiologic procedure that is medically 

25 necessary for the purpose of diagnosing breast 


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1 cancer and includes a physician’s interpretation 

2 of the results of the procedure. 

3 ‘‘(B) The term ‘high risk woman’ means a 

4 woman who— 

5 ‘‘(i) has a known BRCA1 or BRCA2 

6 gene mutation; 

7 ‘‘(ii) has a mother, father, brother, 

8 sister, or child with such a gene mutation 

9 and has not had genetic testing to deter10 mine the existence of such a gene muta11 tion; 

12 ‘‘(iii) has a lifetime risk of breast can13 cer of 20 percent or greater, according to 

14 risk assessment tools that are based main15 ly on family history; 

16 ‘‘(iv) had radiation therapy to the 

17 chest when the woman was between the 

18 ages of 10 and 30 years of age; 

19 ‘‘(v) has Li-Fraumeni syndrome, 

20 Cowden syndrome, or Bannayan-Riley21 Ruvalcaba syndrome, or has a relative de22 scribed in clause (ii) who has one of such 

23 syndromes; or 

24 ‘‘(vi) has another predisposing condi25 tion, as determined by a physician, that 


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1 significantly increases the risk of the 

2 woman contracting breast cancer. 

3 ‘‘(C) The term ‘screening mammography’ 

4 means a radiologic procedure provided to a 

5 woman for the purpose of early detection of 

6 breast cancer and includes a physician’s inter7 pretation of the results of the procedure. 

8 ‘‘(b) PROTECTIONS.—A group health plan, and a 

9 health insurance issuer offering group health insurance 

10 coverage in connection with a group health plan, may 

11 not— 

12 ‘‘(1) deny coverage described in subsection 

13 (a)(1) on the basis that the coverage is not medically 

14 necessary or on the basis that the screening mam15 mography or magnetic resonance imaging is not pur16 suant to a referral, consent, or recommendation by 

17 any health care provider; 

18 ‘‘(2) deny to a woman eligibility, or continued 

19 eligibility, to enroll or to renew coverage under the 

20 terms of the plan, solely for the purpose of avoiding 

21 the requirements of this section; 

22 ‘‘(3) provide monetary payments or rebates to 

23 women to encourage such women to accept less than 

24 the minimum protections available under this sec25 tion; 


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1 ‘‘(4) penalize or otherwise reduce or limit the 

2 reimbursement of an attending provider because 

3 such provider provided care to an individual partici4 pant or beneficiary in accordance with this section; 

5 or 

6 ‘‘(5) provide incentives (monetary or otherwise) 

7 to an attending provider to induce such provider to 

8 provide care to an individual participant or bene9 ficiary in a manner inconsistent with this section. 

10 ‘‘(c) RULES OF CONSTRUCTION.— 

11 ‘‘(1) Nothing in this section shall be construed 

12 to require a woman who is a participant or bene13 ficiary to undergo annual screening mammography 

14 or annual magnetic resonance imaging. 

15 ‘‘(2) This section shall not apply with respect to 

16 any group health plan, or any group health insur17 ance coverage offered by a health insurance issuer, 

18 which does not provide benefits for diagnostic mam19 mography. 

20 ‘‘(3) Nothing in this section shall be construed 

21 as preventing a group health plan or issuer from im22 posing deductibles, coinsurance, or other cost-shar23 ing in relation to benefits for screening mammog24 raphy or magnetic resonance imaging under the plan 

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1 nection with a group health plan), except that such 

2 coinsurance or other cost-sharing for any portion of 

3 such benefits may not be greater than such coinsur4 ance or cost-sharing that is otherwise applicable with 

5 respect to benefits for diagnostic mammography. 

6 ‘‘(4) Women should (but are not required to) 

7 consult with appropriate health care practitioners 

8 before undergoing screening mammography or mag9 netic resonance imaging, but nothing in this section 

10 shall be construed as requiring the approval of a 

11 health care practitioner before a woman undergoes 

12 an annual screening mammography or annual mag13 netic resonance imaging. 

14 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The 

15 imposition of the requirements of this section shall be 

16 treated as a material modification in the terms of the sum17 mary plan described in section 102(a), for purposes of as18 suring notice of such requirements under the plan; except 

19 that the summary description required to be provided 

20 under the last sentence of section 104(b)(1) with respect 

21 to such modification shall be provided by not later than 

22 60 days after the first day of the first plan year in which 

23 such requirements apply. 

24 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.— 

25 Nothing in this section shall be construed to prevent a 


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1 group health plan or a health insurance issuer offering 

2 group health insurance coverage from negotiating the level 

3 and type of reimbursement with a provider for care pro4 vided in accordance with this section. 

5 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR6 ANCE COVERAGE IN CERTAIN STATES.— 

7 ‘‘(1) SCREENING MAMMOGRAPHY.—The re8 quirements of this section, with respect to annual 

9 screening mammography for women who are 40 

10 years of age or older or for high risk women, shall 

11 not apply with respect to health insurance coverage 

12 if there is a State law (as defined in section 

13 731(d)(1)) for a State that regulates such coverage, 

14 that requires coverage to be provided for annual 

15 screening mammography for women who are 40 

16 years of age or older or for high risk women (as de17 fined in subsection (a)(2)(B)), respectively, and that 

18 provides at least the protections described in sub19 section (b). 

20 ‘‘(2) MAGNETIC RESONANCE IMAGING.—The re21 quirements of this section, with respect to annual 

22 magnetic resonance imaging, shall not apply with re23 spect to health insurance coverage if there is a State 

24 law (as defined in section 731(d)(1)) for a State 

25 that regulates such coverage, that requires coverage 


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1 to be provided for annual magnetic resonance imag2 ing for high risk women (as defined in subsection 

3 (a)(2)(B)), and that provides at least the protections 

4 described in subsection (b). 

5 ‘‘(3) CONSTRUCTION.—Section 731(a)(1) shall 

6 not be construed as superseding a State law de7 scribed in paragraph (1) or (2).’’. 

8 (2) Section 731(c) of such Act (29 U.S.C. 

9 1191(c)) is amended by striking ‘‘section 711’’ and 

10 inserting ‘‘sections 711 and 716’’. 

11 (3) Section 732(a) of such Act (29 U.S.C. 

12 1191a(a)) is amended by striking ‘‘section 711’’ and 

13 inserting ‘‘sections 711 and 716’’. 

14 (4) The table of contents in section 1 of such 

15 Act is amended by inserting after the item relating 

16 to section 714 the following new item: 

‘‘Sec. 715. Additional market reforms. 

‘‘Sec. 716. Standards relating to benefits for screening mammography and 

magnetic resonance imaging.’’. 

17 (c) EFFECTIVE DATES.— 

18 (1) Subject to paragraph (2), the amendments 

19 made by subsection (b) shall apply with respect to 

20 group health plans (and health insurance coverage 

21 offered in connection with group health plans) for 

22 plan years beginning on or after 1 year after the 

23 date of the enactment of this Act. 


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1 (2)(A) In the case of a group health plan main2 tained pursuant to 1 or more collective bargaining 

3 agreements between employee representatives and 1 

4 or more employers ratified before the date of the en5 actment of this Act, the amendments made by this 

6 section shall not apply to plan years beginning be7 fore the later of— 

8 (i) the date on which the last collec9 tive bargaining agreements relating to the 

10 plan terminates (determined without re11 gard to any extension thereof agreed to 

12 after the date of the enactment of this 

13 Act); or 

14 (ii) 1 year after the date of the enact15 ment of this Act. 

16 (B) For purposes of subparagraph (A)(i), any 

17 plan amendment made pursuant to a collective bar18 gaining agreement relating to the plan which 

19 amends the plan solely to conform to any require20 ment added by this section shall not be treated as 

21 a termination of such collective bargaining agree22 ment. 

Æ 


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