I 

116TH CONGRESS 

1ST SESSION H. R. 2428 

To amend title XXVII of the Public Health Service Act to prohibit group 

health plans and health insurance issuers offering group or individual 

health insurance coverage from imposing cost-sharing requirements or 

treatment limitations with respect to diagnostic examinations for breast 

cancer that are less favorable than such requirements with respect to 

screening examinations for breast cancer. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 1, 2019 

Mrs. DINGELL (for herself, Mr. KING of New York, Ms. WASSERMAN

SCHULTZ, Mr. FITZPATRICK, Mr. ALLRED, and Mrs. RODGERS of Washington) introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

A BILL 

To amend title XXVII of the Public Health Service Act 

to prohibit group health plans and health insurance 

issuers offering group or individual health insurance coverage from imposing cost-sharing requirements or treatment limitations with respect to diagnostic examinations 

for breast cancer that are less favorable than such requirements with respect to screening examinations for 

breast cancer. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Access to Breast Can3 cer Diagnosis Act of 2019’’. 

4 SEC. 2. REQUIRING PARITY IN COST-SHARING AND TREAT5 MENT LIMITATIONS WITH RESPECT TO DIAG6 NOSTIC AND SCREENING EXAMINATIONS FOR 

7 BREAST CANCER. 

8 (a) IN GENERAL.—Section 2719A of the Public 

9 Health Service Act (42 U.S.C. 300gg–19a) is amended by 

10 adding at the end the following new subsection: 

11 ‘‘(e) DIAGNOSTIC AND SCREENING EXAMINATIONS

12 FOR BREAST CANCER PARITY.— 

13 ‘‘(1) IN GENERAL.—In the case of a group 

14 health plan, or a health insurance issuer offering 

15 group or individual health insurance coverage, that 

16 provides benefits with respect to a diagnostic exam17 ination for breast cancer furnished to an individual 

18 enrolled under such plan or such coverage, such plan 

19 or such coverage shall ensure that— 

20 ‘‘(A) the cost-sharing requirements appli21 cable to such examination for such individual 

22 are no less favorable than such requirements 

23 applicable to a screening examination for breast 

24 cancer for such individual; and 

25 ‘‘(B) the treatment limitations applicable 

26 to such diagnostic examination for breast canVerDate Sep 11 2014 01:38 May 04, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2428.IH H2428

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1 cer for such individual are no less favorable 

2 than such limitations applicable to a screening 

3 examinations for breast cancer for such indi4 vidual. 

5 ‘‘(2) RESTRICTION ON CERTAIN CHANGES.—A 

6 group health plan or health insurance issuer may 

7 not, for the sole purpose of complying with para8 graph (1), increase cost-sharing requirements with 

9 respect to screening examinations for breast cancer. 

10 ‘‘(3) CONSTRUCTION.—Nothing in this sub11 section shall be construed— 

12 ‘‘(A) to require the use of diagnostic ex13 aminations for breast cancer as a replacement 

14 for screening examinations for breast cancer; 

15 ‘‘(B) to prohibit a group health plan or 

16 health insurance issuers from requiring prior 

17 authorization or imposing other appropriate uti18 lization controls in approving coverage for any 

19 screening or diagnostic imaging; or 

20 ‘‘(C) to supersede a State law that pro21 vides greater protections with respect to the 

22 coverage of diagnostic examinations for breast 

23 cancer than is provided under this subsection. 

24 ‘‘(4) DEFINITIONS.—In this subsection: 


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1 ‘‘(A) COST-SHARING REQUIREMENT.—The 

2 term ‘cost-sharing requirement’ includes a de3 ductible, coinsurance, copayment, and any max4 imum limitation on the application of such a 

5 deductible, coinsurance, copayment, or similar 

6 out-of-pocket expense. 

7 ‘‘(B) DIAGNOSTIC EXAMINATION FOR

8 BREAST CANCER.—The term ‘diagnostic exam9 ination for breast cancer’ means a medically 

10 necessary and appropriate (as determined by 

11 the health care professional treating the indi12 vidual) examination for breast cancer to evalu13 ate an abnormality in the breast that is— 

14 ‘‘(i) seen or suspected from a screen15 ing examination for breast cancer; 

16 ‘‘(ii) detected by another means of ex17 amination; or 

18 ‘‘(iii) suspected based on the medical 

19 history or family medical history of the in20 dividual. 

21 ‘‘(C) EXAMINATION FOR BREAST CAN22 CER.—The term ‘examination for breast cancer’ 

23 includes such an examination using breast 

24 ultrasound, breast magnetic resonance imaging, 

25 or mammography. 


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1 ‘‘(D) TREATMENT LIMITATION.—The term 

2 ‘treatment limitation’ includes limits on the fre3 quency of treatment, number of visits, days of 

4 coverage, or other similar limits on the scope or 

5 duration of treatment.’’. 

6 (b) APPLICATION TO GRANDFATHERED HEALTH

7 PLANS.—Section 1251(a)(4)(A) of the Patient Protection 

8 and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 

9 amended— 

10 (1) by striking ‘‘title’’ and inserting ‘‘title, or as 

11 added after the date of the enactment of this Act)’’; 

12 and 

13 (2) by adding at the end the following new 

14 clause: 

15 ‘‘(v) Section 2719A(e) (relating to 

16 parity for diagnostic and screening exami17 nations for breast cancer).’’. 

18 (c) EFFECTIVE DATE.—The amendments made by 

19 this section shall apply with respect to plan years begin20 ning on or after January 1, 2020. 

Æ 


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