I

104TH CONGRESS

1ST SESSION H. R. 777

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

FEBRUARY 1, 1995

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

Committee on Commerce

A BILL

To amend title XIX of the Social Security Act to require

State medicaid plans to provide coverage of screening

mammography.

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 1995’’.

6 SEC. 2. FINDINGS.

7 Congress finds the following:

8 (1) Breast cancer is the second leading cause of

9 death by cancer in women.
2

•HR 777 IH

1 (2) An estimated 182,000 new invasive cases of

2 breast cancer in the United States are expected dur3 ing 1995.

4 (3) An estimated 46,240 individuals are ex5 pected to die of breast cancer during 1995, of whom

6 46,000 will be women.

7 (4) There is no cure for breast cancer.

8 (5) Early detection is the key to survival of this

9 devastating disease.

10 (6) Mammography is recognized as a valuable

11 diagnostic technique for the detection of breast

12 cancer.

13 (7) The American Cancer Society recommends

14 that asymptomatic women have a screening mammo15 gram by age 40 and a screening mammogram every

16 1 to 2 years between the ages of 40 and 49.

17 (8) The American Cancer Society and the Na18 tional Cancer Institute recommend an annual mam19 mogram for women over age 50.

20 (9) Lower-income women are often unable to

21 afford recommended cancer screening.

22 (10) Many lower-income women receive health

23 care benefits under the medicaid program.
3

•HR 777 IH

1 SEC. 3. COVERAGE OF SCREENING MAMMOGRAPHY UNDER

2 MEDICAID.

3 (a) IN GENERAL.—Section 1905(a) of the Social Se4 curity Act (42 U.S.C. 1396d(a)) is amended—

5 (1) by striking ‘‘and’’ at the end of paragraph

6 (24);

7 (2) by redesignating paragraph (25) as para8 graph (26); and

9 (3) by inserting after paragraph (24) the fol10 lowing new paragraph:

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

12 subsection (t)(1)) that is conducted by a facility that

13 has a certificate (or provisional certificate) issued

14 under section 354 of the Public Health Service Act,

15 to the extent consistent with the frequency permitted

16 under subsection (t)(2); and’’.

17 (b) FREQUENCY OF COVERAGE.—Section 1905 of

18 such Act (42 U.S.C. 1396d) is amended by adding at the

19 end the following new subsection:

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

21 ‘‘(1) DEFINITION.—The term ‘screening mam22 mography’ means a radiologic procedure provided to

23 a woman for the purpose of early detection of breast

24 cancer and includes a physician’s interpretation of

25 the results of the procedure.

26 ‘‘(2) FREQUENCY COVERED.—
4

•HR 777 IH

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
5

•HR 777 IH

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, 1997.’’.
6

•HR 777 IH

1 (c) MAKING COVERAGE MANDATORY.—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 (25)’’.

5 (d) PROHIBITING IMPOSITION OF CHARGES AGAINST

6 BENEFICIARIES.—Sections 1916(a)(2)(D) and

7 1916(b)(2)(D) of such Act (42 U.S.C. 1396o(a)(2)(D),

8 1396o(b)(2)(D)) are each amended by inserting ‘‘services

9 described in section 1905(a)(25),’’ after ‘‘1905(a)(4)(C),’’.

10 (e) 100 PERCENT FEDERAL MATCH.—Section

11 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by

12 adding at the end the following: ‘‘Notwithstanding the

13 first sentence of this subsection, the Federal medical as14 sistance percentage shall be 100 percent with respect to

15 amounts expended for medical assistance consisting of

16 screening mammography under subsection (a)(25).’’.

17 (f) CONFORMING AMENDMENTS.—(1) Section

18 1902(a)(10)(C)(iv) of such Act (42 U.S.C.

19 1396a(a)(10)(C)(iv)) is amended—

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

21 ‘‘(5), (17), and (25)’’; and

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

23 ‘‘through (25)’’.
7

•HR 777 IH

1 (2) Section 1902(j) (42 U.S.C. 1396a(j)) of such Act

2 is amended by striking ‘‘through (22)’’ and inserting

3 ‘‘through (26)’’.

4 (g) EFFECTIVE DATE.—(1) Except as provided in

5 paragraph (2), the amendments made by this section shall

6 apply to screening mammography performed on or after

7 January 1, 1996, without regard to whether or not final

8 regulations to carry out such amendments have been pro9 mulgated by such date.

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

11 under title XIX of the Social Security Act which the Sec12 retary of Health and Human Services determines requires

13 State legislation (other than legislation appropriating

14 funds) in order for the plan to meet the additional require15 ment imposed by the amendments made by this section,

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

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

18 its failure to meet this additional requirement before the

19 first day of the first calendar quarter beginning after the

20 close of the first regular session of the State legislature

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

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

23 State that has a 2-year legislative session, each year of
8

•HR 777 IH

1 such session shall be deemed to be a separate regular ses2 sion of the State legislature.

Æ