I

105TH CONGRESS

1ST SESSION H. R. 760

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 screening

mammography and pap smears.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 13, 1997

Mr. FOX of Pennsylvania (for himself, Mrs. CARSON, Ms. JACKSON-LEE of

Texas, and Mr. ROMERO-BARCELO ́) introduced the following bill; which

was referred to the Committee on 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 screening mammography and pap smears.

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 ‘‘Women’s Preventive

5 Health Care Act of 1997’’.
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1 SEC. 2. REQUIRING COVERAGE OF SCREENING MAMMOG2 RAPHY AND PAP SMEARS UNDER HEALTH

3 PLANS.

4 (a) GROUP HEALTH PLANS.—

5 (1) PUBLIC HEALTH SERVICE ACT AMEND6 MENTS.—(A) Subpart 2 of part A of title XXVII of

7 the Public Health Service Act, as amended by sec8 tion 703(a) of Public Law 104–204, is amended by

9 adding at the end the following new section:

10 ‘‘SEC. 2706. STANDARDS RELATING TO BENEFITS FOR

11 SCREENING MAMMOGRAPHY AND PAP

12 SMEARS.

13 ‘‘(a) REQUIREMENTS FOR COVERAGE OF SCREENING

14 MAMMOGRAPHY AND PAP SMEARS.—

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

16 health insurance issuer offering group health insur17 ance coverage, shall include (consistent with this sec18 tion)—

19 ‘‘(A) coverage for screening pap smears,

20 and

21 ‘‘(B) coverage for low-dose screening mam22 mography.

23 ‘‘(b) DEFINITIONS RELATING TO COVERAGE.—In

24 this section:

25 ‘‘(1) LOW-DOSE SCREENING MAMMOGRAPHY.—

26 The term ‘low-dose screening mammography’ means
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1 a radiologic procedure for the early detection of

2 breast cancer provided to an asymptomatic women

3 using equipment dedicated specifically for mammog4 raphy and at a facility which meets mammography

5 accreditation standards established by the Secretary

6 of Health and Human Services for coverage of

7 screening mammography under the medicare pro8 gram under title XVIII of the Social Security Act.

9 Such term also includes a physician’s interpretation

10 of the results of the procedure.

11 ‘‘(2) SCREENING PAP SMEAR.—The term

12 ‘screening pap smear’ means a diagnostic laboratory

13 test consisting of a routine exfoliative cytology test

14 (Papanicolaou test) provided to a woman for the

15 purpose of early detection of cervical cancer and in16 cludes the examination, the laboratory test itself,

17 and a physician’s interpretation of the results of the

18 test. If the Secretary of Health and Human Services

19 establishes qualify standards for facilities furnishing

20 screening pap smears, such term shall only include

21 a test if the test is performed in a facility that has

22 been determined to meet such standards.

23 ‘‘(c) RESTRICTIONS ON COST-SHARING.—The cov24 erage under this section shall not provide for the applica25 tion of deductibles, coinsurance, or other limitations for
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1 low-dose screening mammography or screening pap

2 smears that are greater than the deductibles, coinsurance,

3 and limitations that are applied to similar services under

4 the health insurance coverage or group health plan.

5 ‘‘(d) FREQUENCY OF COVERAGE OF SCREENING

6 MAMMOGRAPHY.—

7 ‘‘(1) IN GENERAL.—Coverage of low-dose

8 screening mammography is consistent with this sec9 tion only if it is provided consistent with the follow10 ing periodicity schedule:

11 ‘‘(A) Coverage is made available for one

12 baseline low-dose screening mammography for

13 any woman between 35 and 40 years of age.

14 ‘‘(B) Coverage is made available for such

15 mammography on an annual basis to any

16 woman who is 50 years of age or older or who

17 is determined by a physician to be at-risk of

18 breast cancer (as defined in paragraph (2)).

19 ‘‘(C) Coverage is made available for such

20 mammography for a woman at least once every

21 other year.

22 ‘‘(2) AT-RISK OF BREAST CANCER.—For pur23 poses of paragraph (1)(B), a woman is considered to

24 be ‘at-risk of breast cancer’ if any of the following

25 is true:
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1 ‘‘(A) The woman has a personal history of

2 breast cancer.

3 ‘‘(B) The woman has a personal history of

4 biopsy-proven benign breast disease.

5 ‘‘(C) The woman’s mother, sister, or

6 daughter has or has had breast cancer.

7 ‘‘(D) The woman has not given birth prior

8 to the age of 30.

9 ‘‘(e) FREQUENCY OF COVERAGE OF SCREENING PAP

10 SMEARS.—Coverage of screening pap smears is consistent

11 with this section only if it is provided not more often than

12 once every year (or more frequently if recommended by

13 a physician).

14 ‘‘(f) PROHIBITIONS.—A group health plan, and a

15 health insurance issuer offering group health insurance

16 coverage in connection with a group health plan, may

17 not—

18 ‘‘(1) 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 ‘‘(2) 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 ‘‘(3) 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 ‘‘(4) 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 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec11 tion shall be construed to require a woman who is a partic12 ipant or beneficiary to undergo a screening mammograph

13 or screening pap smear.

14 ‘‘(h) NOTICE.—A group health plan under this part

15 shall comply with the notice requirement under section

16 713(d) of the Employee Retirement Income Security Act

17 of 1974 with respect to the requirements of this section

18 as if such section applied to such plan.

19 ‘‘(i) LEVEL AND TYPE OF REIMBURSEMENTS.—

20 Nothing in this section shall be construed to prevent a

21 group health plan or a health insurance issuer offering

22 group health insurance coverage from negotiating the level

23 and type of reimbursement with a provider for care pro24 vided in accordance with this section.

25 ‘‘(j) PREEMPTION.—
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1 ‘‘(1) IN GENERAL.—The provisions of this sec2 tion do not preempt State law relating to health in3 surance coverage to the extent such State law pro4 vides greater protection to women in relation to the

5 benefits provided under this section.

6 ‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall

7 not be construed as superseding a State law de8 scribed in paragraph (1).’’.

9 (B) Section 2723(c) of such Act (42 U.S.C.

10 300gg–23(c)), as amended by section 604(b)(2) of

11 Public Law 104–204, is amended by striking ‘‘sec12 tion 2704’’ and inserting ‘‘sections 2704 and 2706’’.

13 (2) ERISA AMENDMENTS.—(A) Subpart B of

14 part 7 of subtitle B of title I of the Employee Re15 tirement Income Security Act of 1974, as amended

16 by section 702(a) of Public Law 104–204, is amend17 ed by adding at the end the following new section:

18 ‘‘SEC. 713. STANDARDS RELATING TO BENEFITS FOR

19 SCREENING MAMMOGRAPHY AND PAP

20 SMEARS.

21 ‘‘(a) REQUIREMENTS FOR COVERAGE OF SCREENING

22 MAMMOGRAPHY AND PAP SMEARS.—
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1 ‘‘(1) IN GENERAL.—A group health plan, and a

2 health insurance issuer offering group health insur3 ance coverage, shall include (consistent with this sec4 tion)—

5 ‘‘(A) coverage for screening pap smears,

6 and

7 ‘‘(B) coverage for low-dose screening mam8 mography.

9 ‘‘(b) DEFINITIONS RELATING TO COVERAGE.—In

10 this section:

11 ‘‘(1) LOW-DOSE SCREENING MAMMOGRAPHY.—

12 The term ‘low-dose screening mammography’ means

13 a radiologic procedure for the early detection of

14 breast cancer provided to an asymptomatic women

15 using equipment dedicated specifically for mammog16 raphy and at a facility which meets mammography

17 accreditation standards established by the Secretary

18 of Health and Human Services for coverage of

19 screening mammography under the medicare pro20 gram under title XVIII of the Social Security Act.

21 Such term also includes a physician’s interpretation

22 of the results of the procedure.

23 ‘‘(2) SCREENING PAP SMEAR.—The term

24 ‘screening pap smear’ means a diagnostic laboratory

25 test consisting of a routine exfoliative cytology test
9

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1 (Papanicolaou test) provided to a woman for the

2 purpose of early detection of cervical cancer and in3 cludes the examination, the laboratory test itself,

4 and a physician’s interpretation of the results of the

5 test. If the Secretary of Health and Human Services

6 establishes qualify standards for facilities furnishing

7 screening pap smears, such term shall only include

8 a test if the test is performed in a facility that has

9 been determined to meet such standards.

10 ‘‘(c) RESTRICTIONS ON COST-SHARING.—The cov11 erage under this section shall not provide for the applica12 tion of deductibles, coinsurance, or other limitations for

13 low-dose screening mammography or screening pap

14 smears that are greater than the deductibles, coinsurance,

15 and limitations that are applied to similar services under

16 the health insurance coverage or group health plan.

17 ‘‘(d) FREQUENCY OF COVERAGE OF SCREENING

18 MAMMOGRAPHY.—

19 ‘‘(1) IN GENERAL.—Coverage of low-dose

20 screening mammography is consistent with this sec21 tion only if it is provided consistent with the follow22 ing periodicity schedule:

23 ‘‘(A) Coverage is made available for one

24 baseline low-dose screening mammography for

25 any woman between 35 and 40 years of age.
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1 ‘‘(B) Coverage is made available for such

2 mammography on an annual basis to any

3 woman who is 50 years of age or older or who

4 is determined by a physician to be at-risk of

5 breast cancer (as defined in paragraph (2)).

6 ‘‘(C) Coverage is made available for such

7 mammography for a woman at least once every

8 other year.

9 ‘‘(2) AT-RISK OF BREAST CANCER.—For pur10 poses of paragraph (1)(B), a woman is considered to

11 be ‘at-risk of breast cancer’ if any of the following

12 is true:

13 ‘‘(A) The woman has a personal history of

14 breast cancer.

15 ‘‘(B) The woman has a personal history of

16 biopsy-proven benign breast disease.

17 ‘‘(C) The woman’s mother, sister, or

18 daughter has or has had breast cancer.

19 ‘‘(D) The woman has not given birth prior

20 to the age of 30.

21 ‘‘(e) FREQUENCY OF COVERAGE OF SCREENING PAP

22 SMEARS.—Coverage of screening pap smears is consistent

23 with this section only if it is provided not more often than

24 once every year (or more frequently if recommended by

25 a physician).
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1 ‘‘(f) PROHIBITIONS.—A group health plan, and a

2 health insurance issuer offering group health insurance

3 coverage in connection with a group health plan, may

4 not—

5 ‘‘(1) deny to a woman eligibility, or continued

6 eligibility, to enroll or to renew coverage under the

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

8 the requirements of this section;

9 ‘‘(2) provide monetary payments or rebates to

10 women to encourage such women to accept less than

11 the minimum protections available under this sec12 tion;

13 ‘‘(3) penalize or otherwise reduce or limit the

14 reimbursement of an attending provider because

15 such provider provided care to an individual partici16 pant or beneficiary in accordance with this section;

17 or

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

19 to an attending provider to induce such provider to

20 provide care to an individual participant or bene21 ficiary in a manner inconsistent with this section.

22 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec23 tion shall be construed to require a woman who is a partic24 ipant or beneficiary to undergo a screening mammograph

25 or screening pap smear.
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1 ‘‘(h) NOTICE UNDER GROUP HEALTH PLAN.—The

2 imposition of the requirements of this section shall be

3 treated as a material modification in the terms of the plan

4 described in section 102(a)(1), for purposes of assuring

5 notice of such requirements under the plan; except that

6 the summary description required to be provided under the

7 last sentence of section 104(b)(1) with respect to such

8 modification shall be provided by not later than 60 days

9 after the first day of the first plan year in which such

10 requirements apply.

11 ‘‘(i) LEVEL AND TYPE OF REIMBURSEMENTS.—

12 Nothing in this section shall be construed to prevent a

13 group health plan or a health insurance issuer offering

14 group health insurance coverage from negotiating the level

15 and type of reimbursement with a provider for care pro16 vided in accordance with this section.

17 ‘‘(j) PREEMPTION.—

18 ‘‘(1) IN GENERAL.—The provisions of this sec19 tion do not preempt State law relating to health in20 surance coverage to the extent such State law pro21 vides greater protection to women in relation to the

22 benefits provided under this section.

23 ‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall

24 not be construed as superseding a State law de25 scribed in paragraph (1).’’.
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1 (B) Section 731(c) of such Act (29 U.S.C.

2 1191(c)), as amended by section 603(b)(1) of Public

3 Law 104–204, is amended by striking ‘‘section 711’’

4 and inserting ‘‘sections 711 and 713’’.

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

6 1191a(a)), as amended by section 603(b)(2) of Pub7 lic Law 104–204, is amended by striking ‘‘section

8 711’’ and inserting ‘‘sections 711 and 713’’.

9 (D) The table of contents in section 1 of such

10 Act is amended by inserting after the item relating

11 to section 712 the following new item:

‘‘Sec. 713. Standards relating to benefits for screening mammography and pap

smears.

12 (b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B

13 of title XXVII of the Public Health Service Act, as amend14 ed by section 605(a) of Public Law 104–204, is amended

15 by inserting after section 2751 the following new section:

16 ‘‘SEC. 2752. STANDARDS RELATING TO BENEFITS FOR

17 SCREENING MAMMOGRAPHY AND PAP

18 SMEARS.

19 ‘‘(a) IN GENERAL.—The provisions of section 2706

20 (other than subsection (h)) shall apply to health insurance

21 coverage offered by a health insurance issuer in the indi22 vidual market in the same manner as it applies to health

23 insurance coverage offered by a health insurance issuer
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1 in connection with a group health plan in the small or

2 large group market.

3 ‘‘(b) NOTICE.—A health insurance issuer under this

4 part shall comply with the notice requirement under sec5 tion 713(h) of the Employee Retirement Income Security

6 Act of 1974 with respect to the requirements referred to

7 in subsection (a) as if such section applied to such issuer

8 and such issuer were a group health plan.

9 ‘‘(c) PREEMPTION.—

10 ‘‘(1) IN GENERAL.—The provisions of this sec11 tion do not preempt State law relating to health in12 surance coverage to the extent such State law pro13 vides greater protection to women in relation to the

14 benefits provided under this section.

15 ‘‘(2) CONSTRUCTION.—Section 2762(a) shall

16 not be construed as superseding a State law de17 scribed in paragraph (1).’’.

18 (2) Section 2762(b)(2) of such Act (42 U.S.C.

19 300gg–62(b)(2)), as added by section 605(b)(3)(B) of

20 Public Law 104–204, is amended by striking ‘‘section

21 2751’’ and inserting ‘‘sections 2751 and 2752’’.

22 (c) EFFECTIVE DATES.—(1) The amendments made

23 by subsection (a) shall apply with respect to group health

24 plans for plan years beginning on or after January 1,

25 1998.
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1 (2) The amendment made by subsection (b) shall

2 apply with respect to health insurance coverage offered,

3 sold, issued, renewed, in effect, or operated in the individ4 ual market on or after such date.

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