I 

108TH CONGRESS 

1ST SESSION H. R. 736

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 if the coverage 

or plans include coverage for diagnostic mammography. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 12, 2003

Mr. NADLER (for himself, Mr. WEINER, Ms. LEE, Mr. SERRANO, Mr. TOWNS, 

Ms. WOOLSEY, Mr. MCINTYRE, Mr. LANGEVIN, Ms. NORTON, Mr. OBERSTAR, Mr. MCNULTY, Mr. KILDEE, Mr. HOLDEN, Mr. FROST, Mr. 

TIERNEY, Mr. MEEHAN, Mr. GRIJALVA, Mr. LAMPSON, Mr. SANDERS, 

Mr. WALSH, Mr. CASE, Mrs. JONES of Ohio, Ms. KAPTUR, Ms. CARSON

of Indiana, Mr. OLVER, Mr. BAIRD, Mr. RUSH, Mr. FRANK of Massachusetts, Ms. ROS-LEHTINEN, Mr. LANTOS, Mr. DAVIS of Illinois, Ms. 

BORDALLO, Mr. HINCHEY, Mr. RANGEL, Mr. HINOJOSA, Mr. MICHAUD, 

Mr. ROTHMAN, Mr. HASTINGS of Florida, Mr. CUMMINGS, Mr. WEXLER, 

Mrs. CHRISTENSEN, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. VAN

HOLLEN, Mr. WYNN, Mr. MCDERMOTT, Mr. BRADY of Pennsylvania, Mr. 

LYNCH, Mr. GUTIERREZ, Mr. KUCINICH, Mr. ACKERMAN, Mr. PAYNE, 

Mr. OWENS, and Mr. RYAN of Ohio) 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 
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group health plans provide coverage for annual screening 

mammography for women 40 years of age or older if 

the coverage or plans include coverage for diagnostic 

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; FINDINGS. 

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

5 ‘‘Mammogram Availability Act of 2003’’. 

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

7 (1) Breast cancer is the single leading cause of 

8 death for women between the ages of 40 and 49 in 

9 the United States. 

10 (2) An expert panel convened by the National 

11 Institutes of Health recommended on January 23, 

12 1997, that all women between the ages of 40 and 49 

13 should choose for themselves, following consultation 

14 with their health care provider, whether to undergo 

15 screening mammography. 

16 (3) The same panel unanimously recommended 

17 that for women between the ages of 40 and 49 who 

18 choose to have a screening mammogram, costs of the 

19 mammograms should be reimbursed by third-party 

20 payers or covered by health maintenance organiza21 tions. 
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1 SEC. 2. COVERAGE OF ANNUAL SCREENING MAMMOG2 RAPHY UNDER GROUP HEALTH PLANS. 

3 (a) PUBLIC HEALTH SERVICE ACT AMENDMENTS.—

4 (1) Subpart 2 of part A of title XXVII of the 

5 Public Health Service Act is amended by adding at 

6 the end the following new section: 

7 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR 

8 SCREENING MAMMOGRAPHY. 

9 ‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL

10 SCREENING MAMMOGRAPHY.—

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

12 health insurance issuer offering group health insur13 ance coverage, that provides coverage for diagnostic 

14 mammography for any woman who is 40 years of 

15 age or older shall provide coverage for annual 

16 screening mammography for such a woman under 

17 terms and conditions that are not less favorable than 

18 the terms and conditions for coverage of diagnostic 

19 mammography. 

20 ‘‘(2) DIAGNOSTIC AND SCREENING MAMMOG21 RAPHY DEFINED.—For purposes of this section—

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

23 means a radiologic procedure that is medically 

24 necessary for the purpose of diagnosing breast 

25 cancer and includes a physician’s interpretation 

26 of the results of the procedure. 
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1 ‘‘(B) 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) PROHIBITIONS.—A group health plan, and a 

7 health insurance issuer offering group health insurance 

8 coverage in connection with a group health plan, may 

9 not—

10 ‘‘(1) deny coverage for annual screening mam11 mography on the basis that the coverage is not 

12 medically necessary or on the basis that the screen13 ing mammography is not pursuant to a referral, con14 sent, or recommendation by any health care pro15 vider; 

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

13 any group health plan, or any group health insur14 ance coverage offered by a health insurance issuer, 

15 which does not provide benefits for diagnostic mam16 mography. 

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

18 as preventing a group health plan or issuer from im19 posing deductibles, coinsurance, or other cost-shar20 ing in relation to benefits for screening mammog21 raphy under the plan (or under health insurance 

22 coverage offered in connection with a group health 

23 plan), except that such coinsurance or other cost24 sharing for any portion may not be greater than 

25 such coinsurance or cost-sharing that is otherwise 
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1 applicable with respect to benefits for diagnostic 

2 mammography. 

3 ‘‘(4) Women between the ages of 40 and 49 

4 should (but are not required to) consult with appro5 priate health care practitioners before undergoing

6 screening mammography, but nothing in this section 

7 shall be construed as requiring the approval of such 

8 a practitioner before undergoing an annual screening 

9 mammography. 

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

11 shall comply with the notice requirement under section 

12 714(d) of the Employee Retirement Income Security Act 

13 of 1974 with respect to the requirements of this section 

14 as if such section applied to such plan. 

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

16 Nothing in this section shall be construed to prevent a 

17 group health plan or a health insurance issuer offering 

18 group health insurance coverage from negotiating the level 

19 and type of reimbursement with a provider for care pro20 vided in accordance with this section.

21 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR22 ANCE COVERAGE IN CERTAIN STATES.—

23 ‘‘(1) IN GENERAL.—The requirements of this 

24 section shall not apply with respect to health insur25 ance coverage if there is a State law (as defined in 
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1 section 2723(d)(1)) for a State that regulates such 

2 coverage, that requires coverage to be provided for 

3 annual screening mammography for women who are 

4 40 years of age or older and that provides at least 

5 the protections described in subsection (b). 

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

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

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

10 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

11 and inserting ‘‘sections 2704 and 2707’’. 

12 (b) ERISA AMENDMENTS.—

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

14 I of the Employee Retirement Income Security Act 

15 of 1974 is amended by adding at the end the fol16 lowing new section: 

17 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR 

18 SCREENING MAMMOGRAPHY. 

19 ‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL

20 SCREENING MAMMOGRAPHY.—

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

22 health insurance issuer offering group health insur23 ance coverage, that provides coverage for diagnostic 

24 mammography for any woman who is 40 years of 

25 age or older shall provide coverage for annual 
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1 screening mammography for such a woman under 

2 terms and conditions that are not less favorable than 

3 the terms and conditions for coverage of diagnostic 

4 mammography. 

5 ‘‘(2) DIAGNOSTIC AND SCREENING MAMMOG6 RAPHY DEFINED.—For purposes of this section—

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

8 means a radiologic procedure that is medically 

9 necessary for the purpose of diagnosing breast 

10 cancer and includes a physician’s interpretation 

11 of the results of the procedure. 

12 ‘‘(B) The term ‘screening mammography’ 

13 means a radiologic procedure provided to a 

14 woman for the purpose of early detection of 

15 breast cancer and includes a physician’s inter16 pretation of the results of the procedure. 

17 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

18 health insurance issuer offering group health insurance 

19 coverage in connection with a group health plan, may 

20 not—

21 ‘‘(1) deny coverage described in subsection 

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

23 necessary or on the basis that the screening mam24 mography is not pursuant to a referral, consent, or 

25 recommendation by any health care provider; 
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1 ‘‘(2) deny to a woman eligibility, or continued 

2 eligibility, to enroll or to renew coverage under the 

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

4 the requirements of this section; 

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

6 women to encourage such women to accept less than 

7 the minimum protections available under this sec8 tion; 

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

10 reimbursement of an attending provider because 

11 such provider provided care to an individual partici12 pant or beneficiary in accordance with this section; 

13 or 

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

15 to an attending provider to induce such provider to 

16 provide care to an individual participant or bene17 ficiary in a manner inconsistent with this section. 

18 ‘‘(c) RULES OF CONSTRUCTION.—

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

20 to require a woman who is a participant or bene21 ficiary to undergo annual screening mammography. 

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

23 any group health plan, or any group health insur24 ance coverage offered by a health insurance issuer, 
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1 which does not provide benefits for diagnostic mam2 mography. 

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

4 as preventing a group health plan or issuer from im5 posing deductibles, coinsurance, or other cost-shar6 ing in relation to benefits for screening mammog7 raphy under the plan (or under health insurance 

8 coverage offered in connection with a group health 

9 plan), except that such coinsurance or other cost10 sharing for any portion may not be greater than 

11 such coinsurance or cost-sharing that is otherwise 

12 applicable with respect to benefits for diagnostic 

13 mammography. 

14 ‘‘(4) Women between the ages of 40 and 49 

15 should (but are not required to) consult with appro16 priate health care practitioners before undergoing 

17 screening mammography, but nothing in this section 

18 shall be construed as requiring the approval of such 

19 a practitioner before undergoing an annual screening 

20 mammography. 

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

22 imposition of the requirements of this section shall be 

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

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

25 notice of such requirements under the plan; except that 
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1 the summary description required to be provided under the 

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

3 modification shall be provided by not later than 60 days 

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

5 requirements apply.

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

7 Nothing in this section shall be construed to prevent a 

8 group health plan or a health insurance issuer offering 

9 group health insurance coverage from negotiating the level 

10 and type of reimbursement with a provider for care pro11 vided in accordance with this section.

12 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR13 ANCE COVERAGE IN CERTAIN STATES.—

14 ‘‘(1) IN GENERAL.—The requirements of this 

15 section shall not apply with respect to health insur16 ance coverage if there is a State law (as defined in 

17 section 731(d)(1)) for a State that regulates such 

18 coverage, that requires coverage to be provided for 

19 annual screening mammography for women who are 

20 40 years of age or older, and that provides at least 

21 the protections described in subsection (b). 

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

23 not be construed as superseding a State law de24 scribed in paragraph (1).’’. 
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1 (2) Section 731(c) of such Act (29 U.S.C. 

2 1191(c)) is amended by striking ‘‘section 711’’ and 

3 inserting ‘‘sections 711 and 714’’. 

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

5 1191a(a)) is amended by striking ‘‘section 711’’ and 

6 inserting ‘‘sections 711 and 714’’. 

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

8 Act is amended by inserting after the item relating 

9 to section 713 the following new item:

‘‘Sec. 714. Standards relating to benefits for screening mammography.’’.

10 (c) EFFECTIVE DATES.—(1) Subject to paragraph 

11 (2), the amendments made by this section shall apply with 

12 respect to group health plans (and health insurance cov13 erage offered in connection with group health plans) for 

14 plan years beginning on or after 1 year after the date of 

15 the enactment of this Act. 

16 (2) In the case of a group health plan maintained 

17 pursuant to 1 or more collective bargaining agreements 

18 between employee representatives and 1 or more employ19 ers ratified before the date of enactment of this Act, the 

20 amendments made by this section shall not apply to plan 

21 years beginning before the later of—

22 (A) the date on which the last collective bar23 gaining agreements relating to the plan terminates 

24 (determined without regard to any extension thereof 
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1 agreed to after the date of enactment of this Act), 

2 or 

3 (B) 1 year after the date of the enactment of 

4 this Act. 

5 For purposes of subparagraph (A), any plan amendment 

6 made pursuant to a collective bargaining agreement relat7 ing to the plan which amends the plan solely to conform 

8 to any requirement added by this section shall not be 

9 treated as a termination of such collective bargaining 

10 agreement. 

11 SEC. 3. COVERAGE OF ANNUAL SCREENING MAMMOG12 RAPHY UNDER INDIVIDUAL HEALTH COV13 ERAGE. 

14 (a) IN GENERAL.—Part B of title XXVII of the Pub15 lic Health Service Act is amended by inserting after sec16 tion 2751 the following new section: 

17 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR 

18 SCREENING MAMMOGRAPHY. 

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

20 (other than subsections (d) and (f)) shall apply to health 

21 insurance coverage offered by a health insurance issuer 

22 in the individual market in the same manner as it applies 

23 to health insurance coverage offered by a health insurance 

24 issuer in connection with a group health plan in the small 

25 or large group market. 
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1 ‘‘(b) NOTICE.—A health insurance issuer under this 

2 part shall comply with the notice requirement under sec3 tion 714(d) of the Employee Retirement Income Security 

4 Act of 1974 with respect to the requirements referred to 

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

6 and such issuer were a group health plan. 

7 ‘‘(c) PREEMPTION; EXCEPTION FOR HEALTH INSUR8 ANCE COVERAGE IN CERTAIN STATES.—

9 ‘‘(1) IN GENERAL.—The requirements of this 

10 section shall not apply with respect to health insur11 ance coverage if there is a State law (as defined in 

12 section 2723(d)(1)) for a State that regulates such 

13 coverage, that requires coverage in the individual 

14 health insurance market to be provided for annual 

15 screening mammography for women who are 40 

16 years of age or older and that provides at least the 

17 protections described in section 2706(b) (as applied 

18 under subsection (a)). 

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

20 not be construed as superseding a State law de21 scribed in paragraph (1).’’. 

22 (b) CONFORMING AMENDMENT.—Section 2763(b)(2) 

23 of such Act (42 U.S.C. 300gg–63(b)(2)) is amended by 

24 striking ‘‘section 2751’’ and inserting ‘‘sections 2751 and 

25 2753’’. 
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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply with respect to health insurance 

3 coverage offered, sold, issued, or renewed in the individual 

4 market on or after the date that is 1 year after the date 

5 of the enactment of this Act.

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