Access to Breast Cancer Diagnosis Act of 2021

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. Short title This Act may be cited as the Access to Breast Cancer Diagnosis Act of 2021 2. Requiring parity in cost-sharing and treatment limitations with respect to diagnostic and screening examinations for breast cancer (a) In general Section 2719A of the Public Health Service Act ( 42 U.S.C. 300gg–19a (e) Diagnostic and screening examinations for breast cancer parity (1) In general In the case of a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to a diagnostic examination for breast cancer furnished to an individual enrolled under such plan or such coverage, such plan or such coverage shall ensure that— (A) the cost-sharing requirements applicable to such examination for such individual are no less favorable than such requirements applicable to a screening examination for breast cancer for such individual; and (B) the treatment limitations applicable to such diagnostic examination for breast cancer for such individual are no less favorable than such limitations applicable to a screening examinations for breast cancer for such individual. (2) Restriction on certain changes A group health plan or health insurance issuer may not, for the sole purpose of complying with paragraph (1), increase cost-sharing requirements with respect to screening examinations for breast cancer. (3) Construction Nothing in this subsection shall be construed— (A) to require the use of diagnostic examinations for breast cancer as a replacement for screening examinations for breast cancer; (B) to prohibit a group health plan or health insurance issuers from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for any screening or diagnostic imaging; or (C) to supersede a State law that provides greater protections with respect to the coverage of diagnostic examinations for breast cancer than is provided under this subsection. (4) Definitions In this subsection: (A) Cost-sharing requirement The term cost-sharing requirement (B) Diagnostic examination for breast cancer The term diagnostic examination for breast cancer (i) seen or suspected from a screening examination for breast cancer; (ii) detected by another means of examination; or (iii) suspected based on the medical history or family medical history of the individual. (C) Examination for breast cancer The term examination for breast cancer (D) Treatment limitation The term treatment limitation . (b) Application to grandfathered health plans Section 1251(a)(4)(A) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18011(a)(4)(A) (1) by striking title title, or as added after the date of the enactment of this Act) (2) by adding at the end the following new clause: (v) Section 2719A(e) (relating to parity for diagnostic and screening examinations for breast cancer). . (c) Effective date The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2022.

Summary: Access to Breast Cancer Diagnosis Act of 2021 This bill prohibits private health insurance plans from imposing higher cost-sharing requirements on breast cancer diagnostic examinations than initial breast cancer screening examinations. Diagnostic examinations are generally required after an initial screening detects an abnormality and typically require additional mammogram images (e.g., x-rays).