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 insur-
ance coverage and group health plans provide coverage for annual screen-
ing 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. OBER-
STAR, 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 Massachu-
setts, 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 con-
cerned 
A BILL 
To amend the Public Health Service Act and Employee Re-
tirement 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Mammogram Availability Act of 2003’’. 
(b) FINDINGS.—Congress finds the following: 
(1) Breast cancer is the single leading cause of 
death for women between the ages of 40 and 49 in 
the United States. 
(2) An expert panel convened by the National 
Institutes of Health recommended on January 23, 
1997, that all women between the ages of 40 and 49 
should choose for themselves, following consultation 
with their health care provider, whether to undergo 
screening mammography. 
(3) The same panel unanimously recommended 
that for women between the ages of 40 and 49 who 
choose to have a screening mammogram, costs of the 
mammograms should be reimbursed by third-party 
payers or covered by health maintenance organiza-
tions.
SEC. 2. COVERAGE OF ANNUAL SCREENING MAMMOG-
RAPHY UNDER GROUP HEALTH PLANS. 
(a) PUBLIC HEALTH SERVICE ACT AMENDMENTS.—
(1) Subpart 2 of part A of title XXVII of the 
Public Health Service Act is amended by adding at 
the end the following new section: 
‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR 
SCREENING MAMMOGRAPHY. 
‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL 
SCREENING MAMMOGRAPHY.—
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, that provides coverage for diagnostic 
mammography for any woman who is 40 years of 
age or older shall provide coverage for annual 
screening mammography for such a woman under 
terms and conditions that are not less favorable than 
the terms and conditions for coverage of diagnostic 
mammography. 
‘‘(2) DIAGNOSTIC
AND
SCREENING
MAMMOG-
RAPHY DEFINED.—For purposes of this section—
‘‘(A) The term ‘diagnostic mammography’ 
means a radiologic procedure that is medically 
necessary for the purpose of diagnosing breast 
cancer and includes a physician’s interpretation 
of the results of the procedure.
‘‘(B) The term ‘screening mammography’ 
means a radiologic procedure provided to a 
woman for the purpose of early detection of 
breast cancer and includes a physician’s inter-
pretation of the results of the procedure. 
‘‘(b) PROHIBITIONS.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage in connection with a group health plan, may 
not—
‘‘(1) deny coverage for annual screening mam-
mography on the basis that the coverage is not 
medically necessary or on the basis that the screen-
ing mammography is not pursuant to a referral, con-
sent, or recommendation by any health care pro-
vider; 
‘‘(2) deny to a woman eligibility, or continued 
eligibility, to enroll or to renew coverage under the 
terms of the plan, solely for the purpose of avoiding 
the requirements of this section; 
‘‘(3) provide monetary payments or rebates to 
women to encourage such women to accept less than 
the minimum protections available under this sec-
tion; 
‘‘(4) penalize or otherwise reduce or limit the 
reimbursement of an attending provider because
such provider provided care to an individual partici-
pant or beneficiary in accordance with this section; 
or 
‘‘(5) provide incentives (monetary or otherwise) 
to an attending provider to induce such provider to 
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section. 
‘‘(c) RULES OF CONSTRUCTION.—
‘‘(1) Nothing in this section shall be construed 
to require a woman who is a participant or bene-
ficiary to undergo annual screening mammography. 
‘‘(2) This section shall not apply with respect to 
any group health plan, or any group health insur-
ance coverage offered by a health insurance issuer, 
which does not provide benefits for diagnostic mam-
mography. 
‘‘(3) Nothing in this section shall be construed 
as preventing a group health plan or issuer from im-
posing deductibles, coinsurance, or other cost-shar-
ing in relation to benefits for screening mammog-
raphy under the plan (or under health insurance 
coverage offered in connection with a group health 
plan), except that such coinsurance or other cost-
sharing for any portion may not be greater than 
such coinsurance or cost-sharing that is otherwise
applicable with respect to benefits for diagnostic 
mammography. 
‘‘(4) Women between the ages of 40 and 49 
should (but are not required to) consult with appro-
priate health care practitioners before undergoing
screening mammography, but nothing in this section 
shall be construed as requiring the approval of such 
a practitioner before undergoing an annual screening 
mammography. 
‘‘(d) NOTICE.—A group health plan under this part 
shall comply with the notice requirement under section 
714(d) of the Employee Retirement Income Security Act 
of 1974 with respect to the requirements of this section 
as if such section applied to such plan. 
‘‘(e) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a 
group health plan or a health insurance issuer offering 
group health insurance coverage from negotiating the level 
and type of reimbursement with a provider for care pro-
vided in accordance with this section.
‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
ANCE COVERAGE IN CERTAIN STATES.—
‘‘(1) IN GENERAL.—The requirements of this 
section shall not apply with respect to health insur-
ance coverage if there is a State law (as defined in