I 
112TH CONGRESS 
1ST SESSION H. R. 1784 
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 and for such 
screening and annual magnetic resonance imaging for women at high 
risk for breast cancer if the coverage or plans include coverage for 
diagnostic mammography for women 40 years of age or older. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 5, 2011 
Mr. NADLER introduced the following bill; which was referred to the Com-
mittee 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 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 and 
for such screening and annual magnetic resonance imag-
ing for women at high risk for breast cancer if the 
coverage or plans include coverage for diagnostic mam-
mography for women 40 years of age or older. 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
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 and MRI Availability Act of 2011’’. 
(b) FINDINGS.—Congress finds the following: 
(1) An estimated 207,000 women were diag-
nosed with invasive breast cancer and an estimated 
40,000 women died from breast cancer during 2010. 
(2) Breast Cancer is the second leading cause 
of cancer death for women in the United States and 
is the leading cause of death for women between the 
ages of 40 and 49 in the United States. 
(3) Due to earlier detection through screening, 
increased awareness, and improved treatment proto-
cols, breast cancer death rates were reduced by 24 
percent from 1990 to 2000 and continue to de-
crease. 
(4) A study sponsored by the National Cancer 
Institute and published on October 27, 2005, con-
cluded that up to 65 percent of the reduction in the 
number of breast cancer deaths was directly attrib-
utable to screening mammography. 
(5) An expert panel convened by the National 
Institutes of Health’s National Cancer Institute rec-
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
ommended on February 21, 2002, that women be-
tween the ages of 40 and 49 should be screened 
every one to two years with mammography. 
(6) The American Cancer Society recommends 
that women over the age of 40 receive an annual 
mammogram. 
(7) The American Cancer Society urges that 
women at high risk for breast cancer receive annual 
magnetic resonance imaging in addition to a mam-
mogram because such imaging may detect small tu-
mors not found by a mammogram. 
SEC. 2. COVERAGE OF ANNUAL SCREENING MAMMOG-
RAPHY UNDER GROUP HEALTH PLANS. 
(a) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 
(1) Title XXVII of the Public Health Service 
Act is amended by inserting after section 2728 of 
such Act (42 U.S.C. 300gg–28), as redesignated by 
section 1001(2) of the Patient Protection and Af-
fordable Care Act (Public Law 111–148), the fol-
lowing new section: 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
‘‘SEC. 2729. STANDARDS RELATING TO BENEFITS FOR 
SCREENING MAMMOGRAPHY AND MAGNETIC 
RESONANCE IMAGING. 
‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL 
SCREENING MAMMOGRAPHY
AND ANNUAL MAGNETIC 
RESONANCE IMAGING.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group or individual 
health insurance coverage, that provides coverage for 
diagnostic mammography for any woman who is 40 
years of age or older shall provide coverage for an-
nual screening mammography for such a woman and 
diagnostic mammography, annual screening mam-
mography, and annual magnetic resonance imaging 
for any high risk woman under terms and conditions 
that are not less favorable than the terms and condi-
tions for coverage of diagnostic mammography for a 
woman who is 40 years of age or older. 
‘‘(2) DEFINITIONS.—For purposes of this sec-
tion— 
‘‘(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. 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
‘‘(B) The term ‘high risk woman’ means a 
woman who— 
‘‘(i) has a known BRCA1 or BRCA2 
gene mutation; 
‘‘(ii) has a mother, father, brother, 
sister, or child with such a gene mutation 
and has not had genetic testing to deter-
mine the existence of such a gene muta-
tion; 
‘‘(iii) has a lifetime risk of breast can-
cer of 20 percent or greater, according to 
risk assessment tools that are based main-
ly on family history; 
‘‘(iv) had radiation therapy to the 
chest when the woman was between the 
ages of 10 and 30 years of age; 
‘‘(v) 
has 
Li-Fraumeni 
syndrome, 
Cowden syndrome, or Bannayan-Riley- 
Ruvalcaba syndrome, or has a relative de-
scribed in clause (ii) who has one of such 
syndromes; or 
‘‘(vi) has another predisposing condi-
tion, as determined by a physician, that 
significantly increases the risk of the 
woman contracting breast cancer. 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
‘‘(C) 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) PROTECTIONS.—A group health plan, and a 
health insurance issuer offering group or individual health 
insurance coverage, may not— 
‘‘(1) deny coverage for annual screening mam-
mography or annual magnetic resonance imaging on 
the basis that the coverage is not medically nec-
essary or on the basis that the screening mammog-
raphy or magnetic resonance imaging, respectively, 
is not pursuant to a referral, consent, or rec-
ommendation by any health care provider; 
‘‘(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 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
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 
or annual magnetic resonance imaging. 
‘‘(2) This section shall not apply with respect to 
any group health plan, or any group or individual 
health insurance coverage offered by a health insur-
ance issuer, which does not provide benefits for diag-
nostic mammography. 
‘‘(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 or magnetic resonance imaging under the plan 
(or under health insurance coverage offered in con-
nection with a group health plan), except that such 
coinsurance or other cost-sharing for any portion of 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
such benefits may not be greater than such coinsur-
ance or cost-sharing that is otherwise applicable with 
respect to benefits for diagnostic mammography. 
‘‘(4) Women should (but are not required to) 
consult with appropriate health care practitioners 
before undergoing screening mammography or mag-
netic resonance imaging, but nothing in this section 
shall be construed as requiring the approval of a 
health care practitioner before a woman undergoes 
an annual screening mammography or annual mag-
netic resonance imaging. 
‘‘(d) NOTICE.—A group health plan under this part 
shall comply with the notice requirement under section 
716(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. A health insurance 
issuer shall comply with the notice requirement under such 
section with respect to the requirements of this section as 
if such section 716(d) applied to such issuer and such 
issuer were a group health 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 or individual health insurance coverage from negoti-
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
ating the level and type of reimbursement with a provider 
for care provided in accordance with this section. 
‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
ANCE COVERAGE IN CERTAIN STATES.— 
‘‘(1) SCREENING
MAMMOGRAPHY.—The re-
quirements of this section, with respect to annual 
screening mammography, shall not apply with re-
spect to health insurance coverage for women who 
are 40 years of age or older or who are high risk 
women if there is a State law (as defined in section 
2723(d)(1)) for a State that regulates such cov-
erage, that requires coverage to be provided for an-
nual screening mammography for women who are 40 
years of age or older or who are high risk women 
(as defined in subsection (a)(2)(B)), respectively, 
and that provides at least the protections described 
in subsection (b). 
‘‘(2) MAGNETIC RESONANCE IMAGING.—The re-
quirements of this section, with respect to annual 
magnetic resonance imaging, shall not apply with re-
spect to health insurance coverage if there is a State 
law (as defined in section 2723(d)(1)) for a State 
that regulates such coverage, that requires coverage 
to be provided for annual magnetic resonance imag-
ing for high risk women (as defined in subsection 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
(a)(2)(B)), and that provides at least the protections 
described in subsection (b). 
‘‘(3) CONSTRUCTION.—Section 2723(a)(1) shall 
not be construed as superseding a State law de-
scribed in paragraph (1) or (2). 
‘‘(g) EFFECTIVE DATE.—Notwithstanding any other 
provision of law and subject to section 2(c)(2) of the Mam-
mogram and MRI Availability Act of 2011, this section 
shall apply with respect to plan years beginning on or after 
the date that is one year after the date of such Act and 
with respect to health insurance coverage issued on or 
after such date.’’. 
(2) Section 2723(c) of such Act (42 U.S.C. 
300gg–23(c)) is amended by striking ‘‘section 2704’’ 
and inserting ‘‘sections 2704 and 2729’’. 
(3) For purposes of applying section 2729 of 
the Public Health Service Act, as inserted by para-
graph (1), to individual health insurance coverage 
before 2014, the provisions of such section shall be 
treated as also included under part B of title XXVII 
of the Public Health Service Act. 
(b) ERISA AMENDMENTS.— 
(1) Subpart B of part 7 of subtitle B of title 
I of the Employee Retirement Income Security Act 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
of 1974 (29 U.S.C. 1185 et seq.) is amended by 
adding at the end the following new section: 
‘‘SEC. 716. STANDARDS RELATING TO BENEFITS FOR 
SCREENING MAMMOGRAPHY AND MAGNETIC 
RESONANCE IMAGING. 
‘‘(a) REQUIREMENTS FOR COVERAGE OF ANNUAL 
SCREENING MAMMOGRAPHY
AND ANNUAL MAGNETIC 
RESONANCE IMAGING.— 
‘‘(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 and di-
agnostic mammography, annual screening mammog-
raphy, and annual magnetic resonance imaging for 
any high risk woman under terms and conditions 
that are not less favorable than the terms and condi-
tions for coverage of diagnostic mammography for a 
woman who is 40 years of age or older. 
‘‘(2) DEFINITIONS.—For purposes of this sec-
tion: 
‘‘(A) The term ‘diagnostic mammography’ 
means a radiologic procedure that is medically 
necessary for the purpose of diagnosing breast 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
cancer and includes a physician’s interpretation 
of the results of the procedure. 
‘‘(B) The term ‘high risk woman’ means a 
woman who— 
‘‘(i) has a known BRCA1 or BRCA2 
gene mutation; 
‘‘(ii) has a mother, father, brother, 
sister, or child with such a gene mutation 
and has not had genetic testing to deter-
mine the existence of such a gene muta-
tion; 
‘‘(iii) has a lifetime risk of breast can-
cer of 20 percent or greater, according to 
risk assessment tools that are based main-
ly on family history; 
‘‘(iv) had radiation therapy to the 
chest when the woman was between the 
ages of 10 and 30 years of age; 
‘‘(v) 
has 
Li-Fraumeni 
syndrome, 
Cowden syndrome, or Bannayan-Riley- 
Ruvalcaba syndrome, or has a relative de-
scribed in clause (ii) who has one of such 
syndromes; or 
‘‘(vi) has another predisposing condi-
tion, as determined by a physician, that 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
significantly increases the risk of the 
woman contracting breast cancer. 
‘‘(C) 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) PROTECTIONS.—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 described in subsection 
(a)(1) on the basis that the coverage is not medically 
necessary or on the basis that the screening mam-
mography or magnetic resonance imaging is not pur-
suant to a referral, consent, or recommendation by 
any health care provider; 
‘‘(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; 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
‘‘(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 
or annual magnetic resonance imaging. 
‘‘(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 or magnetic resonance imaging under the plan 
(or under health insurance coverage offered in con-
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
nection with a group health plan), except that such 
coinsurance or other cost-sharing for any portion of 
such benefits may not be greater than such coinsur-
ance or cost-sharing that is otherwise applicable with 
respect to benefits for diagnostic mammography. 
‘‘(4) Women should (but are not required to) 
consult with appropriate health care practitioners 
before undergoing screening mammography or mag-
netic resonance imaging, but nothing in this section 
shall be construed as requiring the approval of a 
health care practitioner before a woman undergoes 
an annual screening mammography or annual mag-
netic resonance imaging. 
‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The 
imposition of the requirements of this section shall be 
treated as a material modification in the terms of the sum-
mary plan described in section 102(a), for purposes of as-
suring notice of such requirements under the plan; except 
that the summary description required to be provided 
under the last sentence of section 104(b)(1) with respect 
to such modification shall be provided by not later than 
60 days after the first day of the first plan year in which 
such requirements apply. 
‘‘(e) LEVEL
AND TYPE
OF REIMBURSEMENTS.— 
Nothing in this section shall be construed to prevent a 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
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) SCREENING
MAMMOGRAPHY.—The re-
quirements of this section, with respect to annual 
screening mammography for women who are 40 
years of age or older or for high risk women, shall 
not apply with respect to health insurance coverage 
if there is a State law (as defined in section 
731(d)(1)) for a State that regulates such coverage, 
that requires coverage to be provided for annual 
screening mammography for women who are 40 
years of age or older or for high risk women (as de-
fined in subsection (a)(2)(B)), respectively, and that 
provides at least the protections described in sub-
section (b). 
‘‘(2) MAGNETIC RESONANCE IMAGING.—The re-
quirements of this section, with respect to annual 
magnetic resonance imaging, shall not apply with re-
spect to health insurance coverage if there is a State 
law (as defined in section 731(d)(1)) for a State 
that regulates such coverage, that requires coverage 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
to be provided for annual magnetic resonance imag-
ing for high risk women (as defined in subsection 
(a)(2)(B)), and that provides at least the protections 
described in subsection (b). 
‘‘(3) CONSTRUCTION.—Section 731(a)(1) shall 
not be construed as superseding a State law de-
scribed in paragraph (1) or (2).’’. 
(2) Section 731(c) of such Act (29 U.S.C. 
1191(c)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 716’’. 
(3) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 716’’. 
(4) The table of contents in section 1 of such 
Act is amended by inserting after the item relating 
to section 714 the following new item: 
‘‘Sec. 715. Additional market reforms. 
‘‘Sec. 716. Standards relating to benefits for screening mammography and 
magnetic resonance imaging.’’. 
(c) EFFECTIVE DATES.— 
(1) Subject to paragraph (2), the amendments 
made by subsection (b) shall apply with respect to 
group health plans (and health insurance coverage 
offered in connection with group health plans) for 
plan years beginning on or after 1 year after the 
date of the enactment of this Act. 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS
(2)(A) In the case of a group health plan main-
tained pursuant to 1 or more collective bargaining 
agreements between employee representatives and 1 
or more employers ratified before the date of the en-
actment of this Act, the amendments made by this 
section shall not apply to plan years beginning be-
fore the later of— 
(i) the date on which the last collec-
tive bargaining agreements relating to the 
plan terminates (determined without re-
gard to any extension thereof agreed to 
after the date of the enactment of this 
Act); or 
(ii) 1 year after the date of the enact-
ment of this Act. 
(B) For purposes of subparagraph (A)(i), any 
plan amendment made pursuant to a collective bar-
gaining agreement relating to the plan which 
amends the plan solely to conform to any require-
ment added by this section shall not be treated as 
a termination of such collective bargaining agree-
ment. 
Æ 
VerDate Mar 15 2010 
02:32 May 11, 2011
Jkt 099200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6301
E:\BILLS\H1784.IH
H1784
jbell on DSKDVH8Z91PROD with BILLS