I 
110TH CONGRESS 
1ST SESSION H. R. 2708 
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 
JUNE 13, 2007 
Mr. NADLER (for himself, Mr. MURPHY of Connecticut, Mr. PATRICK J. MUR-
PHY of Pennsylvania, Mr. HIGGINS, Ms. SOLIS, Mr. GRIJALVA, Mr. 
MICHAUD, Mr. RUSH, Mr. SCOTT of Georgia, Mrs. CAPPS, and Mr. 
HONDA) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Education and Labor, 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. 
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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 2007’’. 
(b) FINDINGS.—Congress finds the following: 
(1) An estimated 211,000 women will have been 
diagnosed with breast cancer and an estimated 
40,000 women will have died from breast cancer 
during 2005. 
(2) Breast cancer is the second leading cause of 
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) Breast cancer death rates were reduced by 
24 percent from 1990 to 2000. 
(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-
ommended on February 21, 2002, that women be-
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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, after review-
ing research since 2002, urges that women at high 
risk for breast cancer receive annual magnetic reso-
nance imaging in addition to a mammogram because 
such imaging may detect small tumors not found by 
a mammogram. 
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 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-
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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 
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-
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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. 
‘‘(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 
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coverage in connection with a group health plan, 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 
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 
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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-
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 
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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 
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) 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 
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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 
(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).’’. 
(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 2707’’. 
(b) ERISA AMENDMENTS.— 
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(1) Subpart B of part 7 of subtitle B of title 
I of the Employee Retirement Income Security Act 
of 1974 is amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 714. 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— 
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‘‘(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 ‘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-
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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. 
‘‘(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; 
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‘‘(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 
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-
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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 
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 
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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 
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 
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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 
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 714’’. 
(3) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 714’’. 
(4) The table of contents in section 1 of such 
Act is amended by inserting after the item relating 
to section 713 the following new item: 
‘‘Sec. 714. Standards relating to benefits for screening mammography and 
magnetic resonance imaging.’’. 
(c) EFFECTIVE DATES.—(1) Subject to paragraph 
(2), the amendments made by this section shall apply with 
respect to group health plans (and health insurance cov-
erage offered in connection with group health plans) for 
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plan years beginning on or after 1 year after the date of 
the enactment of this Act. 
(2)(A) In the case of a group health plan maintained 
pursuant to 1 or more collective bargaining agreements 
between employee representatives and 1 or more employ-
ers ratified before the date of the enactment of this Act, 
the amendments made by this section shall not apply to 
plan years beginning before the later of— 
(i) the date on which the last collective 
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of the 
enactment of this Act); or 
(ii) 1 year after the date of the enactment 
of this Act. 
(B) For purposes of subparagraph (A)(i), any plan 
amendment made pursuant to a collective bargaining 
agreement relating to the plan which amends the plan 
solely to conform to any requirement added by this section 
shall not be treated as a termination of such collective bar-
gaining agreement. 
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SEC. 3. COVERAGE OF ANNUAL SCREENING MAMMOG-
RAPHY AND ANNUAL MAGNETIC RESONANCE 
IMAGING UNDER INDIVIDUAL HEALTH COV-
ERAGE. 
(a) IN GENERAL.—Part B of title XXVII of the Pub-
lic Health Service Act is amended by inserting after sec-
tion 2752 the following new section: 
‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR 
SCREENING MAMMOGRAPHY AND MAGNETIC 
RESONANCE IMAGING. 
‘‘(a) IN GENERAL.—The provisions of section 2707 
(other than subsections (d) and (f)) shall apply to health 
insurance coverage offered by a health insurance issuer 
in the individual market in the same manner as it applies 
to health insurance coverage offered by a health insurance 
issuer in connection with a group health plan in the small 
or large group market. 
‘‘(b) NOTICE.—A health insurance issuer under this 
part shall comply with the notice requirement under sec-
tion 714(d) of the Employee Retirement Income Security 
Act of 1974 with respect to the requirements referred to 
in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan. 
‘‘(c) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
ANCE COVERAGE IN CERTAIN STATES.— 
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‘‘(1) ANNUAL
SCREENING
MAMMOGRAPHY.— 
The requirements of this section, with respect to an-
nual 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 
2723(d)(1)) for a State that regulates such cov-
erage, that requires coverage in the individual health 
insurance market to be provided for annual screen-
ing mammography for women who are 40 years of 
age or older or for high risk women, respectively, 
and that provides at least the protections described 
in section 2707(b) (as applied under subsection (a)). 
‘‘(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 
in the individual health insurance market to be pro-
vided for annual magnetic resonance imaging for 
high risk women, and that provides at least the pro-
tections described in section 2707(b) (as applied 
under subsection (a)). 
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‘‘(3) CONSTRUCTION.—Section 2762(a) shall 
not be construed as superseding a State law de-
scribed in paragraph (1) or (2).’’. 
(b) CONFORMING AMENDMENT.—Section 2762(b)(2) 
of such Act (42 U.S.C. 300gg–63(b)(2)) is amended by 
striking ‘‘section 2751’’ and inserting ‘‘sections 2751 and 
2753’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to health insurance 
coverage offered, sold, issued, or renewed in the individual 
market on or after the date that is 1 year after the date 
of the enactment of this Act. 
Æ 
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