I
105TH CONGRESS
1ST SESSION
H. R. 2152
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 any class of covered individuals if the coverage
or plans include coverage for diagnostic mammography for such class,
and to amend titles XVIII and XIX of the Social Security Act to
provide for coverage of annual screening mammography.
IN THE HOUSE OF REPRESENTATIVES
JULY 11, 1997
Mr. ANDREWS introduced the following bill; which was referred to the Com-
mittee on Commerce, and in addition to the Committees on Ways and
Means and Education and the Workforce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provi-
sions 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 any class of covered individuals if
the coverage or plans include coverage for diagnostic
mammography for such class, and to amend titles XVIII
and XIX of the Social Security Act to provide for cov-
erage of annual screening 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.
This Act may be cited as the ‘‘Screening Mammog-
raphy Act of 1997’’.
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, as amended by section
703(a) of Public Law 104–204, is amended by add-
ing at the end the following new section:
‘‘SEC. 2706. 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 class of participants or bene-
ficiaries shall provide coverage for annual screening
mammography for such class under terms and con-
ditions that are not less favorable than the terms
and conditions for coverage of diagnostic mammog-
raphy.
‘‘(2) DIAGNOSTIC
AND
ANNUAL
SCREENING
MAMMOGRAPHY
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 ‘annual screening mam-
mography’ means a radiologic procedure pro-
vided to an individual, not more frequently than
on an annual basis, for the purpose of early de-
tection of breast cancer and includes a physi-
cian’s interpretation of the results of the proce-
dure.
‘‘(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 participant or beneficiary eligi-
bility, 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
participants or beneficiaries to encourage them to
accept less than the minimum protections available
under this section;
‘‘(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 participant or beneficiary 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,
thorization before undergoing an annual screening
mammography.
‘‘(d) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
713(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 as preventing
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 for any class of participants or bene-
ficiaries 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 such class, and
that provides at least the protections described in
subsection (b).
‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(2) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)), as amended by section 604(b)(2) of
Public Law 104–204, is amended by striking ‘‘sec-
tion 2704’’ and inserting ‘‘sections 2704 and 2706’’.
(b) ERISA AMENDMENTS.—
(1) Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act
of 1974, as amended by section 702(a) of Public
Law 104–204, is amended by adding at the end the
following new section:
‘‘SEC. 713. 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 class of participants or bene-
ficiaries shall provide coverage for annual screening
mammography for such class under terms and con-
ditions that are not less favorable than the terms
and conditions for coverage of diagnostic mammog-
raphy.
‘‘(2) DIAGNOSTIC
AND
ANNUAL
SCREENING
MAMMOGRAPHY
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 ‘annual screening mam-
mography’ means a radiologic procedure pro-
vided to an individual, not more frequently than
on an annual basis, for the purpose of early de-
tection of breast cancer and includes a physi-
cian’s interpretation of the results of the proce-
dure.
‘‘(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 described in subsection
(a)(1) on the basis that the coverage is not medically
necessary or on the basis that the annual screening
mammography is not pursuant to a referral, con-
sent, or recommendation by any health care pro-
vider;
‘‘(2) deny to a participant or beneficiary eligi-
bility, 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
participants or beneficiaries to encourage them to
accept less than the minimum protections available
under this section;
‘‘(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 participant or beneficiary 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 a health insur-
ance issuer offering group health insurance coverage
from imposing deductibles, coinsurance, or other
cost-sharing in relation to benefits for annual
screening mammography 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 di-
agnostic mammography.
‘‘(4) Nothing in this section shall be construed
as preventing a group health plan or a health insur-
ance issuer offering group health insurance coverage
from requiring that a participant or beneficiary, be-
fore undergoing an annual screening mammography
more frequently than on an annual basis, consult
with an appropriate health care practitioner or ob-
tain a written authorization from such a practitioner
for submission to the plan or issuer, but nothing in
this section shall be construed as requiring prior au-
thorization before undergoing an annual screening
mammography.
‘‘(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 plan
described in section 102(a)(1), for purposes of assuring
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 as preventing
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 for any class of participants or bene-
ficiaries if there is a State law (as defined in section
731(d)(1)) for a State that regulates such coverage,
tions described in section 2706(b) (as applied under
subsection (a)).
‘‘(2) CONSTRUCTION.—Section 2762(a) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(b) CONFORMING AMENDMENT.—Section 2763(b)(2)
of such Act (42 U.S.C. 300gg–63(b)(2)), as added by sec-
tion 605(b)(3)(B) of Public Law 104–204, is amended by
striking ‘‘section 2751’’ and inserting ‘‘sections 2751 and
2752’’.
(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 such January 1, 1998.
SEC. 4. ANNUAL SCREENING MAMMOGRAPHY UNDER MEDI-
CARE PROGRAM.
(a) PROVIDING ANNUAL SCREENING MAMMOGRAPHY
FOR WOMEN OF ALL AGES.—Paragraph (2) of section
1834(c) of the Social Security Act (42 U.S.C. 1395m(c))
is amended to read as follows:
‘‘(2) COVERED
ON
AN
ANNUAL
BASIS.—Pay-
ment may not be made under this part for a screen-
ing mammography performed within the 11 months
following the month in which a previous screening
mammography was performed.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to screening mammography per-
formed on or after January 1, 1998.
SEC. 5. COVERAGE OF ANNUAL SCREENING MAMMOG-
RAPHY UNDER MEDICAID.
(a) IN GENERAL.—Section 1905(a) of the Social Se-
curity Act (42 U.S.C. 1396d(a)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(24);
(2) by redesignating paragraph (25) as para-
graph (26); and
(3) by inserting after paragraph (24) the fol-
lowing new paragraph:
‘‘(25) annual screening mammography (as de-
fined in subsection (t)) that is conducted by a facil-
ity that has a certificate (or provisional certificate)
issued under section 354 of the Public Health Serv-
ice Act; and’’.
(b) 
ANNUAL
SCREENING
MAMMOGRAPHY
DE-
FINED.—Section 1905 of such Act (42 U.S.C. 1396d) is
amended by adding at the end the following new sub-
section:
‘‘(t) The term ‘annual screening mammography’
means a radiologic procedure provided to a woman, not
more frequently than on an annual basis, for the purpose
of early detection of breast cancer and includes a physi-
cian’s interpretation of the results of the procedure.’’.
(c) 
MAKING
COVERAGE
MANDATORY.—Section
1902(a)(10)(A) of such Act (42 U.S.C. 1396a(a)(10)(A))
is amended by striking ‘‘(17) and (21)’’ and inserting
‘‘(17), (21), and (25)’’.
(d) CONFORMING AMENDMENTS.—Section 1902 of
such Act (42 U.S.C. 1396a) is amended—
(1) in subsection (a)(10)(C)(iv)—
(A) by striking ‘‘and (17)’’ and inserting
‘‘, (17), and (25)’’, and
(B) by striking ‘‘through (24)’’ and insert-
ing ‘‘through (25)’’; and
(2) in subsection (j), by striking ‘‘through (25)’’
and inserting ‘‘through (26)’’.
(e) EFFECTIVE DATE.—(1) Except as provided in
paragraph (2), the amendments made by this section shall
apply to screening mammography performed on or after
January 1, 1998, without regard to whether or not final
regulations to carry out such amendments have been pro-
mulgated by such date.
(2) In the case of a State plan for medical assistance
under title XIX of the Social Security Act which the Sec-
retary of Health and Human Services determines requires
State legislation (other than legislation appropriating
funds) in order for the plan to meet the additional require-
ment imposed by the amendments made by this section,
the State plan shall not be regarded as failing to comply
with the requirements of such title solely on the basis of
its failure to meet this additional requirement before the
first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act.
For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of
such session shall be deemed to be a separate regular ses-
sion of the State legislature.
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