I
107TH CONGRESS
1ST SESSION
H. R. 1064
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 title XIX of the Social Security Act to provide for coverage
of annual screening mammography under the Medicaid Program.
IN THE HOUSE OF REPRESENTATIVES
MARCH 15, 2001
Mr. ANDREWS 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 any class of covered individuals if
the coverage or plans include coverage for diagnostic
mammography for such class and to amend title XIX
of the Social Security Act to provide for coverage of
annual screening mammography under the Medicaid Pro-
gram.
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 2001’’.
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 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,
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 plan coverage from
imposing deductibles, coinsurance, or other cost-
sharing in relation to benefits for annual screening
mammography under the plan (or under health in-
surance 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) 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.—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 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)) is amended by striking ‘‘section 2704’’
and inserting ‘‘sections 2704 and 2707’’.
(b) ERISA AMENDMENTS.—
(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.
‘‘(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) 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,
that requires coverage to be provided for annual
screening mammography for such class, and that
provides at least the protections described in sub-
section (b).
‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(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.’’.
(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
plan years beginning on or after January 1, 2002.
(2) 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 enactment of this Act, the
amendments made by this section shall not apply to plan
years beginning before the later of—
(A) the date on which the last collective bar-
gaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act),
or
(B) January 1, 2002.
For purposes of subparagraph (A), any plan amendment
made pursuant to a collective bargaining agreement relat-
ing 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 bargaining
agreement.
SEC. 3. COVERAGE OF ANNUAL SCREENING MAMMOG-
RAPHY 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.
‘‘(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.—
‘‘(1) IN GENERAL.—The requirements of this
section shall not apply with respect to health insur-
ance coverage for any class of individuals 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 provided for annual screening mammography
for such class and that provides at least the protec-
tions described in section 2707(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 2762(b)(2)
of such Act (42 U.S.C. 300gg–62(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 such January 1, 2002.
SEC. 4. 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
(26);
(2) by redesignating paragraph (27) as para-
graph (28); and
(3) by inserting after paragraph (26) the fol-
lowing new paragraph:
‘‘(27) annual screening mammography (as de-
fined in subsection (x)) 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:
‘‘(x) 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 (27)’’.
(d) 
CONFORMING
AMENDMENTS.—Section
1902(a)(10)(C)(iv) 
of 
such 
Act 
(42 
U.S.C.
1396a(a)(10)(C)(iv)) is amended—
(1) by striking ‘‘and (17)’’ and inserting ‘‘,
(17), and (27)’’, and
(2) by striking ‘‘through (24)’’ and inserting
‘‘through (28)’’; and
(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, 2002, 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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