I
103D CONGRESS
1ST SESSION
H. R. 425
To amend title XIX of the Social Security Act to require State medicaid
plans to provide coverage of screening mammography.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 5, 1993
Mrs. VUCANOVICH introduced the following bill; which was referred to the
Committee on Energy and Commerce
A BILL
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 ‘‘Medicaid Mammog-
raphy Coverage Act of 1993’’.
SEC. 2. COVERAGE OF SCREENING MAMMOGRAPHY UNDER
MEDICAID.
(a) IN GENERAL.—Section 1905(a) of the Social Se-
curity Act (42 U.S.C. 1396d(a)), as amended by the Om-
nibus Budget Reconciliation Act of 1990, is amended—
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(1) by striking ‘‘and’’ at the end of paragraph
(21);
(2) in paragraph (24), by striking the comma
at the end and inserting a semicolon;
(3) by redesignating paragraphs (22), (23), and
(24) as paragraphs (21), (22), and (23), respec-
tively, and by transferring and inserting paragraph
(25) after paragraph (23), as so redesignated; and
(4) by inserting after paragraph (23) the fol-
lowing new paragraph:
‘‘(24) screening mammography (as defined in
subsection (t)(1)) that meets the quality standards
established under section 1834(c)(3), to the extent
consistent with the frequency permitted under sub-
section (t)(2); and’’.
(b) FREQUENCY OF COVERAGE.—Section 1905 of the
Social Security Act (42 U.S.C. 1396d) is amended by add-
ing at the end the following new subsection:
‘‘(t) COVERAGE OF SCREENING MAMMOGRAPHY.—
‘‘(1) DEFINITION.—The term ‘screening mam-
mography’ means a radiologic procedure provided to
a woman for the purpose of early detection of breast
cancer and includes a physician’s interpretation of
the results of the procedure.
‘‘(2) FREQUENCY COVERED.—
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‘‘(A) IN GENERAL.—Subject to revision by
the Secretary under subparagraph (B)—
‘‘(i) Medical assistance is not required
to be made under this title for screening
mammography performed on a woman
under 35 years of age.
‘‘(ii) Medical assistance is available
under this title for only 1 screening mam-
mography performed on a woman over 34
years of age, but under 40 years of age.
‘‘(iii) In the case of a woman over 39
years of age, but under 50 years of age,
who—
‘‘(I) is at a high risk of develop-
ing breast cancer (as determined pur-
suant to factors identified by the Sec-
retary), medical assistance is not re-
quired to be made available under this
title for a screening mammography
performed within 11 months of a pre-
vious screening mammography, or
‘‘(II) is not at a high risk of de-
veloping breast cancer, medical assist-
ance is not required to be made avail-
able under this title for a screening
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mammography performed within 23
months of a previous screening mam-
mography.
‘‘(iv) In the case of a woman over 49
years of age, medical assistance is not re-
quired to be made available under this title
for screening mammography performed
within 11 months of a previous screening
mammography.
‘‘(B) REVISION OF FREQUENCY.—
‘‘(i) REVIEW.—The Secretary, in con-
sultation with the Director of the National
Cancer Institute, shall review periodically
appropriate 
frequency 
for 
performing
screening mammography, based on age
and such other factors as the Secretary be-
lieves to be pertinent.
‘‘(ii) REVISION OF FREQUENCY.—The
Secretary, taking into consideration the re-
view made under clause (i), may revise
from time to time the frequency with
which medical assistance is required to be
made available under this title, but no such
revision shall apply to screening mammog-
raphy performed before January 1, 1993.’’.
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(c) 
CONFORMING
AMENDMENTS.—(1) 
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 (24)’’.
(2) 
Section 
1902(a)(10)(C)(iv) 
(42 
U.S.C.
1396a(a)(10)(C)(iv)) is amended—
(A) by striking ‘‘(5) and (17)’’ and inserting
‘‘(5), (17), and (24)’’; and
(B) by striking ‘‘through (21)’’ and inserting
‘‘through (24)’’.
(3) Section 1902(j) (42 U.S.C. 1396a(j)) is amended
by striking ‘‘through (22)’’ and inserting ‘‘through (24)’’.
(4) Sections 1916(a)(2)(D) and 1916(b)(2)(D) (42
U.S.C. 1396o(a)(2)(D), 1396o(b)(2)(D)) are each amend-
ed 
by 
inserting 
‘‘services 
described 
in 
section
1905(a)(24)’’ before ‘‘family planning services’’.
(d) EFFECTIVE DATE.—(1) Except as provided in
paragraph (2), the amendments made by subsections (a),
(b), and (c) shall apply to screening mammography per-
formed on or after January 1, 1994, without regard to
whether or not final regulations to carry out such amend-
ments have been promulgated 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
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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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