I 
109TH CONGRESS 
1ST SESSION H. R. 2761 
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 
JUNE 7, 2005 
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 2005’’. 
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-