I
104TH CONGRESS
1ST SESSION
H. R. 777
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
FEBRUARY 1, 1995
Mrs. VUCANOVICH introduced the following bill; which was referred to the
Committee on Commerce
A BILL
To amend title XIX of the Social Security Act to require
State medicaid plans to provide coverage of 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 ‘‘Medicaid Mammog-
raphy Coverage Act of 1995’’.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Breast cancer is the second leading cause of
death by cancer in women.
(2) An estimated 182,000 new invasive cases of
breast cancer in the United States are expected dur-
ing 1995.
(3) An estimated 46,240 individuals are ex-
pected to die of breast cancer during 1995, of whom
46,000 will be women.
(4) There is no cure for breast cancer.
(5) Early detection is the key to survival of this
devastating disease.
(6) Mammography is recognized as a valuable
diagnostic technique for the detection of breast
cancer.
(7) The American Cancer Society recommends
that asymptomatic women have a screening mammo-
gram by age 40 and a screening mammogram every
1 to 2 years between the ages of 40 and 49.
(8) The American Cancer Society and the Na-
tional Cancer Institute recommend an annual mam-
mogram for women over age 50.
(9) Lower-income women are often unable to
afford recommended cancer screening.
(10) Many lower-income women receive health
care benefits under the medicaid program.
SEC. 3. COVERAGE OF SCREENING MAMMOGRAPHY 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) screening mammography (as defined in
subsection (t)(1)) that is conducted by a facility that
has a certificate (or provisional certificate) issued
under section 354 of the Public Health Service Act,
to the extent consistent with the frequency permitted
under subsection (t)(2); and’’.
(b) FREQUENCY OF COVERAGE.—Section 1905 of
such Act (42 U.S.C. 1396d) is amended by adding 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.—
‘‘(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
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, 1997.’’.
(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) PROHIBITING IMPOSITION OF CHARGES AGAINST
BENEFICIARIES.—Sections 
1916(a)(2)(D) 
and
1916(b)(2)(D) of such Act (42 U.S.C. 1396o(a)(2)(D),
1396o(b)(2)(D)) are each amended by inserting ‘‘services
described in section 1905(a)(25),’’ after ‘‘1905(a)(4)(C),’’.
(e) 100 PERCENT
FEDERAL
MATCH.—Section
1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by
adding at the end the following: ‘‘Notwithstanding the
first sentence of this subsection, the Federal medical as-
sistance percentage shall be 100 percent with respect to
amounts expended for medical assistance consisting of
screening mammography under subsection (a)(25).’’.
(f) 
CONFORMING
AMENDMENTS.—(1) 
Section
1902(a)(10)(C)(iv) 
of 
such 
Act 
(42 
U.S.C.
1396a(a)(10)(C)(iv)) is amended—
(A) by striking ‘‘(5) and (17)’’ and inserting
‘‘(5), (17), and (25)’’; and
(B) by striking ‘‘through (21)’’ and inserting
‘‘through (25)’’.
(2) Section 1902(j) (42 U.S.C. 1396a(j)) of such Act
is amended by striking ‘‘through (22)’’ and inserting
‘‘through (26)’’.
(g) 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, 1996, 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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