I 
118TH CONGRESS 
1ST SESSION H. R. 4286 
To amend title XIX of the Social Security Act to require coverage under 
State plans under the Medicaid program for annual lung cancer screening 
with no cost sharing for individuals for whom screening is recommended 
by U.S. Preventive Services Task Force guidelines, to expand coverage 
under Medicaid of counseling and pharmacotherapy for cessation of to-
bacco use, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 22, 2023 
Mr. HIGGINS of New York (for himself, Mr. FITZPATRICK, and Ms. CASTOR 
of Florida) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, 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 title XIX of the Social Security Act to require 
coverage under State plans under the Medicaid program 
for annual lung cancer screening with no cost sharing 
for individuals for whom screening is recommended by 
U.S. Preventive Services Task Force guidelines, to ex-
pand coverage under Medicaid of counseling and 
pharmacotherapy for cessation of tobacco use, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Increasing Access to 
Lung Cancer Screening Act’’. 
SEC. 2. MEDICAID COVERAGE OF ANNUAL LUNG CANCER 
SCREENING WITH NO COST SHARING FOR 
CERTAIN INDIVIDUALS. 
(a) IN GENERAL.—Section 1905(a)(4) of the Social 
Security Act (42 U.S.C. 1396d(a)(4)) is amended— 
(1) by striking ‘‘and’’ before ‘‘(F)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘; and (G) an annual lung cancer 
screening for individuals who are eligible under the 
plan and for whom such screening is recommended 
under guidelines published by the United States Pre-
ventive Services Task Force, without regard to prior 
authorization’’. 
(b) NO COST SHARING.— 
(1) IN
GENERAL.—Subsections (a)(2) and 
(b)(2) of section 1916 of the Social Security Act (42 
U.S.C. 1396o) are each amended— 
(A) in subparagraph (G), by adding at the 
end ‘‘, or’’; and 
(B) by adding at the end the following new 
subparagraph: 
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(H) lung cancer screening for which pay-
ment may be made under the State plan pursu-
ant section to 1905(a)(4)(G);’’. 
(2) APPLICATION TO ALTERNATIVE COST SHAR-
ING.—Section 1916A(b)(3)(B) of the Social Security 
Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by 
adding at the end the following new clause: 
‘‘(xiv) Lung cancer screening for 
which payment may be made under the 
State 
plan 
pursuant 
to 
section 
1905(a)(4)(G).’’. 
(c) APPLICATION TO MEDICAID MANAGED CARE OR-
GANIZATIONS.—Section 1932(b) of the Social Security Act 
(42 U.S.C. 1396u–2(b)) is amended by adding at the end 
the following new paragraph: 
‘‘(9) LUNG
CANCER
SCREENING.—Each con-
tract with a medicaid managed care organization 
under section 1903(m) shall require the organization 
to provide coverage for lung cancer screening for 
which payment may be made under the State plan 
pursuant to section 1905(a)(4)(G) without regard to 
prior authorization.’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall apply 
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
with respect to items and services furnished on or 
after January 1, 2024. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirements imposed by the 
amendments made by this section, the State plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet such additional requirements before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
SEC. 3. EXPANDING COVERAGE UNDER MEDICAID OF 
COUNSELING AND PHARMACOTHERAPY FOR 
CESSATION OF TOBACCO USE TO ALL MED-
ICAID INDIVIDUALS. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)(4)(D)— 
(A) by striking ‘‘by pregnant women’’; and 
(B) by inserting ‘‘without regard to prior 
authorization’’ after ‘‘(as defined in subsection 
(bb))’’; and 
(2) in subsection (bb)— 
(A) in paragraph (1)— 
(i) by striking the first place it ap-
pears ‘‘by pregnant women’’; and 
(ii) by striking ‘‘by pregnant women 
who’’ and inserting ‘‘by individuals who’’; 
(B) in paragraph (2)(A), by striking ‘‘with 
respect to pregnant women’’; and 
(C) in paragraph (2)(B), by striking ‘‘by 
pregnant women’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1927(d)(2)(F) of the Social Secu-
rity Act (42 U.S.C. 1396r–8(d)(2)(F)) is amended 
by striking ‘‘, in the case of pregnant women’’. 
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
fined in subsection (k)(2) of section 1927 and 
including nonprescription drugs described in 
subsection (d)(2) of such section) that are pre-
scribed for purposes of promoting, and when 
used to promote, tobacco cessation in accord-
ance with the Guideline referred to in section 
1905(bb)(2)(A); and’’. 
(3) Section 1916A(b)(3)(B) of such Act (42 
U.S.C. 1396o–1(b)(3)(B)), as amended by section 1, 
is further amended— 
(A) in clause (iii), by striking ‘‘, and coun-
seling and pharmacotherapy for cessation of to-
bacco use by pregnant women (as defined in 
section 1905(bb))’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(xv) 
Counseling 
and 
pharmacotherapy for cessation of tobacco 
use (as defined in section 1905(bb)).’’. 
(c) APPLICATION TO MEDICAID MANAGED CARE OR-
GANIZATIONS.—Section 1932(b) of the Social Security Act 
(42 U.S.C. 1396u–2(b)), as amended by section 1, is fur-
ther amended by adding at the end the following new para-
graph: 
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(10) CESSATION
OF
TOBACCO
USE.—Each 
contract with a medicaid managed care organization 
under section 1903(m) shall require the organization 
to 
provide 
coverage 
for 
counseling 
and 
pharmacotherapy for cessation of tobacco use with-
out regard to prior authorization.’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall apply 
with respect to items and services furnished on or 
after January 1, 2024. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirements 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 such additional requirements 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 en-
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
SEC. 4. COVERAGE UNDER MEDICARE AND PRIVATE 
HEALTH INSURANCE OF ANNUAL LUNG CAN-
CER 
SCREENING 
WITHOUT 
UTILIZATION 
MANAGEMENT REQUIREMENTS. 
(a) MEDICARE.— 
(1) IN GENERAL.—Section 1834 of the Social 
Security Act (42 U.S.C. 1395m) is amended by add-
ing at the end the following new subsection: 
‘‘(z) SPECIAL RULE FOR ANNUAL LUNG CANCER 
SCREENING.—Notwithstanding any other provision of this 
title, in the case of an annual lung cancer screening for 
which benefits are provided under this part for any indi-
vidual for whom such screening is recommended in accord-
ance with guidelines issued by the Secretary, such benefits 
shall be provided without application of any prior author-
ization.’’. 
(2) APPLICATION
UNDER
MEDICARE
ADVAN-
TAGE.—Section 1852(a)(1)(B) of the Social Security 
Act (42 U.S.C. 1395w–22(a)(1)(B)) is amended by 
adding at the end the following new clause: 
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(vii) PROHIBITION OF APPLICATION 
OF CERTAIN REQUIREMENTS FOR ANNUAL 
LUNG CANCER SCREENING.—In the case of 
an annual lung cancer screening for which 
benefits are provided under part B for any 
individual for whom such screening is rec-
ommended in accordance with guidelines 
issued by the Secretary for purposes of 
section 1834(z), an MA plan may not im-
pose any prior authorization with respect 
to the coverage of such screening under 
such plan.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to serv-
ices furnished on or after January 1, 2024. 
(b) INDIVIDUAL AND GROUP HEALTH INSURANCE 
MARKETS.— 
(1) IN GENERAL.—Section 2713 of the Public 
Health Service Act (42 U.S.C. 300gg–(3)) is amend-
ed by adding at the end the following new sub-
section: 
‘‘(d) PROHIBITION OF APPLICATION OF CERTAIN RE-
QUIREMENTS FOR ANNUAL LUNG CANCER SCREENING.— 
A group health plan and a health insurance issuer offering 
group or individual health insurance coverage may not im-
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
pose any prior authorization with respect to the benefits 
under such plan or coverage for an annual lung cancer 
screening for any individual for whom such screening is 
recommended by the United States Preventive Services 
Task Force.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to plan 
years beginning on or after January 1, 2024. 
SEC. 5. LUNG CANCER SCREENING EDUCATION AND OUT-
REACH. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’), in consultation with patient and lung cancer ad-
vocacy groups, shall conduct an education and outreach 
campaign for purposes of informing individuals and health 
care providers of— 
(1) the importance of lung cancer screenings; 
and 
(2) the categories of individuals who should re-
ceive such screenings. 
(b) MANNER OF OUTREACH.—The Secretary may 
carry out the campaign described in subsection (a) di-
rectly, by contract, through the issuance of grants, or oth-
erwise. In carrying out such campaign, the Secretary shall 
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB
ensure that the campaign is targeted to reach individuals 
at high risk of lung cancer. 
(c) FUNDING.—There are authorized to be appro-
priated $10,000,000 for each of fiscal years 2023 through 
2027 for purposes of carrying out this section. 
SEC. 6. REPORT. 
Not later than 1 year after the date of the enactment 
of this Act, the Comptroller General of the United States 
shall conduct a study and submit to Congress a report 
on the demographics of individuals diagnosed with lung 
cancer and individuals screened for such cancer. Such re-
port shall identify— 
(1) any segments of the population diagnosed 
with lung cancer but not captured in current screen-
ing eligibility guidelines (such as firefighters, vet-
erans, and women under 50 years of age); and 
(2) actions the Federal Government could take 
to improve screening for such cancer among such 
segments. 
Æ 
VerDate Sep 11 2014 
21:46 Jul 31, 2023
Jkt 039200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6301
E:\BILLS\H4286.IH
H4286
pbinns on DSKJLVW7X2PROD with $$_JOB