erogeneously or extremely dense breast tis-
sue (as defined by the Breast Imaging Re-
porting and Data System established by 
the American College of Radiology), in ad-
dition to any other item or service de-
scribed in this subsection, screening and 
diagnostic imaging for the detection of 
breast cancer, including 2D or 3D mam-
mograms, breast ultrasounds, breast mag-
netic resonance imaging, molecular breast 
imaging, contrast-enhanced mammography, 
or other technologies (as determined in ac-
cordance with such applicable criteria or 
guidelines) furnished not more frequently 
than is recommended in guidelines set 
forth by the National Comprehensive Can-
cer Network; and (ii) with respect to an in-
dividual who is not described in clause (i) 
and who is determined by a health care 
provider (in accordance with such most re-
cent applicable criteria or guidelines) to re-
quire screening or diagnostic breast imag-
ing by reason of factors, including age, 
race, ethnicity, or personal or family med-
ical history, screening and diagnostic imag-
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ing for the detection of breast cancer, in-
cluding 2D or 3D mammograms, breast 
ultrasounds, breast magnetic resonance im-
aging, molecular breast imaging, contrast- 
enhanced mammography, or other tech-
nologies (as determined in accordance with 
such applicable criteria or guidelines) fur-
nished not more frequently than is rec-
ommended in guidelines set forth by the 
National Comprehensive Cancer Network’’; 
and 
(B) in paragraph (13), in the matter pre-
ceding subparagraph (A), by inserting ‘‘(other 
than an item or service for which medical as-
sistance is provided pursuant to paragraph 
(4)(G))’’ after ‘‘services’’. 
(2) NO COST-SHARING FOR CERTAIN BREAST 
CANCER SCREENING AND DIAGNOSTIC IMAGING.— 
(A) IN GENERAL.—Section 1916 of the So-
cial Security Act (42 U.S.C. 1396o) is amend-
ed— 
(i) in subsection (a)(2)— 
(I) in subparagraph (I), by strik-
ing ‘‘or’’ at the end; 
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(II) in subparagraph (J), by 
striking at the end ‘‘; and’’ and in-
serting ‘‘, or’’; and 
(III) by adding at the end the 
following subparagraph: 
‘‘(K) screening and diagnostic imaging and 
other technologies described in clause (i) or (ii) 
of section 1904(a)(4)(G) furnished not more 
frequently than is recommended in guidelines 
set forth by the National Comprehensive Cancer 
Network to an individual described in such 
clause (i) or (ii), respectively; and’’; and 
(ii) in subsection (b)(2)— 
(I) in subparagraph (I), by strik-
ing ‘‘or’’ at the end; 
(II) in subparagraph (J), by 
striking at the end ‘‘; and’’ and in-
serting ‘‘, or’’; and 
(III) by adding at the end the 
following subparagraph: 
‘‘(K) screening and diagnostic imaging and 
other technologies described in clause (i) or (ii) 
of section 1904(a)(4)(G) furnished not more 
frequently than is recommended in guidelines 
set forth by the National Comprehensive Cancer 
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Network to an individual described in such 
clause (i) or (ii), respectively; and’’. 
(B) APPLICATION TO ALTERNATIVE COST- 
SHARING.—Section 1916A(b)(3)(B) of the So-
cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 
is amended by adding at the end the following 
new clause: 
‘‘(xv) Screening and diagnostic imag-
ing and other technologies described in 
clause (i) or (ii) of section 1904(a)(4)(G) 
furnished not more frequently than is rec-
ommended in guidelines set forth by the 
National Comprehensive Cancer Network 
to an individual described in such clause 
(i) or (ii), respectively.’’. 
(3) INCLUSION
IN
BENCHMARK
COVERAGE.— 
Section 1937(b) of the Social Security Act (42 
U.S.C. 1396u–7(b)) is amended by adding at the 
end the following new paragraph: 
‘‘(9) COVERAGE OF CERTAIN BREAST CANCER 
SCREENING AND DIAGNOSTIC IMAGING FOR CERTAIN 
INDIVIDUALS.—Notwithstanding the previous provi-
sions of this section, a State may not provide for 
medical assistance through enrollment of an indi-
vidual with benchmark coverage or benchmark-equiv-
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alent coverage under this section unless such cov-
erage includes medical assistance for screening and 
diagnostic imaging and other technologies described 
in clause (i) or (ii) of section 1904(a)(4)(G) fur-
nished at such frequency as is recommended in 
guidelines set forth by the National Comprehensive 
Cancer Network to an individual described in such 
clause (i) or (ii), respectively.’’. 
(4) EFFECTIVE DATE.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the amendments made by 
this subsection shall take effect on January 1, 
2026. 
(B) DELAY PERMITTED IF STATE LEGISLA-
TION REQUIRED.—In the case of a State plan 
approved under title XIX of the Social Security 
Act which the Secretary of Health and Human 
Services determines requires State legislation 
(other than legislation appropriating funds) in 
order for the plan to meet the additional re-
quirements imposed 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 the failure of the plan to meet such ad-
ditional requirements before the first day of the 
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‘‘(21)(A) Screening and diagnostic imaging for 
the detection of breast cancer, including 2D or 3D 
mammograms, breast ultrasounds, breast magnetic 
resonance imaging, molecular breast imaging, con-
trast-enhanced mammography, or other technologies 
(as determined in accordance with the most recent 
applicable criteria or guidelines described in sub-
paragraph (B)), shall be provided at such frequency 
as is recommended in guidelines set forth by the Na-
tional Comprehensive Cancer Network if the patient 
is an individual described in subparagraph (B). 
‘‘(B) An individual described in this subpara-
graph is— 
‘‘(i) an individual who is at increased risk 
of breast cancer (as determined in accordance 
with the most recent applicable American Col-
lege of Radiology Appropriateness Criteria or 
the most recent applicable guidelines of the Na-
tional Comprehensive Cancer Network) or with 
heterogeneously or extremely dense breast tis-
sue (as defined by the Breast Imaging Report-
ing and Data System established by the Amer-
ican College of Radiology); or 
‘‘(ii) an individual who is not described in 
clause (i) and who is determined by a health 
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care provider (in accordance with such most re-
cent applicable criteria or guidelines) to require 
screening or diagnostic breast imaging by rea-
son of factors including age, race, ethnicity, or 
personal or family medical history.’’. 
(2) ELIMINATION
OF
COST-SHARING.—Such 
title is further amended— 
(A) in section 1075a, by adding at the end 
the following new subsection: 
‘‘(e) ELIMINATION OF COST-SHARING FOR CERTAIN 
BREAST CANCER-RELATED ITEMS AND SERVICES.—Not-
withstanding any other provision of this section, cost-shar-
ing requirements may not be imposed or collected with re-
spect to any beneficiary enrolled in TRICARE Prime for 
any item or service described in subparagraph (A) of sec-
tion 1079(a)(20) of this title provided under TRICARE 
Prime, in accordance with the limitations specified in such 
subparagraph, if the beneficiary is an individual described 
in subparagraph (B) of such section.’’; 
(B) in section 1075(c), by adding at the 
end the following new paragraph: 
‘‘(4) Notwithstanding any other provision of 
this section, cost-sharing requirements may not be 
imposed or collected with respect to any beneficiary 
enrolled in TRICARE Select for any item or service 
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described 
in 
subparagraph 
(A) 
of 
section 
1079(a)(20) of this title provided under TRICARE 
Select, in accordance with the limitations specified in 
such subparagraph, if the beneficiary is an indi-
vidual described in subparagraph (B) of such sec-
tion.’’; and 
(C) in section 1086, by adding at the end 
the following new subsection: 
‘‘(j) Notwithstanding any other provision of this sec-
tion, cost-sharing may not be imposed or collected under 
a plan contracted for under subsection (a) with respect 
to any individual described in subparagraph (B) of section 
1079(a)(20) of this title for an item or service described 
in subparagraph (A) of such section and provided in ac-
cordance with the limitations specified in such subpara-
graph.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2026. 
(e) COVERAGE AND ELIMINATION OF COST-SHARING 
WITH RESPECT TO VETERANS.— 
(1) COVERAGE
AND
ELIMINATION
OF
COST- 
SHARING.—Subchapter II of chapter 17 of title 38, 
United States Code, is amended by inserting after 
section 1720L the following new section: 
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‘‘§ 1720M. Breast screenings for certain individuals at 
increased risk for breast cancer 
‘‘(a) COVERAGE OF ITEMS AND SERVICES.— 
‘‘(1) COVERAGE.—The Secretary shall furnish 
to a veteran described in paragraph (2) screening 
and diagnostic imaging for the detection of breast 
cancer, including 2D or 3D mammograms, breast 
ultrasounds, breast magnetic resonance imaging, 
molecular breast imaging, contrast-enhanced mam-
mography, or other technologies (as determined in 
accordance with the most recent applicable criteria 
or guidelines described in such paragraph) at such 
frequency as is recommended in guidelines set forth 
by the National Comprehensive Cancer Network 
pursuant to this section. 
‘‘(2) ELIGIBILITY.—A veteran described in this 
paragraph is— 
‘‘(A) a veteran who is at increased risk of 
breast cancer (as determined in accordance with 
the most recent applicable American College of 
Radiology Appropriateness Criteria or the most 
recent applicable guidelines of the National 
Comprehensive Cancer Network) or with het-
erogeneously or extremely dense breast tissue 
(as defined by the Breast Imaging Reporting 
and Data System established by the American 
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College of Radiology), without regard to wheth-
er the veteran is enrolled in the system of an-
nual patient enrollment established and oper-
ated under section 1705(a) of this title; or 
‘‘(B) a veteran who is not described in sub-
paragraph (A) and who is determined by a 
health care provider (in accordance with such 
most recent applicable criteria or guidelines) to 
require screening or diagnostic breast imaging 
by reason of factors including age, race, eth-
nicity, or personal or family medical history, 
without regard to whether the veteran is en-
rolled in the system of annual patient enroll-
ment established and operated under section 
1705(a) of this title. 
‘‘(b) PROHIBITION
ON
COST-SHARING.—Notwith-
standing subsections (f) and (g) of section 1710 and sec-
tion 1722A of this title, the Secretary may not require 
any veteran described in paragraph (2) of subsection (a) 
to make any copayment for, or charge the veteran for any 
other cost of, the receipt of any item or service furnished 
pursuant to paragraph (1) of such subsection.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
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by inserting after the item relating to section 1720J 
the following new item: 
‘‘1720M. Breast screenings for certain individuals at increased risk for breast 
cancer.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2026. 
Æ 
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