I 
117TH CONGRESS 
1ST SESSION H. R. 5769 
To amend title XXVII of the Public Health Service Act to prohibit group 
health plans and health insurance issuers offering group or individual 
health insurance coverage from imposing cost-sharing requirements or 
treatment limitations with respect to diagnostic examinations for breast 
cancer that are less favorable than such requirements with respect to 
screening examinations for breast cancer. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 28, 2021 
Mrs. DINGELL (for herself, Ms. WASSERMAN SCHULTZ, Mr. FITZPATRICK, 
Mr. COLE, and Mr. ALLRED) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce 
A BILL 
To amend title XXVII of the Public Health Service Act 
to prohibit group health plans and health insurance 
issuers offering group or individual health insurance cov-
erage from imposing cost-sharing requirements or treat-
ment limitations with respect to diagnostic examinations 
for breast cancer that are less favorable than such re-
quirements with respect to screening examinations for 
breast cancer. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
04:21 Oct 29, 2021
Jkt 029200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5769.IH
H5769
kjohnson on DSK79L0C42PROD with BILLS
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Access to Breast Can-
cer Diagnosis Act of 2021’’. 
SEC. 2. REQUIRING PARITY IN COST-SHARING AND TREAT-
MENT LIMITATIONS WITH RESPECT TO DIAG-
NOSTIC AND SCREENING EXAMINATIONS FOR 
BREAST CANCER. 
(a) IN GENERAL.—Subpart II of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg–11 et seq.) is amended by adding at the end the 
following new section: 
‘‘SEC. 2730. DIAGNOSTIC AND SCREENING EXAMINATIONS 
FOR BREAST CANCER PARITY. 
‘‘(a) IN GENERAL.—In the case of a group health 
plan, or a health insurance issuer offering group or indi-
vidual health insurance coverage, that provides benefits 
with respect to a diagnostic examination for breast cancer 
furnished to an individual enrolled under such plan or 
such coverage, such plan or such coverage shall ensure 
that— 
‘‘(1) the cost-sharing requirements applicable to 
such examination for such individual are no less fa-
vorable than such requirements applicable to a 
screening examination for breast cancer for such in-
dividual; and 
VerDate Sep 11 2014 
04:21 Oct 29, 2021
Jkt 029200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5769.IH
H5769
kjohnson on DSK79L0C42PROD with BILLS
‘‘(2) the treatment limitations applicable to 
such diagnostic examination for breast cancer for 
such individual are no less favorable than such limi-
tations applicable to a screening examinations for 
breast cancer for such individual. 
‘‘(b) RESTRICTION ON CERTAIN CHANGES.—A group 
health plan or health insurance issuer may not, for the 
sole purpose of complying with subsection (a), increase 
cost-sharing requirements with respect to screening exami-
nations for breast cancer. 
‘‘(c) CONSTRUCTION.—Nothing in this section shall 
be construed— 
‘‘(1) to require the use of diagnostic examina-
tions for breast cancer as a replacement for screen-
ing examinations for breast cancer; 
‘‘(2) to prohibit a group health plan or health 
insurance issuers from requiring prior authorization 
or imposing other appropriate utilization controls in 
approving coverage for any screening or diagnostic 
imaging; or 
‘‘(3) to supersede a State law that provides 
greater protections with respect to the coverage of 
diagnostic examinations for breast cancer than is 
provided under this subsection. 
‘‘(d) DEFINITIONS.—In this section: 
VerDate Sep 11 2014 
04:21 Oct 29, 2021
Jkt 029200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5769.IH
H5769
kjohnson on DSK79L0C42PROD with BILLS
‘‘(1) COST-SHARING REQUIREMENT.—The term 
‘cost-sharing requirement’ includes a deductible, co-
insurance, copayment, and any maximum limitation 
on the application of such a deductible, coinsurance, 
copayment, or similar out-of-pocket expense. 
‘‘(2) DIAGNOSTIC
EXAMINATION
FOR
BREAST 
CANCER.—The term ‘diagnostic examination for 
breast cancer’ means a medically necessary and ap-
propriate (as determined by the health care profes-
sional treating the individual) examination for breast 
cancer to evaluate an abnormality in the breast that 
is— 
‘‘(A) seen or suspected from a screening 
examination for breast cancer; 
‘‘(B) detected by another means of exam-
ination; or 
‘‘(C) suspected based on the medical his-
tory or family medical history of the individual. 
‘‘(3) EXAMINATION FOR BREAST CANCER.—The 
term ‘examination for breast cancer’ includes such 
an examination using breast ultrasound, breast mag-
netic resonance imaging, or mammography. 
‘‘(4) 
TREATMENT
LIMITATION.—The 
term 
‘treatment limitation’ includes limits on the fre-
quency of treatment, number of visits, days of cov-
VerDate Sep 11 2014 
04:21 Oct 29, 2021
Jkt 029200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5769.IH
H5769
kjohnson on DSK79L0C42PROD with BILLS
erage, or other similar limits on the scope or dura-
tion of treatment.’’. 
(b) APPLICATION
TO GRANDFATHERED HEALTH 
PLANS.—Section 1251(a)(4)(A) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 
amended— 
(1) by striking ‘‘title’’ and inserting ‘‘title, or as 
added after the date of the enactment of this Act)’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(v) Section 2730 (relating to parity 
for diagnostic and screening examinations 
for breast cancer).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2022. 
Æ 
VerDate Sep 11 2014 
04:21 Oct 29, 2021
Jkt 029200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6301
E:\BILLS\H5769.IH
H5769
kjohnson on DSK79L0C42PROD with BILLS