Find It Early Act
Bill: H.R.9505 | Sponsor: Rep. DeLauro, Rosa L. (D-CT)
Policy area: Health

Summary:
Find It Early Act
This bill requires health insurance plans (including public health insurance programs) to cover screenings and diagnostic imaging (with no cost sharing and no limit on frequency) for individuals who are at an increased risk of breast cancer.

To provide for health coverage with no cost-sharing for additional 
 breast screenings for certain individuals at greater risk for breast 
                                cancer.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Find It Early Act''.

SEC. 2. COVERAGE WITH NO COST-SHARING FOR ADDITIONAL BREAST SCREENINGS 
              FOR CERTAIN INDIVIDUALS AT GREATER RISK FOR BREAST 
              CANCER.

    (a) Coverage Under Group Health Plans and Group and Individual 
Health Insurance Coverage.--
            (1) In general.--Section 2713(a) of the Public Health 
        Service Act (42 U.S.C. 300gg-13(a)) is amended--
                    (A) in paragraph (2), by striking at the end 
                ``and'';
                    (B) in paragraph (3), by striking at the end the 
                period and inserting a semicolon;
                    (C) in paragraph (4), by striking at the end the 
                period and inserting ``; and'';
                    (D) by striking ``(5) for the purposes of this 
                Act,'' and inserting:
``For the purposes of this Act, subject to paragraph (5)''; and
                    (E) by inserting after paragraph (4) the following:
            ``(5) for plan years beginning on or after January 1, 2023, 
        in addition to any items or services otherwise described in 
        this subsection--
                    ``(A) with respect to an individual 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 heterogeneously 
                or extremely dense breast tissue (as defined by the 
                Breast Imaging Reporting and Data System established by 
                the American College of Radiology), screening and 
                diagnostic imaging (with no limitation applied on 
                frequency) for the detection of breast cancer, 
                including 2D or 3D mammograms, breast ultrasounds, 
                breast magnetic resonance imaging, or other 
                technologies (as determined in accordance with such 
                applicable criteria or guidelines); and
                    ``(B) with respect to an individual who is not 
                described in subparagraph (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, ethnicity, or personal or 
                family medical history, screening and diagnostic 
                imaging (with no limitation applied on frequency) for 
                the detection of breast cancer, including 2D or 3D 
                mammograms, breast ultrasounds, breast magnetic 
                resonance imaging, or other technologies (as determined 
                in accordance with such applicable criteria or 
                guidelines).''.
            (2) Application to grandfathered plans.--Notwithstanding 
        section 1251 of the Patient Protection and Affordable Care Act, 
        the provisions of paragraph (5) of section 2713(a) of the 
        Public Health Service Act, as added by paragraph (1)(E), shall 
        apply to grandfathered health plans described in such section 
        1251 for plan years beginning on or after January 1, 2023.
    (b) Coverage Under Medicare.--
            (1) In general.--Section 1861(ddd)(1)(B) of the Social 
        Security Act (42 U.S.C. 1395x(ddd)(1)(B)) is amended--
                    (A) by striking ``(B) recommended'' and inserting 
                ``(B)(i) recommended'';
                    (B) by striking ``Task Force; and'' and inserting 
                ``Task Force; or''; and
                    (C) by adding at the end the following new clause:
                    ``(ii) beginning on January 1, 2023, in addition to 
                any other items or services described in this 
                subsection--
                            ``(I) with respect to an individual 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 
                        heterogeneously or extremely dense breast 
                        tissue (as defined by the Breast Imaging 
                        Reporting and Data System established by the 
                        American College of Radiology), screening and 
                        diagnostic imaging (with no limitation applied 
                        on frequency) for the detection of breast 
                        cancer, including 2D or 3D mammograms, breast 
                        ultrasounds, breast magnetic resonance imaging, 
                        or other technologies (as determined in 
                        accordance with such applicable criteria or 
                        guidelines); and
                            ``(II) with respect to an individual who is 
                        not described in subclause (I) 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, ethnicity, or personal or 
                        family medical history, screening and 
                        diagnostic imaging (with no limitation applied 
                        on frequency) for the detection of breast 
                        cancer, including 2D or 3D mammograms, breast 
                        ultrasounds, breast magnetic resonance imaging, 
                        or other technologies (as determined in 
                        accordance with such applicable criteria or 
                        guidelines); and''.
            (2) Application of no cost-sharing under medicare advantage 
        plans.--Section 1852(a)(1)(B) of the Social Security Act (42 
        U.S.C. 1395w-22(a)(1)(B)) is amended--
                    (A) in clause (iv)--
                            (i) by redesignating subclause (VIII) as 
                        subclause (IX); and
                            (ii) inserting after subclause (VII) the 
                        following:
                                    ``(VIII) Beginning on January 1, 
                                2023, screening and diagnostic imaging 
                                and other technologies described in 
                                subclause (I) or (II) of section 
                                1861(ddd)(1)(B)(ii) furnished to an 
                                individual described in such subclause 
                                (I) or (II), respectively.''; and
                    (B) in clause (v), by striking ``and (VI)'' and 
                inserting ``(VI), and (VIII)''.
    (c) Coverage Under Medicaid.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d(a)) is amended--
                    (A) in paragraph (4)--
                            (i) by striking ``; and (D)'' and inserting 
                        ``; (D)'';
                            (ii) by striking ``; and (E)'' and 
                        inserting ``; (E)'';
                            (iii) by striking ``; and (F)'' and 
                        inserting ``; (F)''; and
                            (iv) by inserting before the semicolon at 
                        the end the following: ``; and (G)(i) with 
                        respect to an individual 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 heterogeneously or extremely 
                        dense breast tissue (as defined by the Breast 
                        Imaging Reporting and Data System established 
                        by the American College of Radiology), in 
                        addition to any other item or service described 
                        in this subsection, screening and diagnostic 
                        imaging (with no limitation applied on 
                        frequency) for the detection of breast cancer, 
                        including 2D or 3D mammograms, breast 
                        ultrasounds, breast magnetic resonance imaging, 
                        or other technologies (as determined in 
                        accordance with such applicable criteria or 
                        guidelines); and (ii) with respect to an 
                        individual who is not described in clause (i) 
                        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, ethnicity, or personal or 
                        family medical history, screening and 
                        diagnostic imaging (with no limitation applied 
                        on frequency) for the detection of breast 
                        cancer, including 2D or 3D mammograms, breast 
                        ultrasounds, breast magnetic resonance imaging, 
                        or other technologies (as determined in 
                        accordance with such applicable criteria or 
                        guidelines)''; and
                    (B) in paragraph (13), in the matter preceding 
                subparagraph (A), by inserting ``(other than an item or 
                service for which medical assistance is provided 
                pursuant to paragraph (4)(G))'' after ``services''.
            (2) No cost-sharing for certain breast cancer screening and 
        diagnostic imaging.--
                    (A) In general.--Subsections (a)(2) and (b)(2) of 
                section 1916 of the Social Security Act (42 U.S.C. 
                1396o(a)(2)(D)) are each amended--
                            (i) in the last subparagraph, by striking 
                        at the end ``; and'' and inserting ``, or''; 
                        and
                            (ii) by adding at the end the following 
                        subparagraph:
                    ``(K) with respect to an individual described in 
                clause (i) or (ii) of section 1905(a)(4)(G), screening 
                and diagnostic imaging and other technologies described 
                in such clause (i) or (ii), respectively; and''.
                    (B) Application to alternative cost-sharing.--
                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:
                            ``(xv) With respect to an individual 
                        described in clause (i) or (ii) of section 
                        1905(a)(4)(G), screening and diagnostic imaging 
                        and other technologies 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 provisions of this section, a State may not 
        provide for medical assistance through enrollment of an 
        individual with benchmark coverage or benchmark-equivalent 
        coverage under this section unless such coverage includes 
        medical assistance, with respect to an individual described in 
        clause (i) or (ii) of section 1905(a)(4)(G), for screening and 
        diagnostic imaging and other technologies 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, 2023.
                    (B) Delay permitted if state legislation 
                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 requirements 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 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 ends after the 1-
                year period beginning with the date of the enactment of 
                this section. For purposes of the preceding sentence, 
                in the case of a State that has a 2-year legislative 
                session, each year of the session is deemed to be a 
                separate regular session of the State legislature.
    (d) Coverage and Elimination of Cost-Sharing Under TRICARE.--
            (1) Coverage.--Title 10, United States Code, is amended--
                    (A) in section 1074d(a), by adding at the end the 
                following new paragraph:
    ``(3) Any member or former member of the uniformed services who is 
entitled to medical care under section 1074 or 1074a of this title and 
is an individual described in subparagraph (B) of section 1079(a)(20) 
of this title shall also be entitled to the items and services 
described in subparagraph (A) of such section (subject to the same 
limitations specified in such subparagraph), as part of such medical 
care.''; and
                    (B) in section 1079(a), by adding at the end the 
                following new paragraph:
            ``(20)(A) Screening and diagnostic imaging (with no 
        limitation applied on frequency) for the detection of breast 
        cancer, including 2D or 3D mammograms, breast ultrasounds, 
        breast magnetic resonance imaging, or other technologies (as 
        determined in accordance with the most recent applicable 
        criteria or guidelines described in subparagraph (B)), shall be 
        provided if the patient is an individual described in 
        subparagraph (B).
            ``(B) An individual described in this subparagraph is--
                    ``(i) an individual 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 heterogeneously or extremely dense 
                breast tissue (as defined by the Breast Imaging 
                Reporting and Data System established by the American 
                College of Radiology); or
                    ``(ii) an individual who is not described in clause 
                (i) 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, 
                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:
    ``(d) Elimination of Cost-Sharing for Certain Breast Cancer-Related 
Items and Services.--Notwithstanding any other provision under this 
section, cost-sharing may not be imposed or collected with respect to 
any beneficiary enrolled in TRICARE Prime for any item or service 
described in subparagraph (A) of section 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 under this 
        section, cost-sharing may not be imposed or collected with 
        respect to any beneficiary enrolled in TRICARE Select for any 
        item or service 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 individual described in subparagraph 
        (B) of such section.''; and
                    (C) in section 1086(d)(3)--
                            (i) by redesignating subparagraph (C) as 
                        subparagraph (D); and
                            (ii) by inserting after subparagraph (B) 
                        the following new subparagraph:
    ``(C) Notwithstanding any other provision under this section, cost-
sharing may not be imposed or collected 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 accordance with the 
limitations specified in such subparagraph.''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect on January 1, 2023.
    (e) Coverage and Elimination of Cost-Sharing With Respect to 
Veterans.--
            (1) Coverage and elimination of cost-sharing.--Chapter 17 
        of title 38, United States Code, is amended by inserting after 
        section 1720J the following new section (and conforming the 
        table of sections at the beginning of such chapter 
        accordingly):
``Sec. 1720K. 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 
        (with no limitation applied on frequency) for the detection of 
        breast cancer, including 2D or 3D mammograms, breast 
        ultrasounds, breast magnetic resonance imaging, or other 
        technologies (as determined in accordance with the most recent 
        applicable criteria or guidelines described in such paragraph) 
        pursuant to this section.
            ``(2) Eligibility.--A veteran described in this 
        subparagraph 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 heterogeneously or extremely dense 
                breast tissue (as defined by the Breast Imaging 
                Reporting and Data System established by the American 
                College of Radiology), without regard to whether the 
                veteran is enrolled in the system of annual patient 
                enrollment established under section 1705(a) of this 
                title; or
                    ``(B) a veteran who is not described in 
                subparagraph (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, ethnicity, or personal or family 
                medical history, without regard to whether the veteran 
                is enrolled in the system of annual patient enrollment 
                established under section 1705(a) of this title.
    ``(b) Prohibition on Cost-Sharing.--Notwithstanding subsections (f) 
and (g) of section 1710 and section 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) Effective date.--The amendments made by this subsection 
        shall take effect on January 1, 2023.
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