PALS Act
Bill: H.R.4612 | Sponsor: Rep. Wasserman Schultz, Debbie (D-FL)
Policy area: Health

Summary:
Protecting Access to Lifesaving Screenings Act of 2021 or the PALS Act
This bill makes a series of changes relating to health insurance coverage of screening mammography.
Specifically, the bill requires that any provision of law referring to current recommendations of the U.S. Preventive Services Task Force (USPSTF) with respect to breast cancer screening mammography be administered as if (1) the provision referred to USPSTF recommendations last issued before 2009; and (2) those recommendations applied to any screening mammography modality, including any digital modality of such a procedure. This requirement shall also apply to the Veterans Health Administration's policy on mammography screening for veterans.
In addition, the bill preserves Medicare coverage for screening mammography, without a requirement for coinsurance, and expands the definition of screening mammography to include any digital modality of such a procedure. Further, the Centers for Medicare & Medicaid Services may not decrease the frequency with which screening mammography may be paid by Medicare for a woman over 39 years of age.
In 2009, the USPSTF updated its guidelines to recommend against routine screening mammography for women between 40 to 49 years of age and to recommend biennial, instead of annual, screening mammography for most women between 50 to 74 years of age. In 2015, through the appropriations process, a three-year moratorium was placed on implementing the guidelines; the moratorium was subsequently renewed until January 1, 2023.

To amend title XVIII of the Social Security Act to protect coverage for 
             screening mammography, and for other purposes.

    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 ``Protecting Access to Lifesaving 
Screenings Act of 2021'' or the ``PALS Act''.

SEC. 2. PROTECTING COVERAGE FOR SCREENING MAMMOGRAPHY.

    (a) In General.--Effective during the period beginning on the date 
of the enactment of this Act and ending January 1, 2028, any provision 
of law that refers (including through cross-reference to another 
provision of law) to the current recommendations of the United States 
Preventive Services Task Force with respect to breast cancer screening 
mammography shall be administered as if--
            (1) such reference to such current recommendations were a 
        reference to the recommendations of such Task Force with 
        respect to breast cancer screening mammography last issued 
        before 2009; and
            (2) such recommendations last issued before 2009 applied to 
        any screening mammography modality under section 1861(jj) of 
        the Social Security Act (42 U.S.C. 1395x(jj)).
    (b) Continuing Medicare Coverage Without Coinsurance.--Section 
1833(a)(1)(Y) of the Social Security Act (42 U.S.C. 1395l(a)(1)(Y)) is 
amended by inserting after ``in the case of such services described in 
subparagraph (A)'' the following: ``(other than screening 
mammography)''.
    (c) Maintaining Frequency of Medicare Coverage.--Section 
1834(c)(2)(B)(ii) of the Social Security Act (42 U.S.C. 
1395m(c)(2)(B)(ii)) is amended by inserting before the period at the 
end the following: ``, except that in the case of a woman over 39 years 
of age, such revision may not decrease such frequency''.
    (d) Clarifying the Definition of Screening Mammography.--Section 
1861(jj) of the Social Security Act (42 U.S.C. 1395x(jj)) is amended by 
inserting ``, including any digital modality (such as screening breast 
tomosynthesis) of such a procedure,'' after ``radiologic procedure''.
    (e) Application to Services Furnished Through Department of 
Veterans Affairs.--Section 7322(b) of title 38, United States Code, is 
amended to read as follows:
    ``(b) The policy developed under subsection (a), and any other 
policy of the Department of Veterans Affairs relating to mammography 
screening, shall--
            ``(1) specify standards of mammography screening that 
        ensure that the frequency of such screenings is not less than 
        the frequency of such screenings provided pursuant to section 
        2(a) of the Protecting Access to Lifesaving Screenings Act of 
        2021;
            ``(2) provide recommendations, consistent with paragraph 
        (1), with respect to screening, and the frequency of screening, 
        for veterans, without regard to age, who have clinical 
        symptoms, risk factors, or family history of breast cancer; and
            ``(3) provide for clinician discretion in individual 
        cases.''.
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